RT Journal Article
SR Electronic
T1 Improving diagnostic performance through feedback: the Diagnosis Learning Cycle
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 1002
OP 1009
DO 10.1136/bmjqs-2020-012456
VO 30
IS 12
A1 Carolina Fernandez Branson
A1 Michelle Williams
A1 Teresa M Chan
A1 Mark L Graber
A1 Kathleen P Lane
A1 Skip Grieser
A1 Zach Landis-Lewis
A1 James Cooke
A1 Divvy K Upadhyay
A1 Shawn Mondoux
A1 Hardeep Singh
A1 Laura Zwaan
A1 Charles Friedman
A1 Andrew P J Olson
YR 2021
UL http://qualitysafety.bmj.com/content/30/12/1002.abstract
AB 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.