Competencies for improving diagnosis: an interprofessional framework for education and training in health care
Open accessAbstract
Background: Given an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. Methods: An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Results: Twelve competencies were identified: Six of these are individual competencies: The first four (#1–#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and “closing the loop” on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. Conclusions: These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs.
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The clinical case vignettes curated and summarized by human clinicians do not capture competence in many other areas important to clinical reasoning, including patient interviewing and data collection.
“The clinical case vignettes were curated and summarized by human clinicians, a pragmatic and common approach to isolate the diagnostic reasoning process, but this does not capture competence in many other areas important to clinical reasoning, including patient interviewing and data collection.37”
From Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial (2024) · cites this paper as [37]
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- Authors
- Olson, A., Rencic, J., Cosby, K., Rusz, D., Papa, F., Croskerry, P., Zierler, B., Harkless, G., Giuliano, M. A., Schoenbaum, S., Colford, C., Cahill, M., Gerstner, L., Grice, G. R., & Graber, M. L.
- Affiliations
- University of Minnesota (US)
- Tufts University (US)
- Rush University Medical Center (US)
- Society to Improve Diagnosis in Medicine , Chicago, IL , USA
- University of North Texas Health Science Center (US)
- Dalhousie University (CA)
- University of Washington (US)
- University of New Hampshire (US)
- Hackensack Meridian School of Medicine (US)
- Josiah Macy Jr Foundation (US)
- University of North Carolina at Chapel Hill (US)
- National Council of State Boards of Nursing (US)
- Campbell University (US)
- University of Health Sciences and Pharmacy (US)
- Chief Medical Officer, Society to Improve Diagnosis in Medicine , New York, NY , USA
- Corresponding author
- Graber, Mark L.
- ORCID
- Venue
- Diagnosis
- Publisher
- Walter de Gruyter GmbH
- Published
- 2019-07-04
- Volume
- 6
- Issue
- 4
- Pages
- 335-341
- ISSN
- 2194-8011 (ISSN-L)
- 2194-802X
- OpenAlex
- W2955744164
- Cited by
- 101
- References
- 17
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 14 · 2023: 16 · 2022: 11 · 2021: 18 · 2020: 11 · 2019: 6
- FWCI
- 11.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diagnosis (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- diagnostic errors, diagnostic skills, interprofessional education, health professions education, differential diagnosis, second opinion, clinical decision support, checklists, critical thinking, teamwork, patient and family involvement, handover, test result communication, human factors, organizational culture, error reporting, learning from mistakes
- MeSH terms
- Clinical Competence, Communication, Curriculum, Delivery of Health Care, Diagnostic Errors, Diagnostic Tests, Routine, Health Personnel, Humans, Interprofessional Relations, Patient Care Team, Preceptorship, Quality of Health Care, Incidence, Patient Safety
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