Sunday, November 01, 2009

Diagnostic error prevention and EBM competencies

Last week several colleagues are I were in attendance at the Diagnostic Errors in Medicine Conference in Hollywood. Thoughts and "ah-ahs" from that session will be shared here over time, but this initial post will focus on a breakout discussion we had there on how medical education can help prepare physicians to mitigate the opportunity for error by addressing the cognitive side of error.

One piece of that pie covered use of the evidence and what that means. We know that access to the evidence can effect care decisions, but what can it do to help address confirmation bias, inappropriate heuristics and misplaced reliance on the opinion of experts?

To help ingrain a respect for the need to know when you don't know, see the evidence as a tool to prevent diagnostic error, and recognize the need to evidence gathering to sometimes be a "team sport" the following competencies were collected for future discussion on this topic:

Medical students should learn and be capable of:

  • recognising uncertainty and knowledge gaps
  • anticipating the impact of bias impact on the information gathering and assessment process
  • coordinating a team and locating the expertise needed to collectively address the question at hand
  • identifying and locating the best evidence using the Internet or other information source
  • understanding how to work with a librarian or other qualified open-source research expert
  • considering items both in agreement with the clinical predetermination and others that allow for introspection, further research and dialogue as necessary.
  • Applying specificity, sensitivity, PPV, NPV, RR to the case at hand in a specific and deliberate manner
  • Sharing learnings using both formal (ie via policy or guideline development) and informal (ie social networks and face to face discussions) tactics to counteract similar bias within immediate network

Any thoughts on these ideas would be helpful as we work with the coordinators of the 2010 DEM session in Toronto to flesh these concept out more completely.

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