Interventions to increase medical knowledge and experience
| Author (year) | Study type and participants | Intervention | Outcome measures | Results | Conclusions | Outcomes Rating | Strength of Conclusions (1–5) |
| Training: focused training on specific content area | |||||||
| Fridriksson et al12 (2001) | Group randomised with nurses and physicians | Training on identifying subarachnoid haemorrhages. | Diagnostic errors based on subarachnoid haemorrhage rupture rates in actual patients. | Decrease in diagnostic errors. | Training can have a profound impact on diagnostic error outcome at a low cost. | 4b | 4 |
| Rezvyy et al13 (2008) | Before/after with psychiatrists | Addition of diagnostic coding training to general psychiatric education programme required for psychiatric recertification. | Diagnostic accuracy of clinical case vignettes after training. | Diagnostic accuracy improved more than control group whose education programme focused only on general psychiatry. | Training focused on diagnostic coding can positively affect diagnostic accuracy of case vignettes. Further research needed to determine if improvement leads to changes in routine diagnostic practice. | 4b | 4 |
| Gutmark et al14 (2007) | Survey with physicians (all levels) | Use of teaching database of radiology cases diagnosed accurately or inaccurately. | Physician's opinion of the collection of cases available in database. | Database most used by residents and fellows for learning and reference. Attendings used it for teaching. | Teaching databases can be useful for training and reference. Research needed to determine effects of tool on diagnostic accuracy. | 3 | 2 |
| Simulation: develop simulation exercises to expose clinicians to a greater number and variety of case presentations | |||||||
| Bond et al15 (2004) | Case series with 2nd and 3rd year emergency medicine residents | Embed cognitive error traps in cases within simulation lab to introduce cognitive forcing strategies to deal with errors. Debriefing used to review errors. | Self-report of residents' perception of benefit of intervention. | Residents said simulation was beneficial (though less than direct patient care). Increased knowledge of cognitive errors and forcing strategies. Knowledge was not actually assessed. | Educating residents on cognitive errors and forcing strategies is promising, but warrants further study and quantification of the effectiveness of educational techniques. | 2b | 1 |
| Carlson et al16 (2011) | Before/after with 4th year medical students | Use of diagnostic reminder system (ISABEL) to reduce diagnostic error while clinicians assessed live people trained as patients or a manikin in a simulation lab. | Change in diagnostic accuracy after intervention. View of diagnostic reminder system as an education tool and resource for practice. | Diagnostic accuracy improved. Tool was viewed as beneficial as a training tool and as useful in practice. | Diagnostic reminder systems can potentially reduce cognitive-based diagnostic errors. The optimal time within training to introduce the use of such tools remains unclear. It is unclear whether diagnostic accuracy is increasing simply because of additional time spent on diagnosing problem. | 2b | 2 |
| Feedback and calibration: provide intensive, detailed, specific feedback | |||||||
| Tudor and Finlay17 (2001) | Before/after with expert radiologists | Review feedback regarding diagnostic errors made diagnosing radiographs. | Diagnostic accuracy rate 4–5 months after reviewing feedback. | Diagnostic error rate in same cases decreased nominally (no statistics reported). | Allowing radiologists to review their errors may decrease diagnostic error rate. More research needed to determine if effects generalise to new cases/domain. | 3 | 2 |
| Wood and Tracey18 (2009) | Group randomised control trial with doctoral students | Receiving content-based or principle-based feedback to reduce diagnostic error of overshadowing. | Reduction of overshadowing across feedback conditions. | Similar decrease in overshadowing for both feedback interventions. Less reduction in control group. Generalisation effect for content-based feedback. | Giving clinicians feedback regarding specific attributes of a case or cognitive diagnostic reasoning strategies may reduce diagnostic error involving overshadowing. | 4b | 4 |
Outcomes Ratings reflect the level of impact for each intervention on reducing diagnostic errors.9 ,10 Strength of Conclusions was rated on a numerical scale (1–5) in accordance with Best Evidence in Medical Education guidelines (5=strongest).9 ,11