Home Medicine Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process
Article
Licensed
Unlicensed Requires Authentication

Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process

  • Justin J. Choi ORCID logo EMAIL logo , Michael A. Rosen , Martin F. Shapiro and Monika M. Safford
Published/Copyright: August 11, 2023
Diagnosis
From the journal Diagnosis Volume 10 Issue 4

Abstract

Objectives

Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions.

Methods

We used mixed-methods to develop and refine a conceptual model of how ward team dynamics in an academic medical center influence the diagnostic process. First, we systematically searched existing literature for conceptual models and empirical studies of team dynamics. Then, we conducted field observations with thematic analysis to refine our model.

Results

We present a conceptual model of how medical ward team dynamics influence the diagnostic process, which serves as a roadmap for future research and interventions in this area. We identified three underexplored areas of team dynamics that are relevant to diagnostic excellence and that merit future investigation (1): ward team structures (e.g., team roles, responsibilities) (2); contextual factors (e.g., time constraints, location of team members, culture, diversity); and (3) emergent states (shared mental models, psychological safety, team trust, and team emotions).

Conclusions

Optimizing the diagnostic process to achieve diagnostic excellence is likely to depend on addressing all of the potential barriers and facilitators to ward team dynamics presented in our model.

Keywords: diagnosis; interprofessional collaboration; medical ward team; team dynamics; teamwork
Corresponding author: Justin J. Choi, MD, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA, E-mail:

  1. Research ethics: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the Weill Cornell Medicine Institutional Review Board.

  2. Informed consent: Informed consent was obtained from all ward team members included in this study.

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

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: Data are available from the authors upon reasonable request.

References

1. Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care, Balogh, EP, Miller, BT, Ball, JR, editors. Washington (DC): National Academies Press; 2015.Search in Google Scholar

2. Singh, H, Graber, ML. Improving diagnosis in health care – the next imperative for patient safety. N Engl J Med 2015;373:2493–5. https://doi.org/10.1056/nejmp1512241.Search in Google Scholar PubMed

3. Meyer, AND, Singh, H. The path to diagnostic excellence includes feedback to calibrate how clinicians think. JAMA 2019;321:737–8. https://doi.org/10.1001/jama.2019.0113.Search in Google Scholar PubMed

4. Centor, RM, Geha, R, Manesh, R. The pursuit of diagnostic excellence. JAMA Netw Open 2019;2:e1918040. https://doi.org/10.1001/jamanetworkopen.2019.18040.Search in Google Scholar PubMed

5. Singh, H, Connor, DM, Dhaliwal, G. Five strategies for clinicians to advance diagnostic excellence. BMJ 2022;376:e068044. https://doi.org/10.1136/bmj-2021-068044.Search in Google Scholar PubMed

6. Aaberg, OR, Wiig, S. Interprofessional team training in hospital wards: a literature review. In: European Safety and Reliability Conference (ESREL) 2017; 2017.Search in Google Scholar

7. Rosen, MA, DiazGranados, D, Dietz, AS, Benishek, LE, Thompson, D, Pronovost, PJ, et al.. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol 2018;73:433–50. https://doi.org/10.1037/amp0000298.Search in Google Scholar PubMed PubMed Central

8. Fostering team effectiveness in organizations: toward an integrative theoretical framework. PsycNET [Internet] [cited 2022 Mar 5]. Available from: https://psycnet.apa.org/record/2007-11679-006.Search in Google Scholar

9. Tasca, GA. What is group dynamics? Group Dynam: Theory Res Pract 2020;24:1–5. https://doi.org/10.1037/gdn0000115.Search in Google Scholar

10. Salas, E, Dickinson, TL, Converse, SA, Tannenbaum, SI. Toward an understanding of team performance and training. In Swezey, RW, Salas, E, editors. Teams: their training and performance. New York: Ablex Publishing; 1992.Search in Google Scholar

11. Kozlowski, SWJ, Ilgen, DR. Enhancing the effectiveness of work groups and teams. Psychol Sci Publ Interest 2006;7:77–124. https://doi.org/10.1111/j.1529-1006.2006.00030.x.Search in Google Scholar PubMed

12. Kozlowski, SWJ. Enhancing the effectiveness of work groups and teams: a reflection. Perspect Psychol Sci 2018;13:205–12. https://doi.org/10.1177/1745691617697078.Search in Google Scholar PubMed

13. Kozlowski, SWJ, Chao, GT. The dynamics of emergence: cognition and cohesion in work teams. Manag Decis Econ 2012;33:335–54. https://doi.org/10.1002/mde.2552.Search in Google Scholar

14. Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P, Kyriakidou, O, Peacock, R. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med 2005;61:417–30. https://doi.org/10.1016/j.socscimed.2004.12.001.Search in Google Scholar PubMed

15. Grant, MJ, Booth, A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J 2009;26:91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x.Search in Google Scholar PubMed

16. Ilgen, DR, Hollenbeck, JR, Johnson, M, Jundt, D. Teams in organizations: from input-process-output models to IMOI models. Annu Rev Psychol 2005;56:517–43. https://doi.org/10.1146/annurev.psych.56.091103.070250.Search in Google Scholar PubMed

17. Marks, MA, Mathieu, JE, Zaccaro, SJ. A temporally based framework and taxonomy of team processes. Acad Manag Rev 2001;26:356. https://doi.org/10.2307/259182.Search in Google Scholar

18. Christensen, C, Larson, JR, Abbott, A, Ardolino, A, Franz, T, Pfeiffer, C. Decision making of clinical teams: communication patterns and diagnostic error. Med Decis Making 2000;20:45–50. https://doi.org/10.1177/0272989x0002000106.Search in Google Scholar PubMed

19. Salas, E, Sims, DE, Burke, CS. Is there a “Big Five” in teamwork? Small Group Res 2005;36:555–99. https://doi.org/10.1177/1046496405277134.Search in Google Scholar

20. Burke, CS, Stagl, KC, Salas, E, Pierce, L, Kendall, D. Understanding team adaptation: a conceptual analysis and model. J Appl Psychol 2006;91:1189–207. https://doi.org/10.1037/0021-9010.91.6.1189.Search in Google Scholar PubMed

21. Reeves, S, Lewin, S, Espin, S, Zwarenstein, M. A conceptual framework for interprofessional teamwork. Interprofessional teamwork for health and social care. Oxford, UK: Wiley-Blackwell; 2010:57–76 pp.10.1002/9781444325027.ch4Search in Google Scholar

22. Gagliardi, AR, Dobrow, MJ, Wright, FC. How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management. Surg Oncol 2011;20:146–54. https://doi.org/10.1016/j.suronc.2011.06.004.Search in Google Scholar PubMed

23. Bedwell, WL, Ramsay, PS, Salas, E. Helping fluid teams work: a research agenda for effective team adaptation in healthcare. Transl Behav Med 2012;2:504–9. https://doi.org/10.1007/s13142-012-0177-9.Search in Google Scholar PubMed PubMed Central

24. Khademian, Z, Sharif, F, Tabei, SZ, Bolandparvaz, S, Abbaszadeh, A, Abbasi, HR. Teamwork improvement in emergency trauma departments. Iran J Nurs Midwifery Res 2013;18:333–9.Search in Google Scholar

25. Mitchell, R, Parker, V, Giles, M, Boyle, B. The ABC of health care team dynamics: understanding complex affective, behavioral, and cognitive dynamics in interprofessional teams. Health Care Manag Rev 2014;39:1–9. https://doi.org/10.1097/hcm.0b013e3182766504.Search in Google Scholar

26. Taplin, SH, Weaver, S, Chollette, V, Marks, LB, Jacobs, A, Schiff, G, et al.. Teams and teamwork during a cancer diagnosis: interdependency within and between teams. J Oncol Pract 2015;11:231–8. https://doi.org/10.1200/jop.2014.003376.Search in Google Scholar

27. Song, H, Chien, AT, Fisher, J, Martin, J, Peters, AS, Hacker, K, et al.. Development and validation of the primary care team dynamics survey. Health Serv Res 2015;50:897–921. https://doi.org/10.1111/1475-6773.12257.Search in Google Scholar PubMed PubMed Central

28. Song, H, Ryan, M, Tendulkar, S, Fisher, J, Martin, J, Peters, AS, et al.. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: a mixed methods study. Health Care Manag Rev 2017;42:28–41. https://doi.org/10.1097/hmr.0000000000000091.Search in Google Scholar

29. Lee, CT-S, Doran, DM. The role of interpersonal relations in healthcare team communication and patient safety: a proposed model of interpersonal process in teamwork. Can J Nurs Res 2017;49:75–93. https://doi.org/10.1177/0844562117699349.Search in Google Scholar PubMed

30. Agreli, HF, Peduzzi, M, Bailey, C. Contributions of team climate in the study of interprofessional collaboration: a conceptual analysis. J Interprof Care 2017;31:679–84. https://doi.org/10.1080/13561820.2017.1351425.Search in Google Scholar PubMed

