Diagnostic errors and flaws in clinical reasoning: Mechanisms and prevention in practice

Swiss Medical Weekly

Volumn 142, Issue , 2012, Pages

  Nendaz, Mathieu ^a,b   Perrier, Arnaud ^a  

^a GENEVA UNIVERSITY HOSPITALS   (Switzerland)

^b UNIVERSITY OF GENEVA MEDICAL SCHOOL   (Switzerland)

Author keywords

Clinical reasoning; Clinical training; Diagnostic errors; Medical education

Indexed keywords

CLINICAL PRACTICE; COGNITION; CONTINUING EDUCATION; DIAGNOSTIC ERROR; DIAGNOSTIC REASONING; HEALTH CARE SYSTEM; HUMAN; MEDICAL DECISION MAKING; MEDICAL EDUCATION; MEDICAL SCHOOL; MEDICAL SOCIETY; PHYSICIAN; POSTGRADUATE EDUCATION; REVIEW; TEACHING HOSPITAL; WORKPLACE; ARTICLE; AWARENESS; CLINICAL COMPETENCE; DECISION MAKING; PROBLEM SOLVING; PSYCHOLOGICAL ASPECT;

AWARENESS; CLINICAL COMPETENCE; COGNITION; DECISION MAKING; DIAGNOSTIC ERRORS; EDUCATION, MEDICAL; HUMANS; PHYSICIANS; PROBLEM SOLVING;

EID: 84870465422     PISSN: 14247860     EISSN: None     Source Type: Journal    
DOI: 10.4414/smw.2012.13706     Document Type: Review

References (50)

