TY - JOUR T1 - Improving diagnostic performance through feedback: the Diagnosis Learning Cycle JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 1002 LP - 1009 DO - 10.1136/bmjqs-2020-012456 VL - 30 IS - 12 AU - Carolina Fernandez Branson AU - Michelle Williams AU - Teresa M Chan AU - Mark L Graber AU - Kathleen P Lane AU - Skip Grieser AU - Zach Landis-Lewis AU - James Cooke AU - Divvy K Upadhyay AU - Shawn Mondoux AU - Hardeep Singh AU - Laura Zwaan AU - Charles Friedman AU - Andrew P J Olson Y1 - 2021/12/01 UR - http://qualitysafety.bmj.com/content/30/12/1002.abstract N2 - Background Errors in reasoning are a common cause of diagnostic error. However, it is difficult to improve performance partly because providers receive little feedback on diagnostic performance. Examining means of providing consistent feedback and enabling continuous improvement may provide novel insights for diagnostic performance.Methods We developed a model for improving diagnostic performance through feedback using a six-step qualitative research process, including a review of existing models from within and outside of medicine, a survey, semistructured interviews with individuals working in and outside of medicine, the development of the new model, an interdisciplinary consensus meeting, and a refinement of the model.Results We applied theory and knowledge from other fields to help us conceptualise learning and comparison and translate that knowledge into an applied diagnostic context. This helped us develop a model, the Diagnosis Learning Cycle, which illustrates the need for clinicians to be given feedback about both their confidence and reasoning in a diagnosis and to be able to seamlessly compare diagnostic hypotheses and outcomes. This information would be stored in a repository to allow accessibility. Such a process would standardise diagnostic feedback and help providers learn from their practice and improve diagnostic performance. This model adds to existing models in diagnosis by including a detailed picture of diagnostic reasoning and the elements required to improve outcomes and calibration.Conclusion A consistent, standard programme of feedback that includes representations of clinicians’ confidence and reasoning is a common element in non-medical fields that could be applied to medicine. Adapting this approach to diagnosis in healthcare is a promising next step. This information must be stored reliably and accessed consistently. The next steps include testing the Diagnosis Learning Cycle in clinical settings.Data sharing not applicable as no datasets generated and/or analysed for this study. No data are available. ER -