Teaching About Diagnostic Error: Tools for Creating Space in a Crowded Curriculum
December 14, 2020
December 14, 2020

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By: Andrew Olson, MD | Associate Professor | University of Minnesota Medical School | Aquifer Diagnostic Excellence Senior Director


Diagnostic errors are a major source of morbidity and mortality in health care, and there is an increasing focus on reducing diagnostic errors in medicine. Diagnostic errors result from a combination of systems and cognitive factors, and focusing on improving both is key to improvement.  The field of diagnostic safety and quality is rapidly expanding and the science is evolving as methods to decrease diagnostic errors are increasingly being empirically tested.

The Aquifer Diagnostic Excellence Course includes six virtual patient cases designed in collaboration with the Society to Improve Diagnosis in Medicine. The cases introduce students to foundational aspects of the diagnostic process, why diagnostic errors occur, and how individuals and systems can respond when a diagnostic error occurs. Much like other emerging topics in health professions education, addressing diagnostic error is important and worthy of curricular time. At the same time, however, there are some key challenges to incorporating education about diagnosis and diagnostic error more comprehensively in health professions education. Diagnosis is fundamental for every discipline of medicine and thus no one field “owns” diagnosis – and there is thus a risk that “no one owns it”. Fitting topics such as diagnosis and diagnostic error into traditional block curricula is challenging. To help, I’d like to highlight a few different strategies that educators have found successful over the last few years. 

How: Teaching Strategies

Flipped (Virtual) Classroom Activities

The Diagnostic Excellence course has a robust accompanying Educator Guide and ready-to-use in-class activities for each case, ready to be conducted in a flipped (virtual) classroom. Each activity worksheet and guide reinforces the concepts in the associated case, providing a detailed discussion guide, scenarios to extend the learning, and student worksheets.

I have found that the most powerful learning happens when students talk about their own cases and experiences. Providing the space, time, and words to talk about how errors occur is important for changing attitudes around errors, creating humility, and understanding the fallibility of us and the systems in which we learn and practice.

Self-directed Learning

Although we have found that live discussions are most ideal for covering this topic, if your curriculum simply does not have the time to incorporate a session on this topic, Diagnostic Excellence cases can be assigned as a self-directed activity to complete at the learners’ own pace. The whole course (6 cases) can be used for a focused study on diagnosis, or individual cases can be selected for integration into other courses to improve coverage on the topic.

Where & When: Integration Ideas

The cases apply to a range of learners. Faculty have reported success incorporating cases into a wide range of courses for different levels of learners:

  • Pre-clinical patient safety courses:
    The topic of patient safety is an increasing focus in health professions education programs, and many schools now teach about patient safety very early in the educational journey. These cases are an excellent resource to use in these courses that bring important clinical context and simulated patient experiences that “bring patient safety to life.” The clinical content in the cases is quite accessible to even early learners.
  • Traditional or Longitudinal Integrated Clerkships:
    Longitudinal integrated clerkships are emerging as curricular structures that enable interleaving and the development of rich mentoring relationships. Since each of the six Diagnostic Excellence cases is in a different clinical specialty, the overall curriculum is ideal for incorporating as a thread throughout a longitudinal educational experience–or integrating the corresponding case into a traditional clerkship curriculum.

      • Case 1: Two females with iron-deficiency anemia – Internal Medicine
      • Case 2: 35-year-old male with abdominal pain – Surgery
      • Case 3: 16-year-old female with pelvic pain – Gynecology
      • Case 4: 10-year-old male with chronic abdominal pain – Pediatrics & Psychiatry
      • Case 5: 84-year-old female with sepsis – Family Medicine
      • Case 6: 12 day-old male infant with bloody stool – Pediatrics & Surgery
  • Transition to Residency (TTR) courses:
    Residents will all encounter diagnostic errors during their graduate medical education training. Addressing why diagnostic errors occur, how to deal with them when they do, and how they may be avoided before residency begins will help residents be more successful.

Access & Sharing Suggestions

Diagnostic error must be addressed in medical and health professions education—and the Aquifer Diagnostic Excellence cases are a great resource to address this curricular gap. Aquifer Diagnostic Excellence cases are included with all Aquifer subscriptions—and free access is available to all teachers and learners via Aquifer.org. Please make sure to reach out with any questions or your ideas. 

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