1. Blendon RJ, DesRoches CM, Brodie M, Benson JM, Rosen AB, Schneider E, et al. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347(24):1933-40. (Pubitemid 35429924)
2. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5 Suppl):S2-23.
3. Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145(7):488-96. (Pubitemid 46780952)
4. Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-7.
5. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-9. (Pubitemid 41058029)
6. Nendaz M. Medical education and quality of decision-making: Is there an evidence-based relationship? Rev Med Interne. 2011;32(7):436-42.
7. Nendaz M, Charlin B, Leblanc V, Bordage G. Le raisonnement clinique: données issues de la recherche et implications pour l'enseignement. Ped Med. 2005;6:235-54.
8. Nendaz MR, Gut AM, Perrier A, Louis-Simonet M, Blondon-Choa K, Herrmann FR, et al. Beyond clinical experience: features of data collection and interpretation that contribute to diagnostic accuracy. J Gen Intern Med. 2006;21(12):1302-5. (Pubitemid 44665340)
9. Elstein AS. Thinking about diagnostic thinking: a 30-year perspective. Adv Health Sci Educ Theory Pract. 2009;14(Suppl 1):7-18.
10. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005;39(4):418-27.
11. Bordage G. Prototypes and semantic qualifiers: from past to present. Med Educ. 2007;41(12):1117-21. (Pubitemid 350197069)
12. Charlin B, Tardif J, Boshuizen HP. Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Acad Med. 2000;75(2):182-90. (Pubitemid 30111550)
13. Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: theory and implications. Acad Med. 1990;65(10):611-21. (Pubitemid 20367295)
14. Chang RW, Bordage G, Connell KJ. The importance of early problem representation during case presentations. Acad Med. 1998;73(10 Suppl):S109-11. (Pubitemid 28476078)
15. Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online. 2011;16.
16. Norman G. Dual processing and diagnostic errors. Adv Health Sci Educ Theory Pract. 2009;14(Suppl 1):37-49.
17. Norman GR, Eva KW. Diagnostic error and clinical reasoning. Med Educ. 2010;44(1):94-100.
18. Ark TK, Brooks LR, Eva KW. The benefits of flexibility: the pedagogical value of instructions to adopt multifaceted diagnostic reasoning strategies. Med Educ. 2007;41(3):281-7. (Pubitemid 46280575)
19. Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007;41(12):1140-5. (Pubitemid 350197065)
20. Lucchiari C, Pravettoni G. Cognitive balanced model: a conceptual scheme of diagnostic decision making. J Eval Clin Pract. 2011;18(1):82-8.
21. Brooks LR, LeBlanc VR, Norman GR. On the difficulty of noticing obvious features in patient appearance. Psychol Sci. 2000;11(2):112-7.
22. Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med. 1999;74(10 Suppl):S138-43. (Pubitemid 29493364)
23. Zwaan L, Thijs A, Wagner C, van der Wal G, Timmermans DR. Relating faults in diagnostic reasoning with diagnostic errors and patient harm. Acad Med. 2012;87(2):149-56.
24. Kahneman D, Slovic P, Tversky A. Judgment Under Uncertainty: heuristics and biases. Cambridge, UK: Cambridge University Press 1982.
25. Elstein A, Schwartz A, Nendaz M. Medical decision making. In: Norman G, van der Vleuten C, Newble D, eds. International Handbook of Research in Medical Education. Boston: Kluwer 2002:231-62.
26. Junod A. Décision médicale ou la quête de l'explicite. Genève: Médecine et Hygiène 2007.
27. Gorini A, Pravettoni G. An overview on cognitive aspects implicated in medical decisions. Eur J Intern Med. 2011;22(6):547-53.
28. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775-80. (Pubitemid 36993075)
29. Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv Health Sci Educ Theory Pract. 2009;14(Suppl 1):27-35.
30. Graber ML. Educational strategies to reduce diagnostic error: can you teach this stuff? Adv Health Sci Educ Theory Pract. 2009;14(Suppl 1):63-9.
31. Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Ann Emerg Med. 2003;41(1):110-20. (Pubitemid 36070846)
32. Hall KH. Reviewing intuitive decision-making and uncertainty: the implications for medical education. Med Educ. 2002;36(3):216-24. (Pubitemid 34227239)
33. Sherbino J, Dore KL, Siu E, Norman GR. The effectiveness of cognitive forcing strategies to decrease diagnostic error: an exploratory study. Teach Learn Med. 2011;23(1):78-84.
34. Coderre S, Wright B, McLaughlin K. To think is good: querying an initial hypothesis reduces diagnostic error in medical students. Acad Med. 2010;85(7):1125-9.
35. Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Acad Med. 2011;86(3):307-13.
36. Mamede S, Schmidt HG. The structure of reflective practice in medicine. Med Educ. 2004;38(12):1302-8.
37. Mamede S, Schmidt HG, Rikers RM, Penaforte JC, Coelho-Filho JM. Influence of perceived difficulty of cases on physicians' diagnostic reasoning. Acad Med. 2008;83(12):1210-6.
38. Mamede S, Schmidt HG, Penaforte JC. Effects of reflective practice on the accuracy of medical diagnoses. Med Educ. 2008;42(5):468-75. (Pubitemid 351533478)
39. Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, et al. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA. 2010;304(11):1198-203.
40. Aronson L. Twelve tips for teaching reflection at all levels of medical education. Med Teach. 2011;33(3):200-5.
41. Kassirer JP. Teaching clinical medicine by iterative hypothesis testing. Let's preach what we practice. N Engl J Med. 1983;309(15):921-3. (Pubitemid 13014034)
42. Nendaz MR, Gut AM, Louis-Simonet M, Perrier A, Vu NV. Bringing explicit insight into cognitive psychology features during clinical reasoning seminars: a prospective, controlled study. Educ Health (Abingdon). 2011;24(1):496.
43. Yudkowsky R, Otaki J, Lowenstein T, Riddle J, Nishigori H, Bordage G. A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Med Educ. 2009;43(8):729-40.
44. Hatala RM, Brooks LR, Norman GR. Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills. Adv Health Sci Educ Theory Pract. 2003;8(1):17-26. (Pubitemid 38981435)
45. Nendaz MR, Bordage G. Promoting diagnostic problem representation. Med Educ. 2002;36(8):760-6. (Pubitemid 35002000)
46. Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3-18.
47. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005;331(7513):387-91. (Pubitemid 41153189)
48. Rudaz A, Gut AM, Louis-Simonet M, Perrier A, Vu NV, Nendaz MR. Acquisition of clinical competence: added value of clerkship real-life contextual experience. Med Teach. 2012:e1-e6.
49. Harden RM, Grant J, Buckley G, Hart IR. Best evidence medical education. Adv Health Sci Educ Theory Pract. 2000;5(1):71-90.
50. Steinert Y, Mann K, Centeno A, Dolmans D, Spencer J, Gelula M, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach. 2006;28(6):497-526. (Pubitemid 44660478)