In dual process thinking, Type 1 decisions are made rapidly, but can result in diagnostic error. Type 2 processing is slower and more deliberate, and typically where novice clinicians begin practice. This article proposes adaptive expertise to improve novices’ processing. Incorporating six strategies (rationality, critical thinking, metacognitive processes, lateral thinking, medical humanities, distributed cognition) in medical education may improve learners’ processing and reduce diagnostic errors.

Mitigating diagnostic error has become a critical patient safety concern. As a result, medical education and training programs are increasingly focused on teaching students and residents about diagnostic safety. This article describes the development of a novel interprofessional framework to improve diagnostic competency across health professions education programs. A consensus committee identified 12 key competencies that focus on individual performance (e.g., prioritizing differential diagnosis; utilizing second opinions, decision support, and checklists), teamwork (e.g., engaging patients and families; collaborating with other health professionals), and system-related aspects of clinical care (e.g., developing a culture of diagnostic safety; disclosing and learning from errors). The authors emphasize the innovative aspects of their recommendations and suggest that education programs develop curriculum incorporating these competencies to improve diagnosis. A previous WebM&M commentary discussed an incident involving a diagnostic error.

Clinical reasoning is a complex process that can be influenced by numerous factors. This commentary reviews major factors that affect clinical reasoning such as teamwork, decision-maker characteristics, and environmental conditions. The author suggests that an adaptive rather than linear decision-making approach would support reasoning improvements to reduce diagnostic error.

Cognitive bias is increasingly receiving recognition as a barrier to effective health care delivery. This commentary explores reasons for the lack of evidence regarding the effect of biases on decision making and advocates for learning how cognitive biases affect diagnosis to drive improvement.

Efforts to reduce diagnostic error have mainly focused on safety and quality improvement initiatives. This commentary describes an educational strategy for improving diagnosis. The authors suggest that learners should demonstrate effective use of knowledge, clinical reasoning, system orientation, patient and team engagement, and appropriate attitudes regarding diagnosis to achieve lasting success.

… are vividly illustrated in an AHRQ WebM&M commentary . Dr. Pat Croskerry, the lead author of these articles, was interviewed …

Discussing how weaknesses in cognition contribute to flawed decision making, this commentary includes recommendations to help clinicians prevent cognitive failures.

Diagnostic errors are rapidly gaining attention as the next frontier in patient safety, driven by studies of their incidence in malpractice claims and autopsy reports. On the other hand, checklists have become popularized in health care as a tool to promote safe practices. This commentary explores the application of checklists to the diagnostic process. The authors suggest three types of checklists: a general one that prompts providers to optimize their cognitive approach, a differential diagnosis checklist to ensure correct diagnoses are considered, and a checklist of common pitfalls and cognitive forcing functions to improve evaluation of certain diseases. Specific examples of checklists are provided with a discussion of future directions to study their adoption and impact. A past AHRQ WebM&M perspective and interview discussed diagnostic errors in medicine.

Clinicians are intimately familiar with the pressures of working in a busy, emotionally stressful environment. This commentary uses a framework derived from cognitive psychology to demonstrate the impact of physicians' emotional state on the risk of committing errors. A series of case examples is used to illustrate how subconscious biases, acute stressors, burnout, and overt behavioral disorders can cause clinicians to commit cognitive errors—particularly diagnostic errors—leading to preventable patient harm. Prior research in this area has linked burnout in nurses, resident physicians, and surgeons to increased error rates. The authors offer several suggestions for identifying and minimizing harm among patients and physicians due to emotional stressors; chief among these are early identification of impaired physicians and clinical teaching of metacognition that acknowledges the deleterious effects of clinicians' biases.

Through case examples, the authors illustrate potential pitfalls in clinical reasoning and provide a model for physicians to reduce diagnostic errors in the emergency department.

The authors present a case of delayed diagnosis and discuss the cognitive dispositions that can lead to diagnostic errors of commission in the emergency department.

After a simulated clinical failure, investigators debriefed residents using either a technical debriefing on the subject matter or a cognitive debriefing on the failure. They found that the technical debriefing was received slightly better by residents.

This article summarizes a series of cognitive error types referred to as “cognitive dispositions to respond” (CDRs). The author reviews previously described CDRs, such as failures in perception and heuristics, overconfidence bias, and anchoring. He aims to provide a detailed perspective on the cognitive challenges that impact diagnostic decision making, including strategies to handle them. The author concludes that in order to reduce diagnostic errors, further investigation must pursue effective methods of “cognitively debiasing” ourselves when making clinical decisions.

The authors apply the aviation industry's concept of "authority gradients" to medicine and use several examples to articulate the concept's role in medical error.

Through case studies, this article characterizes the types of medication errors that may occur during the course of emergency department care.