Joseph Rencic

Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.

A 28-year-old man presented to the emergency department with abdominal pain, nausea, and vomiting. He reported 6 weeks of intermittent upper and lower abdominal pain on the right side, which worsened with food intake and usually improved within 1 to 2 hours with antacids.

Recent reports, including the Institute of Medicine’s Improving Diagnosis in Health Care, highlight the pervasiveness and underappreciated harm of diagnostic error, and recommend enhancing health care professional education in diagnostic reasoning. However, little is known about clinical reasoning curricula at US medical schools.

Background: Clinical reasoning is one of the most critical skills to teach to medical learners, yet clinician educators rarely receive adequate training on how to teach this topic. Aims: To enhance clinician educators’ ability to teach clinical reasoning. Methods: I conducted a review of cognitive, medical decision making, and expertise theory literature to develop practical tips that could be applied to typical teaching encounters. Results: Through the literature review, twelve tips were designed to provide a blueprint for teaching clinical reasoning on the wards or in the clinics. Conclusions: Teaching clinical reasoning is important and feasible. Teachers who explicitly teach problem solving and decision making may help learners to improve their diagnostic accuracy and treatment choices.