Disruptive behaviors, including experiencing or witnessing coworker conflict, can lead to staff burnout and adverse events. In this study, emergency medicine and internal medicine physicians reported on conflicts with other physicians they'd experienced in the workplace. Participants reported feeling demoralized and burnt out after a conflict and brought those feelings to future interactions, priming the situation for additional conflict.

Clinical reasoning is an important component of medical education. In this study, first-year general practice residents concluded that diagnostic error cases, both with and without malpractice claim information, are equally effective for clinical reasoning education.

Checklists are increasingly used to support clinical and diagnostic reasoning processes. This study examined the impact of a checklist on electrocardiogram interpretation in 42 first-year general practice residents. Findings indicate that the checklist reduced the time to diagnosis but did not affect accuracy or confidence.

Electronic differential diagnostic support (EDS) are decision aids that suggest one or more differential diagnoses based on clinical data entered by the clinician. The generated list may prompt the clinician to consider additional diagnoses. This study simulated the use of one EDS, Isabel, in the emergency department to identify barriers and supports to its effectiveness. Four themes emerged. Notably, some physicians thought the EDS-generated differentials could reduce bias while others suggested it could introduce bias.

… can be integrated into digital decision support tools. … Schmidt HG, Mamede S. Improving diagnostic decision support through  …

Enhancing clinical reasoning skills is an emerging strategy to reduce diagnostic errors. This meta-analysis of 26 studies estimated that cognitive reasoning tools can lead to small improvements in diagnostic accuracy.

Diagnostic calibration is the relationship between individual confidence in diagnostic decision making and diagnostic accuracy, and it can lead to diagnostic error or overtesting. This study investigated whether feedback would improve general-practice residents’ diagnostic calibration on difficult cases. Results did not show that feedback on diagnostic performance improved diagnostic calibration.

Misdiagnosis of heart failure can lead to serious patient harm. This article reviews the cognitive psychology of diagnostic reasoning in cardiology. Strategies for educators, students, and researchers to reduce cardiovascular misdiagnosis are presented.

… used early or late in the diagnostic process. … Sibbald M, Monteiro S, Sherbino J, et al. Should electronic differential diagnosis …

… could contribute to improved patient safety. … van Heesch G, Frenkel J, Kollen W, et al. Improving handoff by …

Physicians often experience considerable emotional distress, shame, and self-doubt after being involved in a medical error. Based on in-depth interviews with emergency, internal, and family medicine physicians, this qualitative study explores how physicians experience and learn from preventable medical errors. In addition to exploring themes around the physician’s emotional growth and professional development, the authors discuss the value of sharing and learning from these experiences for colleagues and trainees.  

… regardless of the type of reflection used.    … Mamede S, Hautz WE, Berendonk C, et al. Think twice: effects …

… accuracy between immunized and non-immunized physicians. … Mamede S, de Carvalho-Filho MA, de Faria RMD, et al.  … ' … …

Uncertainty in complex care situations is a common experience for both trainees and experienced practitioners. This review explores the concept of comfort with uncertainty in medicine and suggests that individual awareness of uncertainty is required to respond to the condition as it occurs. The authors advocate for educational and research strategies to further manage uncertainty in health care.

In this educational study, internal medicine resident physicians were randomized to solve standardized cases with and without time pressure. The time-pressured group performed worse, and they reported more stress and generated fewer possible diagnoses.

This commentary reviews five differences between diagnostic reasoning and patient management reasoning, such as the changing nature of management over time and the team-based nature of the activity. The authors recommend areas of research needed to further understand patient management reasoning.

Decision making is typically either intuitive or analytical. This commentary discusses the two types of decision making, how heuristics and cognitive biases affect diagnostic reasoning, and strategies to reduce diagnostic error.

As diagnostic errors continue to rise to the forefront of patient safety, identifying specific drivers and target areas will be critical to improving diagnosis. To examine how patients' disruptive behaviors may provoke emotional responses in physicians that contribute to diagnostic inaccuracy, researchers in the Netherlands had 63 family practice residents evaluate 6 clinical vignettes that presented patients as either difficult or neutral. For patients that displayed distressing behaviors, physicians' mean diagnostic accuracy was significantly lower, even though they spent the same amount of time contemplating the diagnosis. In the related study, 74 internal medicine residents were randomized to 8 clinical vignettes that were identical except for whether the patient displayed difficult or neutral behaviors. Once again, mean diagnostic scores were significantly lower for difficult compared to neutral patients' vignettes, and time spent reaching a diagnosis was similar across groups. Physicians recalled fewer clinical findings and more behaviors from difficult-patient vignettes. This finding suggests that the devotion of mental resources to dealing with behaviors may hinder clinical processing. A recent PSNet perspective reviewed emerging progress on addressing diagnostic errors.

Diagnosis is a critical area of patient safety. Prior research demonstrates that physicians perceive time pressure as an impediment to diagnosis, but this has not been objectively documented. This educational simulation study examined the ability of internal medicine residents to correctly diagnose written cases with and without time pressure. Residents under time pressure had reduced diagnostic accuracy, and this decrement was more marked for difficult cases. These results demonstrate the benefit of allowing physicians more time for accurate diagnosis, consistent with recent Institute of Medicine recommendations to examine novel models of care and reimbursement to foster diagnostic safety. A recent PSNet interview discussed diagnostic errors and how to reduce them.

Providing eight ambiguous clinical vignettes to generalist physician members of the Society to Improve Diagnosis in Medicine, this study found participants did not agree on whether cognitive biases were or were not present. When the outcome of the vignette implied an incorrect diagnosis, respondents reported twice as many biases, suggesting that physician judgments are strongly influenced by hindsight bias.