31. Lapierre, A, Lefebvre, H, Gauvin-Lepage, J. Factors affecting interprofessional teamwork in emergency department care of polytrauma patients: results of an exploratory study. J Trauma Nurs 2019;26:312–22. https://doi.org/10.1097/jtn.0000000000000469.Search in Google Scholar PubMed

32. Verhoeven, DC, Chollette, V, Lazzara, EH, Shuffler, ML, Osarogiagbon, RU, Weaver, SJ. The anatomy and physiology of teaming in cancer care delivery: a conceptual framework. J Natl Cancer Inst 2021;113:360–70. https://doi.org/10.1093/jnci/djaa166.Search in Google Scholar PubMed PubMed Central

33. Boon, H, Verhoef, M, O’Hara, D, Findlay, B. From parallel practice to integrative health care: a conceptual framework. BMC Health Serv Res 2004;4:15. https://doi.org/10.1186/1472-6963-4-15.Search in Google Scholar PubMed PubMed Central

34. D’Amour, D, Ferrada-Videla, M, San Martin Rodriguez, L, Beaulieu, M-D. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care 2005;19:116–31. https://doi.org/10.1080/13561820500082529.Search in Google Scholar PubMed

35. San Martín-Rodríguez, L, Beaulieu, M-D, D’Amour, D, Ferrada-Videla, M. The determinants of successful collaboration: a review of theoretical and empirical studies. J Interprof Care 2005;19:132–47. https://doi.org/10.1080/13561820500082677.Search in Google Scholar PubMed

36. Mickan, SM, Rodger, SA. Effective health care teams: a model of six characteristics developed from shared perceptions. J Interprof Care 2005;19:358–70. https://doi.org/10.1080/13561820500165142.Search in Google Scholar PubMed

37. Lemieux-Charles, L, McGuire, WL. What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev 2006;63:263–300. https://doi.org/10.1177/1077558706287003.Search in Google Scholar PubMed

38. Baker, DP, Day, R, Salas, E. Teamwork as an essential component of high-reliability organizations. Health Serv Res 2006;41:1576–98. https://doi.org/10.1111/j.1475-6773.2006.00566.x.Search in Google Scholar PubMed PubMed Central

39. Reeves, S, Lewin, S, Espin, S, Zwarenstein, M. Interprofessional teamwork for health and social care. Oxford, UK: Wiley-Blackwell; 2010.10.1002/9781444325027Search in Google Scholar

40. Saber Tehrani, AS, Lee, H, Mathews, SC, Shore, A, Makary, MA, Pronovost, PJ, et al.. 25-year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf 2013;22:672–80. https://doi.org/10.1136/bmjqs-2012-001550.Search in Google Scholar PubMed

41. Iyasere, CA, Wing, J, Martel, JN, Healy, MG, Park, YS, Finn, KM. Effect of increased interprofessional familiarity on team performance, communication, and psychological safety on inpatient medical teams: a randomized clinical trial. JAMA Intern Med 2022;182:1190–8. https://doi.org/10.1001/jamainternmed.2022.4373.Search in Google Scholar PubMed PubMed Central

42. Joshi, K, Hernandez, J, Martinez, J, AbdelFattah, K, Gardner, AK. Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes. Am J Surg 2018;215:243–9. https://doi.org/10.1016/j.amjsurg.2017.08.048.Search in Google Scholar PubMed

43. Schmutz, JB, Meier, LL, Manser, T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019;9:e028280. https://doi.org/10.1136/bmjopen-2018-028280.Search in Google Scholar PubMed PubMed Central

44. O’Dea, A, O’Connor, P, Keogh, I. A meta-analysis of the effectiveness of crew resource management training in acute care domains. Postgrad Med 2014;90:699–708. https://doi.org/10.1136/postgradmedj-2014-132800.Search in Google Scholar PubMed

45. TeamSTEPPS® for Diagnosis Improvement|Agency for Healthcare Research and Quality [Internet] [cited 2023 Mar 30]. Available from: https://www.ahrq.gov/teamstepps/diagnosis-improvement/index.html.Search in Google Scholar

46. Singh, H, Naik, AD, Rao, R, Petersen, LA. Reducing diagnostic errors through effective communication: harnessing the power of information technology. J Gen Intern Med 2008;23:489–94. https://doi.org/10.1007/s11606-007-0393-z.Search in Google Scholar PubMed PubMed Central

