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Educational agenda for diagnostic error reduction
  1. Robert L Trowbridge1,2,
  2. Gurpreet Dhaliwal3,4,
  3. Karen S Cosby5,6
  1. 1Department of Medicine, Maine Medical Center, Portland, Maine, USA
  2. 2Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3Medical Service, San Francisco Veterans Administration Medical Center, San Francisco, California, USA
  4. 4Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
  5. 5Department of Emergency Medicine, Cook County Medical Center, Chicago, Illinois, USA
  6. 6Department of Emergency Medicine, Rush Medical College, Chicago, Illinois, USA
  1. Corresponding to Dr Robert L Trowbridge, Department of Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04012 USA; trowbr{at}


Diagnostic errors are a major patient safety concern. Although the majority of diagnostic errors are partially attributable to cognitive mistakes, the most effective means of improving clinician cognition in order to achieve gains in diagnostic reliability are unclear. We propose a tripartite educational agenda for improving diagnostic performance among students, residents and practising physicians. This agenda includes strengthening the metacognitive abilities of clinicians, fostering intuitive reasoning and increasing awareness of the role of systems in the diagnostic process. The evidence supporting initiatives in each of these realms is reviewed and a course of future implementation and study is proposed. The barriers to designing and implementing this agenda are substantial and include limited evidence supporting these initiatives and the challenges of changing the practice patterns of practising physicians. Implementation will need to be accompanied by rigorous evaluation.

  • Diagnostic errors
  • Medical education
  • Cognitive biases

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