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Licensed Unlicensed Requires Authentication Published by De Gruyter September 6, 2018

Using computerized virtual cases to explore diagnostic error in practicing physicians

  • Robert L. Trowbridge ORCID logo EMAIL logo , James B. Reilly , Jerome C. Clauser and Steven J. Durning
From the journal Diagnosis

Abstract

Background

Diagnostic errors are a significant cause of patient harm. Cognitive processes often contribute to diagnostic errors but studying and mitigating the effects of these errors is challenging. Computerized virtual patients may provide insight into the diagnostic process without the potential for patient harm, but the feasibility and utility of using such cases in practicing physicians has not been well described.

Methods

We developed a series of computerized virtual cases depicting common presentations of disease that included contextual factors that could result in diagnostic error. Cases were piloted by practicing physicians in two phases and participant impressions of the case platform and cases were recorded, as was outcome data on physician performance.

Results

Participants noted significant challenges in using the case platform. Participants specifically struggled with becoming familiar with the platform and adjusting to the non-adaptive and constraining processes of the model. Although participants found the cases to be typical presentations of problems commonly encountered in practice, the correct diagnosis was identified in less than 33% of cases.

Conclusions

The development of virtual patient cases for use by practicing physicians requires substantial resources and platforms that account for the non-linear and adaptive nature of reasoning in experienced clinicians. Platforms that are without such characteristics may negatively affect diagnostic performance. The novelty of such platforms may also have the potential to increase cognitive load. Nonetheless, virtual cases may have the potential to be a safe and robust means of studying clinical reasoning performance.


Corresponding author: Robert L. Trowbridge, MD, Department of Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA, Phone: +(207) 662-4618; and Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. The views expressed herein are those of the authors and not necessarily those of the Department of Defense or other federal agencies.

  2. Research funding: None declared.

  3. Employment or leadership: Dr. Durning and Dr. Clauser are employed by the American Board of Internal Medicine.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf 2013;22(Suppl 2):ii21–7.10.1136/bmjqs-2012-001615Search in Google Scholar PubMed PubMed Central

2. Saber Tehrani AS, Lee H, Mathews SC, Shore A, Makary MA, Pronovost PJ, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf 2013;22:672–80.10.1136/bmjqs-2012-001550Search in Google Scholar PubMed

3. Balogh EP, Miller BT, Ball JR. Improving diagnosis in health care. Washington, DC: National Academies of Sciences, Engineering and Medicine, 2015.10.17226/21794Search in Google Scholar PubMed

4. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med 2003;78:775–80.10.1097/00001888-200308000-00003Search in Google Scholar PubMed

5. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005;165:1493–9.10.1001/archinte.165.13.1493Search in Google Scholar PubMed

6. Durning SJ, Artino AR Jr., Schuwirth L, van der Vleuten C. Clarifying assumptions to enhance our understanding and assessment of clinical reasoning. Acad Med 2013;88:442–8.10.1097/ACM.0b013e3182851b5bSearch in Google Scholar PubMed

7. Graber ML, Kissam S, Payne VL, Meyer AN, Sorensen A, Lenfestey N, et al. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf 2012;21:535–57.10.1136/bmjqs-2011-000149Search in Google Scholar PubMed

8. Weaver SJ, Newman-Toker DE, Rosen MA. Reducing cognitive skill decay and diagnostic error: theory-based practices for continuing education in health care. J Contin Educ Health Prof 2012;32:269–78.10.1002/chp.21155Search in Google Scholar PubMed

9. McLaughlin K, Eva KW, Norman GR. Reexamining our bias against heuristics. Adv Health Sci Educ Theory Pract 2014;19:457–64.10.1007/s10459-014-9518-4Search in Google Scholar PubMed

10. Zwaan L, Monteiro S, Sherbino J, Ilgen J, Howey B, Norman G. Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups. BMJ Qual Saf 2017;26:104–10.10.1136/bmjqs-2015-005014Search in Google Scholar PubMed


Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2017-0044).


Received: 2017-12-18
Accepted: 2018-07-25
Published Online: 2018-09-06
Published in Print: 2018-11-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

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