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.

Interventions such as deprescribing, pharmacist involvement, and medication reconciliation are used to reduce polypharmacy and use of high-risk medications such as opioids. In this study, a pharmacist was embedded in general practice to support medication management of high-risk patients. This study presents perspectives of the pharmacists, general practitioners, practice personnel, patients, and carers who participated in the program.

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.

Diagnostic safety remains a patient safety priority. This randomized study including emergency medicine and internal medicine physicians as well as medical students found that electronic differential diagnostic support increased the likelihood that the correct diagnosis appeared in the differential, regardless of whether the tool was used early or late in the diagnostic process.

An essential part of resident training is error recovery- recognizing an error has occurred and strategizing how to correct the error to maximize patient safety. Through interviews with surgical residents, barriers and facilitators to experience error recovery were supervision, self, surgical context, and situation safeness. Focusing on these factors may enhance residents’ ability to develop their error recovery skills.

… J Eval Clin Pract … Physicians  often experience considerable …

This survey of surgical residents explored their experiences and perceptions of error recovery training (i.e., how to recognize and manage a technical error in order to ensure patient safety). Nearly all respondents thought error recovery was a key competency, yet only one-third felt they were adequately trained to recover from major events. Error recovery should be incorporated into formal surgical curriculum to support trainees and increase surgical safety.

Enhancing clinical reasoning skill is emerging as a strategy to reduce diagnostic error. This review spotlights the need for a uniform definition of clinical reasoning and a robust literature base to augment efforts to improve reasoning and decision making. The authors suggest these refinements will identify cognitive biases and other contextual influences on clinical reasoning and improve education and professional development.

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.

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.

This medical education study found that self-reflection only minimally improved diagnostic accuracy among medical residents in a simulation setting. These results suggest that a more robust cognitive debiasing curriculum may be needed to enhance diagnostic decision making.

This study used written medical cases to examine whether simulated time pressure or interruptions affect diagnostic accuracy among resident and attending emergency medicine physicians. While the experienced physicians answered the questions more quickly and accurately compared to resident physicians, diagnostic accuracy was not compromised by time pressure or interruptions for either group in this study.

This simulation study found that diagnostic performance by fourth-year medical students improved when they worked in pairs compared to when they worked individually. The authors suggest that working collaboratively allowed students to avoid cognitive biases that can impede timely and correct diagnosis. These results emphasize the importance of real-time feedback in the diagnostic process.

Highlighting how heuristics can both increase and reduce risk of diagnostic error, this commentary applies a set of recommended criteria to examine its usefulness in guiding research and augmenting understanding about factors that affect clinical reasoning and support accurate decision making.

Resident physicians instructed to be "careful, thorough, and reflective" when answering clinical vignette questions took 30% more time with each case but did not have better diagnostic accuracy compared with residents who were told to answer as quickly as possible. These results suggest diagnostic errors are not simply related to insufficient attention or time.

This commentary highlights the need to evaluate diagnostic reasoning in emergency medicine to address gaps and motivate research exploring factors that impair assessment.

… when controlling for clinicians' baseline knowledge. … Sherbino J, Dore KL, Wood TJ, et al. The relationship between response …

This article reviews evidence on the cognitive origins of diagnostic errors and examines theories regarding both clinical reasoning and dual-process thinking.