Aquifer Diagnostic Excellence
In collaboration with: Society to Improve Diagnosis in Medicine

The six virtual patient cases in Aquifer Diagnostic Excellence introduce students to the cognitive processes and system-related issues that can lead to errors.


Diagnostic accuracy is the foundation of safe, effective medicine—yet 15% of inpatient cases involve some degree of diagnostic error. The six virtual patient cases in Aquifer Diagnostic Excellence introduce students to the cognitive processes and system-related issues that can lead to errors.

Coming July 1: New Module & Access

As of July 1, Diagnostic Excellence will be available for subscription as part of Aquifer’s Clinical Excellence Case Sets offering. Paired with other key interdisciplinary topics, this new package provides access to 52 short cases. As part of this upgrade, a new principles module will also be added to Aquifer Diagnostic Excellence, as well as additional self-assessment questions for each of the six current cases. Learn more…

  • Created for educators, by educators, in collaboration with the Society to Improve Diagnosis in Medicine
  • Available by subscription as of July 1, 2023, as part of Aquifer’s Clinical Excellence Case Sets
  • Proven pedagogy that standardizes experiences—overcoming geography, seasonality, and accessibility
  • Evidence-based, peer-reviewed, and continuously updated content
  • A wealth of source material, embedded assessment questions, and full references in each case
  • Foundational, interactive, realistic education about the diagnostic process, as well as how breakdowns in the process lead to diagnostic errors
  • Delivered via the Aqueduct teaching and learning platform, which includes user management tools, easy reporting on student progress and course usage, plus tools for creating custom courses to match a specific curriculum

Cases include foundational content about diagnosis, contributing factors, and strategies to avoid errors. Causes and consequences of diagnostic errors for patients, families, and providers are discussed in detail and students are encouraged to reflect on their own experiences. Aquifer Diagnostic Excellence provides tools to help students mitigate diagnostic error.

This cross-disciplinary course covers a range of topics, including internal medicine, surgery, gynecology, psychiatry, family medicine, and pediatrics.

Coming July 1: New Module & Course Structure

All Clinical Excellence Case Sets, including Diagnostic Excellence, will follow a new course structure.

A new principles module will be added to the course, which covers key definitions, epidemiology, explanations of key principles and why they are important for patient care, and a harm statement that makes it explicit what harm can come to the patient if the principle is not incorporated into practice.

After completing the principles module, students unlock additional application cases (the existing Diagnostic Excellence cases) that explore realistic case scenarios. Application cases are concise and focus on one area of a patient encounter, and are centered around asking students to make important clinical decisions. Content models evidence-based best practices and communication strategies, exploring the real-world impacts on care and potential harm. At the end of each case, a reflection question asks the students to consider key takeaways, implications for their future practice, or personal wellness. Each application case also includes self-assessment questions that extend the learning to other scenarios.

Clinical rotations are a key time to introduce students to the factors that underlie diagnostic error and to help them develop skills to mitigate errors.

These cases can be easily integrated into health professions educational programs. Successful examples of integration include use in pre-clinical patient safety courses, implementation in longitudinal integrated clerkships, use in Capstone courses, and integration into traditional block curricula. With Aqueduct, it’s easy to combine these cases with another course to build a custom curriculum.

Diagnostic Excellence 01: Two females with iron-deficiency anemia

Diagnostic Excellence 02: 35-year-old male with abdominal pain

Diagnostic Excellence 03: 16-year-old female with pelvic pain

Diagnostic Excellence 04: 10-year-old male with chronic abdominal pain

Diagnostic Excellence 05: 84-year-old female with sepsis

Diagnostic Excellence 06: 12-day-old male infant with bloody stool

From Our Cases

Updated Educator Guide & Classroom Activities Available

Course Overview – Integration Strategies – Active Learning Classroom Strategies – Case Details

The Educators Guide—available to institutional subscribers—provides a quick reference guide for all cases and resources included with Aquifer Diagnostic Excellence. Integration strategies and suggestions for custom courses are also included, making it easy to include this key topic in a variety of rotations and courses. The Educator Guide provides a wealth of valuable, engaging Active Learning Classroom Strategies ready to use in your teaching.

The Educator Guide and individual activity worksheets are available in the Educator Resources section of your Aquifer account. Learn more…

Learn More

Learn how Aquifer Diagnostic Excellence—available free of charge—can benefit students and faculty in your program:

Aquifer Diagnostic Excellence Course Board

Medical error is the third leading cause of death in the U.S., causing at least 250,000 deaths every year. Diagnostic error represents anywhere from 40,000 to 80,000 of those deaths, making it the sixth leading cause of death.


“My second-year medical students valued learning about diagnostic errors in an interactive manner and appreciated being able to practice clinical reasoning while learning about patient safety.”

Laurie Broutman, MD, FACP Chicago Medical School, Rosalind Franklin University of Medicine and Science

“In our first year using Aquifer Diagnostic Excellence, we noticed that students started talking about types of errors during their clinical presentations. Clearly, it was sinking in! For me, the most rewarding part was seeing a student take what they learned from the course and create a presentation about a clinical case they observed which had a medical error. The presentation included a discussion about steps to minimize errors in the future, such as better hand-offs, clearer documentation, and avoiding diagnostic momentum.”

Darin Brink, MD University of Minnesota Medical School