Why Verifying Diagnostic Decisions with a Checklist Can Help: Insights from Eye Tracking
Open accessAbstract
Making a diagnosis involves ratifying or verifying a proposed answer. Formalizing this verification process with checklists, which highlight key variables involved in the diagnostic decision, is often advocated. However, the mechanisms by which a checklist might allow clinicians to improve their verification process have not been well studied. We hypothesize that using a checklist to verify diagnostic decisions enhances analytic scrutiny of key variables, thereby improving clinicians' ability to find and fix mistakes. We asked 16 participants to verify their interpretation of 12 electrocardiograms, randomly assigning half to be verified with a checklist and half with an analytic prompt. While participants were verifying their interpretation, we tracked their eye movements. We analyzed these eye movements using a series of eye tracking variables theoretically linked to analytic scrutiny of key variables. We found that more errors were corrected using a checklist compared to an analytic prompt (.27 ± .53 errors per ECG vs. .04 ± .43, F 1,15 = 8.1, p = .01, η (2) = .20). Checklist use was associated with enhanced analytic scrutiny in all eye tracking measures assessed (F 6,10 = 6.0, p = .02). In this experiment, using a key variable checklist to verify diagnostic decisions improved error detection. This benefit was associated with enhanced analytic scrutiny of those key variables as measured by eye tracking.
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The structured approach of checklists helps identify errors, correct them, and prevent premature closure.
“The structured approach helps identify errors, correct them, and prevent premature closure [206].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [206]
The Discussion reports that participants were more likely to find and fix diagnostic errors when verifying ECGs with a checklist. It says their more detailed scrutiny was 'potentially addressing errors related to premature diagnostic closure,' but does not establish that checklists prevent premature closure. Page numbers are not available in the supplied passages. (LLM, conf=0.86)
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Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
- Authors
- Sibbald, M., de Bruin, A. B. H., Yu, E., & van Merrienboer, J. J. G.
- Affiliations
- Hamilton General Hospital (CA)
- University of Toronto (CA)
- Corresponding author
- Sibbald, Matthew
- Venue
- Advances in Health Sciences Education
- Published
- 2015-02-12
- Volume
- 20
- Issue
- 4
- Pages
- 1053-1060
- ISSN
- 1382-4996 (ISSN-L)
- 1573-1677
- PMC
- PMC4564443
- OpenAlex
- W1978687968
- Cited by
- 36
- References
- 3
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 1
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Advances in Health Sciences Education (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- diagnostic decision-making, checklists, error detection, error correction, ECG interpretation, eye movements, clinical judgment, diagnostic errors
- MeSH terms
- Cardiology, Clinical Competence, Decision Making, Diagnostic Errors, Education, Medical, Graduate, Electrocardiography, Eye Movements, Humans, Ontario, Checklist
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