Diagnostic errors by medical students: results of a prospective qualitative study

BMC Medical Education

Research Article

Jan Kiesewetter¹  Martin R. Fischer¹  Leah T. Braun²  Laura Zwaan³  Ralf Schmidmaier⁴ 

[1] Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstr. 1, 80336 München, Munich, Germany;Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstr. 1, 80336 München, Munich, Germany;Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Munich, Germany;Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, Wytemaweg 80, 3015, Rotterdam, CN, the Netherlands;Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Munich, Germany;

关键词: Diagnostic errors;    Undergraduate medical education;    Clinical reasoning;   

DOI  :  10.1186/s12909-017-1044-7

 received in 2017-06-20, accepted in 2017-11-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDiagnostic errors occur frequently in daily clinical practice and put patients’ safety at risk. There is an urgent need to improve education on clinical reasoning to reduce diagnostic errors. However, little is known about diagnostic errors of medical students. In this study, the nature of the causes of diagnostic errors made by medical students was analyzed.MethodsIn June 2016, 88 medical students worked on eight cases with the chief complaint dyspnea in a laboratory setting using an electronic learning platform, in summary 704 processed cases. The diagnostic steps of the students were tracked and analyzed. Furthermore, after each case the participants stated their presumed diagnosis and explained why they came to their diagnostic conclusion. The content of these explanations was analyzed qualitatively.ResultsBased on the diagnostic data gathering process and the students’ explanations, eight different causes could be identified of which the lack of diagnostic skills (24%) and inadequate knowledge base (16%) were the most common. Other causes that often contributed to a diagnostic error were faulty context generation (15%) and premature closure (10%). The causes of misdiagnosis varied per case.ConclusionsInadequate skills/knowledge and faulty context generation are the major problems in students’ clinical reasoning process. These findings are valuable for improving medical education and thus reducing the frequency of diagnostic errors in students’ later everyday clinical practice.

【 授权许可】

CC BY   
© The Author(s). 2017