47. SBAR Tool: Situation-Background-Assessment-Recommendation|IHI – Institute for Healthcare Improvement [Internet] [cited 2023 Mar 30]. Available from: https://www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx.Search in Google Scholar

48. Lo, L, Rotteau, L, Shojania, K. Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review. BMJ Open 2021;11:e055247. https://doi.org/10.1136/bmjopen-2021-055247.Search in Google Scholar PubMed PubMed Central

49. Schmutz, JB, Eppich, WJ. Promoting learning and patient care through shared reflection: a conceptual framework for team reflexivity in health care. Acad Med 2017;92:1555–63. https://doi.org/10.1097/acm.0000000000001688.Search in Google Scholar

50. McHugh, SK, Lawton, R, O’Hara, JK, Sheard, L. Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis. BMJ Qual Saf 2020;29:672–83. https://doi.org/10.1136/bmjqs-2019-009921.Search in Google Scholar PubMed PubMed Central

51. Pannick, S, Athanasiou, T, Long, SJ, Beveridge, I, Sevdalis, N. Translating staff experience into organisational improvement: the HEADS-UP stepped wedge, cluster controlled, non-randomised trial. BMJ Open 2017;7:e014333. https://doi.org/10.1136/bmjopen-2016-014333.Search in Google Scholar PubMed PubMed Central

52. Pannick, S, Archer, S, Johnston, MJ, Beveridge, I, Long, SJ, Athanasiou, T, et al.. Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards. BMJ Open 2017;7:e014401. https://doi.org/10.1136/bmjopen-2016-014401.Search in Google Scholar PubMed PubMed Central

53. Guo, L, Ryan, B, Leditschke, IA, Haines, KJ, Cook, K, Eriksson, L, et al.. Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review. BMJ Qual Saf 2022;31:679–87. https://doi.org/10.1136/bmjqs-2021-013955.Search in Google Scholar PubMed

54. Riskin, A, Erez, A, Foulk, TA, Riskin-Geuz, KS, Ziv, A, Sela, R, et al.. Rudeness and medical team performance. Pediatrics 2017;139:e20162305. https://doi.org/10.1542/peds.2016-2305.Search in Google Scholar PubMed

55. Avesar, M, Erez, A, Essakow, J, Young, C, Cooper, B, Akan, D, et al.. The effects of rudeness, experience, and perspective-taking on challenging premature closure after pediatric ICU physicians receive hand-off with the wrong diagnosis: a randomized controlled simulation trial. Diagnosis (Berl) 2021;8:358–67. https://doi.org/10.1515/dx-2020-0083.Search in Google Scholar PubMed

56. Graber, ML, Rusz, D, Jones, ML, Farm-Franks, D, Jones, B, Cyr Gluck, J, et al.. The new diagnostic team. Diagnosis (Berl) 2017;4:225–38. https://doi.org/10.1515/dx-2017-0022.Search in Google Scholar PubMed

57. Reinforcing the value and roles of nurses in diagnostic safety: pragmatic recommendations for nurse leaders and educators|Agency for Healthcare Research and Quality [Internet] [cited 2023 Jul 19]. Available from: https://www.ahrq.gov/patient-safety/reports/issue-briefs/nurse-role-dxsafety.html.Search in Google Scholar

58. Gleason, KT, Davidson, PM, Tanner, EK, Baptiste, D, Rushton, C, Day, J, et al.. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis (Berl) 2017;4:201–10. https://doi.org/10.1515/dx-2017-0015.Search in Google Scholar PubMed

59. Considine, J. Nurses, diagnosis and diagnostic error. Diagnosis (Berl) 2017;4:197–9. https://doi.org/10.1515/dx-2017-0027.Search in Google Scholar PubMed

60. Zwaan, L, El-Kareh, R, Meyer, AND, Hooftman, J, Singh, H. Advancing diagnostic safety research: results of a systematic research priority setting exercise. J Gen Intern Med 2021;36:2943–51. https://doi.org/10.1007/s11606-020-06428-3.Search in Google Scholar PubMed PubMed Central

61. Arford, PH. Nurse-physician communication: an organizational accountability. Nurs Econ. 2005;23:72–7, 55.Search in Google Scholar

62. Ameen, F. Nurse-physician conflict and power dynamic. JOJ Nurs Health Care 2017;5:77–81.10.19080/JOJNHC.2017.05.555665Search in Google Scholar

63. Gleddie, M, Stahlke, S, Paul, P. Nurses’ perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1–11. https://doi.org/10.1080/13561820.2018.1562422.Search in Google Scholar PubMed

