Abstract
Background:
Diagnostic error is a major problem in health care, yet there are few medical school curricula focused on improving the diagnostic process and decreasing diagnostic errors. Effective strategies to teach medical students about diagnostic error and diagnostic safety have not been established.
Methods:
We designed, implemented and evaluated a virtual patient module featuring two linked cases involving diagnostic errors. Learning objectives developed by a consensus process among medical educators in the Society to Improve Diagnosis in Medicine (SIDM) were utilized. The module was piloted with internal medicine clerkship students at three institutions and with clerkship faculty members recruited from listservs. Participants completed surveys on their experience using the case and a qualitative analysis was performed.
Results:
Thirty-five medical students and 25 faculty members completed the survey. Most students found the module to be relevant and instructive. Faculty also found the module valuable for students but identified insufficient curricular time as a barrier to implementation.
Conclusions:
Medical students and faculty found a prototype virtual patient module about the diagnostic process and diagnostic error to be educational.
Acknowledgments
This project was funded by an Alliance for Academic Internal Medicine Innovation Grant.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
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. National Academies of Sciences, Engineering and M. Improving Diagnosis in Health Care. Natl Acad Press 2015.Search in Google Scholar
2. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121:S2–23.10.1016/j.amjmed.2008.01.001Search in Google Scholar PubMed
3. Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014;23:727–31.10.1136/bmjqs-2013-002627Search in Google Scholar PubMed PubMed Central
4. Cook DA, Erwin PJ, Triola MM. Computerized virtual patients in health professions education: a systematic review and meta-analysis. Acad Med 2010;85:1589–602.10.1097/ACM.0b013e3181edfe13Search in Google Scholar PubMed
5. SIDM Clinical Reasoning Toolkit [Internet]. Available from: https://www.improvediagnosis.org/page/ clinicalreasoning.Search in Google Scholar
6. Adams NE. Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc 2015;103:152–3.10.3163/1536-5050.103.3.010Search in Google Scholar PubMed PubMed Central
7. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. Br Med J 2000;320:726–7.10.1136/bmj.320.7237.726Search in Google Scholar PubMed PubMed Central
8. Mull N, Reilly JB, Myers JS. An elderly woman with “heart failure”: cognitive biases and diagnostic error. Cleve Clin J Med 2015;82:745–53.10.3949/ccjm.82a.14087Search in Google Scholar PubMed
9. Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Acad Med 2017;92:23–30.10.1097/ACM.0000000000001421Search in Google Scholar PubMed
10. Trowbridge RL, Dhaliwal G, Cosby KS. Educational agenda for diagnostic error reduction. BMJ Qual Saf 2013;22:ii28–32.10.1136/bmjqs-2012-001622Search in Google Scholar PubMed PubMed Central
11. Mamede S, van Gog T, Sampaio AM, de Faria RM, Maria JP, Schmidt HG. How can students’ diagnostic competence benefit most from practice with clinical cases? The effects of structured reflection on future diagnosis of the same and novel diseases. Acad Med 2014;89:121–7.10.1097/ACM.0000000000000076Search in Google Scholar PubMed
12. Rencic J, Trowbridge RL, Fagan M, Szauter K, Durning S. Clinical reasoning education at US medical schools: results from a National Survey of Internal Medicine Clerkship Directors. J Gen Intern Med 2017;32:1242–6.10.1007/s11606-017-4159-ySearch in Google Scholar PubMed PubMed Central
Supplementary Material:
The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2018-0023).
©2018 Walter de Gruyter GmbH, Berlin/Boston