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Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty

  • Maren E. Olson EMAIL logo , Emily Borman-Shoap , Karen Mathias , Timothy L. Barnes and Andrew P.J. Olson
Published/Copyright: October 26, 2018
Diagnosis
From the journal Diagnosis Volume 5 Issue 4

Abstract

Background

Uncertainty is ubiquitous in medical practice. The Pediatrics Milestones from the Accreditation Council on Graduate Medical Education state that advanced learners should acknowledge and communicate about clinical uncertainty. If uncertainty is not acknowledged, patient care may suffer. There are no described curricula specifically aimed to improve learners’ ability to acknowledge and discuss clinical uncertainty. We describe an educational intervention designed to fill this gap.

Methods

Second-year pediatric residents engaged in a two-phase simulation-based educational intervention designed to improve their ability to communicate about diagnostic uncertainty with patients and caregivers. In each phase, residents engaged in two simulated cases and debriefs. Performance was assessed after each simulated patient encounter using standardized metrics, along with learner perceptions of the experience.

Results

Residents’ skills in communicating with patients and families about diagnostic uncertainty improved after this intervention (mean score post 3.84 vs. 3.28 pre on a five-point Likert scale, p<0.001). Residents rated the experience as relevant, challenging and positive.

Conclusions

This prospective study suggests that a simulation-based intervention was effective in improving resident physicians’ skills in communicating about diagnostic uncertainty with patients and families. Further study is needed to determine how learners perform in real clinical environments.

Keywords: communication; medical education; simulation; uncertainty
Corresponding author: Maren E. Olson, MD, MPH, Department of Medical Education, Children’s Hospitals and Clinics of Minnesota, 347 North Smith Ave, Mailstop 70-103, Saint Paul, MN 55102, USA; and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Supported by a grant from the Education and Research Committee of Children’s Hospitals and Clinics of Minnesota.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2018-0025).

Received: 2018-05-18
Accepted: 2018-09-16
Published Online: 2018-10-26
Published in Print: 2018-11-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Learning from tragedy – improving diagnosis through case reviews
  4. Diagnostic test accuracy: a valuable tool for promoting quality and patient safety
  5. Review
  6. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?
  7. Opinion Paper
  8. System-related and cognitive errors in laboratory medicine
  9. Original Articles
  10. The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners
  11. Determining qualitative effect size ratings using a likelihood ratio scatter matrix in diagnostic test accuracy systematic reviews
  12. Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up
  13. Teaching about diagnostic errors through virtual patient cases: a pilot exploration
  14. Using computerized virtual cases to explore diagnostic error in practicing physicians
  15. “Closing the loop”: a mixed-methods study about resident learning from outcome feedback after patient handoffs
  16. Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty
  17. Letters to the Editor
  18. Capturing diagnostic errors in incident reporting systems: value of a specific “DX Tile” for diagnosis-related concerns
  19. PSA-based, prostate cancer risk on-line calculators: no such thing as a crystal ball?
  20. Learning from Error
  21. Learning from tragedy: the Julia Berg story
  22. Acknowledgment
  23. Congress Abstracts
  24. Diagnostic Error in Medicine
https://doi.org/10.1515/dx-2018-0025
Keywords for this article
communication; medical education; simulation; uncertainty

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Learning from tragedy – improving diagnosis through case reviews
  4. Diagnostic test accuracy: a valuable tool for promoting quality and patient safety
  5. Review
  6. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?
  7. Opinion Paper
  8. System-related and cognitive errors in laboratory medicine
  9. Original Articles
  10. The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners
  11. Determining qualitative effect size ratings using a likelihood ratio scatter matrix in diagnostic test accuracy systematic reviews
  12. Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up
  13. Teaching about diagnostic errors through virtual patient cases: a pilot exploration
  14. Using computerized virtual cases to explore diagnostic error in practicing physicians
  15. “Closing the loop”: a mixed-methods study about resident learning from outcome feedback after patient handoffs
  16. Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty
  17. Letters to the Editor
  18. Capturing diagnostic errors in incident reporting systems: value of a specific “DX Tile” for diagnosis-related concerns
  19. PSA-based, prostate cancer risk on-line calculators: no such thing as a crystal ball?
  20. Learning from Error
  21. Learning from tragedy: the Julia Berg story
  22. Acknowledgment
  23. Congress Abstracts
  24. Diagnostic Error in Medicine
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