64. Farrell, SE, Bochatay, N, Kim, S. Embracing or relinquishing sources of power in interprofessional communication: implications for patient-centered speaking up. J Interprof Care 2021:1–8. https://doi.org/10.1080/13561820.2021.1975665.Search in Google Scholar PubMed

65. Kim, S, Appelbaum, NP, Baker, N, Bajwa, NM, Chu, F, Pal, JD, et al.. Patient safety over power hierarchy: a scoping review of healthcare professionals’ speaking-up skills training. J Healthc Qual 2020;42:249–63. https://doi.org/10.1097/jhq.0000000000000257.Search in Google Scholar

66. Boyle, JG, Walters, MR, Jamieson, S, Durning, SJ. Reframing context specificity in team diagnosis using the theory of distributed cognition. Diagnosis (Berl) 2023;10:235–41. https://doi.org/10.1515/dx-2022-0100.Search in Google Scholar PubMed

67. Hutchins, E. Cognition, distributed. International encyclopedia of the social & behavioral sciences. Amsterdam: Elsevier; 2001:2068–72 pp.10.1016/B0-08-043076-7/01636-3Search in Google Scholar

68. Rogers, P, Blenko, M. Who has the D? How clear decision roles enhance organizational performance. Harv Bus Rev. 2006;84:52–61, 131.Search in Google Scholar

69. MacDougall, C, Baum, F. The devil’s advocate: a strategy to avoid groupthink and stimulate discussion in focus groups. Qual Health Res 1997;7:532–41. https://doi.org/10.1177/104973239700700407.Search in Google Scholar

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2023-0065).

Received: 2023-06-08
Accepted: 2023-07-31
Published Online: 2023-08-11

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors
  4. Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition
  5. Opinion Papers
  6. The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model
  7. The first diagnostic excellence conference in Japan
  8. Clouds across the new dawn for clinical, diagnostic and biological data: accelerating the development, delivery and uptake of personalized medicine
  9. Original Articles
  10. Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process
  11. Error codes at autopsy to study potential biases in diagnostic error
  12. Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data
  13. Detection of fake papers in the era of artificial intelligence
  14. Is language an issue? Accuracy of the German computerized diagnostic decision support system ISABEL and cross-validation with the English counterpart
  15. The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation
  16. Internal medicine intern performance on the gastrointestinal physical exam
  17. Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool
  18. Learned cautions regarding antibody testing in mast cell activation syndrome
  19. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care
  20. Incomplete filling of spray-dried K2EDTA evacuated blood tubes: impact on measuring routine hematological parameters on Sysmex XN-10
  21. Letters to the Editor
  22. The diagnostic accuracy of AI-based predatory journal detectors: an analogy to diagnosis
  23. Explainable AI for gut microbiome-based diagnostics: colorectal cancer as a case study
  24. Restless X syndrome: a new diagnostic family of nocturnal, restless, abnormal sensations of various body parts
  25. Erratum
  26. Retraction of: Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population
https://doi.org/10.1515/dx-2023-0065
Keywords for this article
diagnosis; interprofessional collaboration; medical ward team; team dynamics; teamwork

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors
  4. Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition
  5. Opinion Papers
  6. The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model
  7. The first diagnostic excellence conference in Japan
  8. Clouds across the new dawn for clinical, diagnostic and biological data: accelerating the development, delivery and uptake of personalized medicine
  9. Original Articles
  10. Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process
  11. Error codes at autopsy to study potential biases in diagnostic error
  12. Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data
  13. Detection of fake papers in the era of artificial intelligence
  14. Is language an issue? Accuracy of the German computerized diagnostic decision support system ISABEL and cross-validation with the English counterpart
  15. The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation
  16. Internal medicine intern performance on the gastrointestinal physical exam
  17. Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool
  18. Learned cautions regarding antibody testing in mast cell activation syndrome
  19. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care
  20. Incomplete filling of spray-dried K2EDTA evacuated blood tubes: impact on measuring routine hematological parameters on Sysmex XN-10
  21. Letters to the Editor
  22. The diagnostic accuracy of AI-based predatory journal detectors: an analogy to diagnosis
  23. Explainable AI for gut microbiome-based diagnostics: colorectal cancer as a case study
  24. Restless X syndrome: a new diagnostic family of nocturnal, restless, abnormal sensations of various body parts
  25. Erratum
  26. Retraction of: Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2026 De Gruyter Brill
Downloaded on 27.1.2026 from https://www.degruyterbrill.com/document/doi/10.1515/dx-2023-0065/html
Scroll to top button