Misdiagnosis teaching and assessment tool

Alexander, Jack W. Alexander.Jack at MAYO.EDU
Mon Jul 29 14:31:26 UTC 2013


Interesting point about biases being common within a particular training program. I've tended to think of them more as a characteristic of an individual rather than something that is learned as part of a culture. This may offer an opportunity for research - looking for commonalities in diagnostic errors within training centers and subsequent training and de-biasing that hasn't been considered before - at least to my knowledge.

Jack W Alexander


Jack W Alexander M.D. | Internal Medicine | Phone: 651-267-5058 | Pager: 651-267-4053 |E-mail: alexander.jack at mayo.edu
Chief Medical Officer
Mayo Clinic Health System-Red Wing | 701 Fairview Blvd, PO Box 95 | Red Wing, MN 55066-0095
 Please don't print this e-mail unless you really need to. Thank you. 

-----Original Message-----
From: owner-improvedx at list.improvediagnosis.org [mailto:owner-improvedx at list.improvediagnosis.org] On Behalf Of Ehud Zamir
Sent: Saturday, July 27, 2013 8:27 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Misdiagnosis teaching and assessment tool

I have recently conducted an experiment where real patients volunteered to be examined by senior ophthalmology residents in a mock clinical exam. Several cases were chosen because they had a history of (usually harmless) misdiagnosis, but were presented to the trainees just as they had presented to the doctor, with (erroneous) presumptive diagnoses from previous doctors or with other contextual/cognitive biases. In the vast majority of cases, trainees misdiagnosed them exactly in the same way it had been done by the original doctors, namely stumbled on the cognitive biases or contextual misleading information inherently present in the cases.  I found this a good way to teach about diagnostic error, as it is not just a list of theoretical biases. It is a very authentic simulation. Trainees are in fact led towards making a diagnostic error (similar to the original doctor) and made the error in a controlled environment, then received feedback and "learned the lesson". In addition to a good teaching model about diagnostic errors, I also believe it is a very useful method for assessment of diagnostic skills. A bit difficult logistically (finding patients with a history of misdiagnosis who still have the findings) but certainly feasible. If we value the skill of diagnosis, we have to test it in authentic conditions, and in the presence of proven misleading factors. Lessons learnt from misdiagnosis should be used for training and assessment in a concrete manner.

Ehud Zamir
Centre for Eye Research Australia
To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>


More information about the Test mailing list