Abstract
This paper examines diagnostic error from an educational perspective. Rather than addressing the question of how educators in the health professions can help learners avoid error, however, the literature reviewed leads to the conclusion that educators should be working to induce error in learners, leading them to short term pain for long term gain. A variety of literatures are reviewed that suggest errors in performance are necessary pre-conditions for learning to occur such that an aversion to errors, while more comforting to the learner, is counter-productive. Similarly, research is reviewed that suggests strategies aimed at avoiding heuristic-driven diagnostic errors may successfully reduce those types of errors, but may do so at the expense of inducing errors of comprehensiveness. Taken together, the variety of studies contained suggest that diagnostic errors are often beneficial and that we as an educational community should strive to determine how to harness their pedagogical and diagnostic benefits rather than simply trying to eliminate mistakes entirely.
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Notes
Throughout this paper I have used the word learner rather than student to encourage the reader to consider how the issues named apply to physicians at all levels of training, including those who are in maintenance of competence mode.
Also important in terms of judging the etiology of overconfidence and its impact upon diagnostic error is that the reverse is likely not true. The self-serving bias (i.e., the tendency we have to attribute success to ourselves and problems to the environment; Miller and Ross 1975) would predict that perceived lack of clarity when reading a text is more likely to be blamed on the incoherence of the author (which is perhaps an accurate conclusion in this instance).
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Eva, K.W. Diagnostic error in medical education: where wrongs can make rights. Adv in Health Sci Educ 14 (Suppl 1), 71–81 (2009). https://doi.org/10.1007/s10459-009-9188-9
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DOI: https://doi.org/10.1007/s10459-009-9188-9