New Tools Aim to Help Develop and Enhance Diagnostic Skills

Megan Brooks

October 13, 2017

New tools to help physicians improve their diagnostic and clinical reasoning skills were unveiled this week at the Society to Improve Diagnosis in Medicine (SIDM) annual Diagnostic Error in Medicine conference in Boston, Massachusetts.

Developed by SIDM and leaders in medical education, the Assessment of Reasoning Tool (ART) is a "straightforward" evaluation tool to support educators in assessing a learner's clinical reasoning skills during patient presentations, the SIDM notes on their website, where the tools are now freely available.

The SIDM says that ART recognizes that the diagnostic process is multifactorial and requires clinicians to develop specific skills that support accurate diagnosis, including:

  • Collecting and reporting history and examination data in a hypothesis-directed manner

  • Articulating a complete problem representation

  • Articulating a prioritized differential diagnosis

  • Directing evaluation/treatment toward high-priority diagnoses

  • Directing evaluation/treatment toward high-priority diagnoses

"Medical educators are looking for a way to assess their learners and provide feedback on their diagnostic and clinical reasoning skills," Satid Thammasitboon, MD, chair of the assessment subcommittee of the SIDM education committee, said in a news release.

ART is "an easy-to-use resource that will support educators in their efforts to increase the diagnostic skills of their learners," added Dr Thammasitboon, from Baylor College of Medicine, Houston, Texas.

Accompanying ART are five faculty development videos that focus on understanding the diagnostic process, analyzing cognitive and systems contributions to diagnostic errors, partnering with patients and families in the diagnostic decision-making process, physician and patient factors in diagnostic decision-making, and recognizing and responding to diagnostic errors.  Each video is about 4 minutes long.

"Many practicing clinicians were never taught the basics of how we make diagnostic decisions on a daily basis and the potential pitfalls in an otherwise remarkably accurate process that is so critical to good patient care," Philip A. Masters, MD, from medical education division of the American College of Physicians, Philadelphia, Pennsylvania, and executive editor of one of the videos, said in the release. "These clinically-based cases are intended to help care providers understand how we all make diagnostic decisions and can seek to improve our own diagnostic accuracy, engage our patients in the diagnostic process, and know better how to respond to diagnostic errors when they occur."

A 2015 report from the National Academies of Sciences, Engineering, and Medicines (formerly the Institute of Medicine) concluded that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.

A key recommendation of the report was to enhance healthcare professional education and training in the diagnostic process.

Yet a 2017 survey of internal medicine clerkship directors found that most medical students enter clinical clerkships with only poor to fair knowledge of clinical reasoning concepts and receive few hours of dedicated training during clerkships.

"Clinical reasoning is a fundamental skill to ensuring a timely and accurate diagnosis for patients. These new tools showcase the need for physicians to learn and develop that skill in training and then reinforce their knowledge with learning activities throughout their careers," SIDM Executive Vice President Paul Epner said in the news release. "We are proud to partner with the American College of Physicians and others to ensure that physicians have access to continuing learning activities to further develop their diagnostic skills."

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