EVALUATION OF A RULE BASE FOR DECISION-MAKING IN GENERAL-PRACTICE

Background Decision making in general practice relies heavily on judgm ental expertise. It should be possible to codify this expertise into r ules and principles. Aim. A study was undertaken to evaluate the effec tiveness of rules from a rule base designed to improve students' and t rainees' management decisions relating to patients seen in general pra ctice. Method The rule base was developed after studying decisions abo ut and management of thousands of patients seen in one general practic e over an eight year period. Vignettes were presented to 93 fourth yea r medical students and 179 general practitioner trainees. They recorde d their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commen ted on their level of agreement with each of the rules provided with t he vignettes. A panel of five independent assessors then rated as good , acceptable or poor, the participants' perception and management of e ach case before and after seeing the rules. Results. Exposure to a few selected rules of thumb improved the problem perception and managemen t decisions of both undergraduates and trainees. The degree of improve ment was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulti es students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not co nsidered. Conclusion. The rules developed to improve decision making s kills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to trai n students and doctors to acquire decision making skills. It could als o be used to provide decision support when confronted with difficult m anagement decisions in general practice.