The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study.

Objectives: Competency in diagnostic reasoning is integral to medical training and patient safety. Situativity theory highlights the importance of contextual factors on learning and performance, such as being informed of a provisional diagnosis prior to a patient encounter. This study aims to determine how being informed of a provisional diagnosis affects an intern's approach to diagnostic reasoning.

The Senior Resident-Fellow Dynamic on Pediatric Hospital Medicine Teams: A Qualitative Study.

Background And Objectives: With the Accreditation Council for Graduate Medical Education accreditation in place for pediatric hospital medicine (PHM) fellowships, fellows are playing a larger role in resident education. However, the impact of PHM fellows on pediatric residency training is not well described. We aimed to identify the factors that affect the dynamic between senior residents and fellows working together on PHM teams.

The Silent Pandemic: the Impact of COVID-19 on the Mental Health of Adolescents Living with HIV.

Purpose Of Review: The pandemic caused by the coronavirus disease (COVID-19) has resulted in millions of confirmed cases and likely more than six million deaths globally Worldometer (2022). We sought to understand secondary mental effects in adolescents living with HIV (ALHIV) on the African continent caused by lockdowns, school closures, and other restriction measures for infection control. We reviewed the broader literature and conducted 86 retrospective chart reviews of mental health disorders of ALHIV and interventions utilized at a pediatric clinic in Eswatini.

Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning.

Objectives: Idiosyncratic approaches to reasoning among teachers and limited reliable workplace-based assessment and feedback methods make teaching diagnostic reasoning challenging. The Assessment of Reasoning Tool (ART) was developed to fill this gap, but its utility and feasibility in providing feedback to residents has not been studied. We evaluated how the ART was used to assess, teach, and guide feedback on diagnostic reasoning to pediatric interns.

COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses.

Objective: We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses.

Methods: We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic.

COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses.

Objective: We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses.

Methods: We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic.

Comparison of a Teaching and Nonteaching Service at a Children's Hospital in the Community.

Objective: The impact of trainees on inpatient patient care is incompletely understood. This study sought to discern the impact of trainees on patient outcomes and costs at a children's hospital in the community. We hypothesized that there would be no differences in patient outcomes and costs on an inpatient teaching service compared to a nonteaching service.

Teaching Diagnostic Reasoning to Faculty Using an Assessment for Learning Tool: Training the Trainer.

Introduction: There is a need for a standardized approach to understand and assess clinical reasoning in medical learners. The Assessment of Reasoning Tool was developed based on prevalent theories and frameworks using a multidisciplinary expert panel. As the tool provides a standardized rubric for assessing clinical reasoning, we designed an interactive train-the-trainer workshop for clinical educators and education leaders interested in improving their teaching skills and/or introducing curricula surrounding diagnostic reasoning.

"PLEASE Complete Your Evaluations!" Strategies to Engage Faculty in Competency-Based Assessments.

Competency-based assessments (CBAs) have gained traction in graduate medical education and inform important learner outcomes through the continuum of medical training. Active participation in new CBAs presents challenges to faculty working in a busy clinical environment. As such, the implementation of new CBAs can be approached with intention to foster acceptance and engagement with new evaluations.

Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey.

Introduction: Meaningful conversations about diagnostic errors require safety cultures where clinicians are comfortable discussing errors openly. However, clinician comfort discussing diagnostic errors publicly and barriers to these discussions remain unexplored. We compared clinicians' comfort discussing diagnostic errors to other medical errors and identified barriers to open discussion.

Pediatric clinician perspectives on communicating diagnostic uncertainty.

Objective: Diagnosis often evolves over time, involves uncertainty, and is vulnerable to errors. We examined pediatric clinicians' perspectives on communicating diagnostic uncertainty to patients' parents and how this occurs.

Design: We conducted semi-structured interviews, which were audiotaped, transcribed, and analyzed using content analysis.

Patient perspectives on how physicians communicate diagnostic uncertainty: An experimental vignette study.

Objective: We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction.

Design/setting: Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city.

Participants/intervention(s): Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents-(i) explicit expression of uncertainty ('not sure' about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using 'most likely' diagnoses.

Creating a medical education enterprise: leveling the playing fields of medical education vs. medical science research within core missions.

Background: Unlike publications of medical science research that are more readily rewarded, clinician-educators' scholarly achievements are more nebulous and under-recognized.

Objective: Create an education enterprise that empowers clinician-educators to engage in a broad range of scholarly activities and produce educational scholarship using strategic approaches to level the playing fields within an organization.

Design: The authors analyzed the advantages and disadvantages experienced by medical science researchers vs.

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations.

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring.

Perspectives from a pediatrician about diagnostic errors.

This opinion paper provides perspectives from a pediatrician about diagnostic challenges in caring for children. This essay shares personal experiences and lessons learned from a pediatric hospitalist about caring for children and making errors in diagnosis. This piece offers guidance about how to teach medical learners key concepts about error in diagnosis with underscoring the importance of developing critical thinking skills.

System-related factors contributing to diagnostic errors.

Several studies in primary care, internal medicine, and emergency departments show that rates of errors in test requests and result interpretations are unacceptably high and translate into missed, delayed, or erroneous diagnoses. Ineffective follow-up of diagnostic test results could lead to patient harm if appropriate therapeutic interventions are not delivered in a timely manner. The frequency of system-related factors that contribute directly to diagnostic errors depends on the types and sources of errors involved.

Diagnosing diagnostic error.

Diagnostic errors are the most common errors in primary care. Diagnostic errors have been found to be the leading cause of malpractice litigation, accounting for twice as many claims and settled cases as medication errors. Diagnostic error is common, harmful, costly, and very critical to the patient-safety issues in health care.

Cognitive debiasing 2: impediments to and strategies for change.

In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply.

Cognitive debiasing 1: origins of bias and theory of debiasing.

Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making.

Preparing for the changing role of instructional technologies in medical education.

As part of an international faculty development conference in February 2010, a working group of medical educators and physicians discussed the changing role of instructional technologies and made recommendations for supporting faculty in using these technologies in medical education. The resulting discussion highlighted ways technology is transforming the entire process of medical education and identified several converging trends that have implications for how medical educators might prepare for the next decade. These trends include the explosion of new information; all information, including both health knowledge and medical records, becoming digital; a new generation of learners; the emergence of new instructional technologies; and the accelerating rate of change, especially related to technology.