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Educational strategies to reduce diagnostic error: can you teach this stuff?

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Abstract

Diagnostic error typically involves both system-related and cognitive root causes. Educational interventions are proposed to address both of these dimensions: In regard to system-related origins, education should focus on communication skills, including handoffs. In regard to cognitive shortcomings, educators need to consider both normative approaches to decision making, as well as the ‘flesh and blood’ processes used by experienced clinicians. In the long term, the goal of education should be to promote expertise, based on the assumption that experts make the fewest mistakes. In the short term, education should emphasize the importance of reflective practice, and consider use of a checklist for diagnosis to improve reliability.

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Author information

Authors and Affiliations

  1. Medical Service, VAMC Northport, Northport, NY, USA

    Mark L. Graber

  2. Department of Medicine, SUNY at Stony Brook, Stony Brook, NY, USA

    Mark L. Graber

Authors
  1. Mark L. Graber
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Correspondence to Mark L. Graber.

Appendices

Appendix: Twelve tips for teaching avoidance of diagnostic errors (Trowbridge 2008)

Robert Trowbridge

  1. 1.

    Explicitly describe heuristics and how they affect clinical reasoning.

  2. 2.

    Promote the use of ‘diagnostic timeout’s.

  3. 3.

    Promote the practice of ‘worst case scenario medicine’.

  4. 4.

    Promote the use of a systematic approach to common problems.

  5. 5.

    Ask why.

  6. 6.

    Teach and emphasize the value of the clinical exam.

  7. 7.

    Teach Bayesian theory as a way to direct the clinical evaluation and avoid premature closure.

  8. 8.

    Acknowledge how the patient makes the clinician feel.

  9. 9.

    Encourage learners to find clinical data that doesn’t fit with a provisional diagnosis; Ask “What can’t we explain?”

  10. 10.

    Embrace Zebras.

  11. 11.

    Encourage learners to slow down.

  12. 12.

    Admit one’s own mistakes.

Ten commandments to reduce cognitive errors

Leo Leonidas MD (Pediatrics, Maine)

  1. 1.

    Thou shalt reflect on how you think and decide.

  2. 2.

    Thou shalt not rely on your memory when making critical decisions.

  3. 3.

    Thou shalt make your working environment information-friendly by using the latest wireless technology such as the Tablet PC and PDA.

  4. 4.

    Thou shalt consider other possibilities even though you are sure of your first diagnosis.

  5. 5.

    Thou shalt know Bayesian probability and the epidemiology of the diseases in your differential diagnosis.

  6. 6.

    Thou shalt mentally rehearse common and serious conditions that you expect to see in your specialty.

  7. 7.

    Thou shalt ask yourself if you are the right person to make the final decision or a specialist after considering the patient’s values and wishes.

  8. 8.

    Thou shalt take time to decide and not be pressured by anyone.

  9. 9.

    Thou shalt create accountability procedures and follow up for decisions made.

  10. 10.

    Thou shalt record in a relational data base software your patient’s problems and decisions for review and improvement.

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Graber, M.L. Educational strategies to reduce diagnostic error: can you teach this stuff?. Adv in Health Sci Educ 14 (Suppl 1), 63–69 (2009). https://doi.org/10.1007/s10459-009-9178-y

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  • DOI: https://doi.org/10.1007/s10459-009-9178-y

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