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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

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Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty

Maren E. Olson
  • Corresponding author
  • Department of Medical Education, Children’s Hospitals and Clinics of Minnesota, 347 North Smith Ave, Mailstop 70-103, Saint Paul, MN 55102, USA
  • Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
  • Email
  • Other articles by this author:
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/ Emily Borman-Shoap / Karen Mathias
  • Department of Pediatrics, Children’s Hospitals and Clinics of Minnesota, University of Minnesota Medical School, Minneapolis, MN, USA
  • Other articles by this author:
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/ Timothy L. Barnes / Andrew P.J. Olson
  • Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
  • Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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  • Other articles by this author:
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Published Online: 2018-10-26 | DOI: https://doi.org/10.1515/dx-2018-0025



Uncertainty is ubiquitous in medical practice. The Pediatrics Milestones from the Accreditation Council on Graduate Medical Education state that advanced learners should acknowledge and communicate about clinical uncertainty. If uncertainty is not acknowledged, patient care may suffer. There are no described curricula specifically aimed to improve learners’ ability to acknowledge and discuss clinical uncertainty. We describe an educational intervention designed to fill this gap.


Second-year pediatric residents engaged in a two-phase simulation-based educational intervention designed to improve their ability to communicate about diagnostic uncertainty with patients and caregivers. In each phase, residents engaged in two simulated cases and debriefs. Performance was assessed after each simulated patient encounter using standardized metrics, along with learner perceptions of the experience.


Residents’ skills in communicating with patients and families about diagnostic uncertainty improved after this intervention (mean score post 3.84 vs. 3.28 pre on a five-point Likert scale, p<0.001). Residents rated the experience as relevant, challenging and positive.


This prospective study suggests that a simulation-based intervention was effective in improving resident physicians’ skills in communicating about diagnostic uncertainty with patients and families. Further study is needed to determine how learners perform in real clinical environments.

This article offers supplementary material which is provided at the end of the article.

Keywords: communication; medical education; simulation; uncertainty


  • 1.

    Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2017;33:103–15.PubMedWeb of ScienceGoogle Scholar

  • 2.

    Kennedy AG. Managing uncertainty in diagnostic practice. J Eval Clin Pract 2017;23:959–63.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 3.

    Simpkin AL, Schwartzstein RM. Tolerating uncertainty – the next medical revolution? N Engl J Med 2016;375:1713–5.CrossrefWeb of SciencePubMedGoogle Scholar

  • 4.

    Malterud K, Guassora AD, Reventlow S, Jutel A. Embracing uncertainty to advance diagnosis in general practice. Br J Gen Pract 2017;67:244–5.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 5.

    National Academies of Sciences, Engineering and Medicine. Improving Diagnosis in Health Care. Natl Acad Press 2015:4.Google Scholar

  • 6.

    Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med 2013;88:1088–94.CrossrefWeb of ScienceGoogle Scholar

  • 7.

    Hicks PJ, Schumacher DJ, Benson BJ, Burke AE, Englander R, Guralnick S, et al. The pediatrics milestones: conceptual framework, guiding principles, and approach to development. J Grad Med Educ 2010;2:410–8.PubMedCrossrefGoogle Scholar

  • 8.

    Indrayan A. Medical biostatistics, 2nd ed. Boco Raton, London, New York: Chapman & Hall/CRC Press, Vol. 8, 2008:673.Google Scholar

  • 9.

    Ruedinger E, Olson M, Yee J, Borman-Shoap E, Olson AP. Education for the next frontier in patient safety: a longitudinal resident curriculum on diagnostic error. Am J Med Qual 2017;32:625–31.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 10.

    Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001;76:390–3.CrossrefPubMedGoogle Scholar

  • 11.

    Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc 2015;10:106–15.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 12.

    Cheng A, Morse KJ, Rudolph J, Arab AA, Runnacles J, Eppich W. Learner-centered debriefing for health care simulation education: lessons for faculty development. Simul Healthc 2016;11:32–40.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 13.

    Boissy A, Windover AK, Bokar D, Karafa M, Neuendorf K, Frankel RM, et al. Communication skills training for physicians improves patient satisfaction. J Gen Intern Med 2016;31: 755–61.Web of SciencePubMedCrossrefGoogle Scholar

  • 14.

    Awdish RL, Buick D, Kokas M, Berlin H, Jackman C, Williamson C, et al. A Communications bundle to improve satisfaction for critically Ill patients and their families: a prospective, cohort pilot study. J Pain Symptom Manage 2017;53:644–9.Web of ScienceCrossrefPubMedGoogle Scholar

  • 15.

    Johnson EM, Hamilton MF, Watson RS, Claxton R, Barnett M, Thompson AE, et al. An intensive, simulation-based communication course for pediatric critical care medicine fellows. Pediatr Crit Care Med 2017;18:e348–55.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 16.

    Entrustable Professional Activities for General Pediatrics | The American Board of Pediatrics. Available at: https://www.abp.org/entrustable-professional-activities-epas. Accessed: 26 Nov 2017.

About the article

Corresponding author: Maren E. Olson, MD, MPH, Department of Medical Education, Children’s Hospitals and Clinics of Minnesota, 347 North Smith Ave, Mailstop 70-103, Saint Paul, MN 55102, USA; and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

Received: 2018-05-18

Accepted: 2018-09-16

Published Online: 2018-10-26

Published in Print: 2018-11-27

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: Supported by a grant from the Education and Research Committee of Children’s Hospitals and Clinics of Minnesota.

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.

Citation Information: Diagnosis, Volume 5, Issue 4, Pages 243–248, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0025.

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