Bayesian reasoning in residents’ preliminary diagnoses

Whether and when humans in general, and physicians in particular, use their beliefs about base rates in Bayesian reasoning tasks is a long-standing question. Unfortunately, previous research on whether doctors use their beliefs about the prevalence of diseases in diagnostic judgments has critical limitations. In this study, we assessed whether residents' beliefs about the prevalence of a disease are associated with their judgments of the likelihood of the disease in diagnosis, and whether residents' beliefs about the prevalence of diseases change across the 3 years of residency. Residents were presented with five ambiguous vignettes typical of patients presenting on the inpatient general medicine services. For each vignette, the residents judged the likelihood of five or six possible diagnoses. Afterward, they judged the prevalence within the general medicine services of all the diseases in the vignettes. Most importantly, residents who believed a disease to be more prevalent tended to rate the disease as more likely in the vignette cases, suggesting a rational tendency to incorporate their beliefs about disease prevalence into their diagnostic likelihood judgments. In addition, the residents' prevalence judgments for each disease were assessed over the 3 years of residency. The precision of the prevalence estimates increased across the 3 years of residency, though the accuracy of the prevalence estimates did not. These results imply that residents do have a rational tendency to use prevalence beliefs for diagnosis, and this finding also contributes to a larger question of whether humans intuitively use base rates for making judgments.