A call to action: next steps to advance diagnosis education in the health professions

Abstract

Objectives Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions. Methods We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions. Results The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis. Conclusions The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.

Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020

“…Before the COVID-19 pandemic, studies on the accuracy and concordance of video telemedicine diagnosis were limited by sample size, breadth of presenting diseases and clinical problems, representativeness of primary and specialty medical and surgical practices, and clinical practice implementation. A recent comprehensive report on the state of telehealth identified quantifying the diagnostic accuracy of telehealth as a critical research gap. The increase in telemedicine volume during the COVID-19 pandemic enabled our institution to rapidly gather data on video telemedicine visits on a larger scale than had previously been available.…”

Errors in clinical diagnosis: a narrative review

“…Diagnosing intricate, uncertain clinical cases requires the use of deliberate, analytic, and effortful cognitive processes and can be aided by decision support resources. 12,15,[20][21][22] In the context of the diagnostic process, adaptive expertise refers to the capacity to demonstrate cognitive flexibility, and the flexible use of existing routine expert knowledge enables the formulation of innovative rules and principles for diagnosing difficult or atypical clinical cases. [23][24][25] It has been argued that the use of "adaptive expertise" by diagnosticians may reduce the rate of occurrence of diagnostic error.…”

Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation

“…Olson et al (2019) developed 12 individual, team-based, and system-based competencies for all health professionals to improve diagnosis quality and safety. Including application opportunities in case studies can directly build two of the individual diagnostic reasoning competencies (a) explain and justify diagnosis prioritization by comparing data, and (b) use reflection, surveillance, and mitigate detrimental cognitive bias (Graber et al, 2022;Olson et al, 2019). Moreover, the simulation design may be used as a foundation for including structured reflection.…”

“…Recent scoping reviews (Griffith et al, 2022; Smith et al, 2022) noted a dearth of studies within NP education on diagnostic reasoning. Moreover, there is a heavy reliance on the clinical curriculum to provide diagnostic reasoning experiences but little consistency in or control over a student’s exposure, opportunity, or autonomy within clinical rotations (Graber et al, 2022). Creating competency-building and assessment opportunities within simulation is one method to ensure students receive a competency-based education (Hodges et al, 2019; Jeffries et al, 2019).…”