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Health Professions Education to Improve Diagnosis in Medicine
New York, NY
Together with four medical schools and their partner health professional schools, the Society to Improve Diagnosis in Medicine (SIDM) is developing a new curriculum to educate health professionals about ways to improve diagnosis. We caught up with SIDM’s Mark L. Graber, MD, and Diana Rusz, MPH, to learn more about their new Macy-funded project.
Why do we need to improve diagnosis in medicine?
In 2015 the National Academies of Sciences, Engineering and Medicine delivered its landmark report on the current state of diagnostic errors, concluding that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. This is a pervasive problem in health care, and one that requires urgent change.
The National Academies report cited that improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families. Another promising avenue is to focus on education, so that the next generation of providers will be better able to steer clear of diagnostic errors. Through our newly supported Macy project, we will hope to develop a new set of curriculum competencies that will help achieve this goal.
What exactly will your curriculum teach?
With four medical schools and several leading educational institutions including the AAMC, we are developing a team-based curriculum to educate new health professionals about ways to improve diagnosis and avoid diagnostic errors.
In our first year, we will be working with our partner schools and with health professionals from many backgrounds, including medicine, nursing, dentistry, and more, to determine what competencies are needed for safe and effective diagnosis.
In year two we will develop recommendations on how to incorporate the new curriculum in both undergraduate and post-graduate training, and how to evaluate competency. In year three we will pilot the curriculum at each of the four pilot schools: The University of Minnesota, University of Texas Medical Branch at Galveston, the University of North Carolina, and the Dell Medical School (University of Texas at Austin).
The curriculum will include new content for the classroom, but the bulk of the content will be learned in the course of caring for patients. For example, we are planning to develop new tools, resources and learning experiences to help trainees recognize when a diagnostic error may have occurred. Then, working together, the team of health professionals would discuss what occurred and create a plan for how to avoid the mistake in the future.
What do you think makes your project unique?
One of the most important recommendations that came from the National Academies report around how to avoid medical errors was to improve (and promote) teamwork in health care. Our curriculum will be built around that. We want the different health professions to be comfortable in a team setting and co-produce a diagnosis together. Then, when needed, be able to make adjustments and corrections as a team.
In the current state of education, students learn about diagnosis by observing their faculty leaders, and believe it or not, we don’t currently have courses dedicated solely to diagnosis. Our new curriculum will teach the elements and process of making a proper diagnosis and show health professionals where the diagnostic process can sometimes break down. This includes the many cognitive shortcomings associated with diagnostic error, as well as the system-related flaws that are so commonly identified, such as breakdowns in communication and coordinating care.
Another unique aspect about the project is that we will be intentional about helping to change attitudes and mindsets. A lot of health care professionals today are very confident, which is good. But it will be important to teach them that confidence should never trump safety. Reflection, learning to accept uncertainty, and incorporating the patient’s goals and preferences are critical elements to successful diagnosis.
Will other institutions be able to easily incorporate this curriculum into their own programs?
Every curriculum change is a battle, but this can absolutely be done. The new curriculum will not require new resources, and the many cognitive biases that trainees need to learn to avoid can be found in everyday life. The schools we are piloting this with will give us an opportunity to show that the curriculum can be incorporated fairly easily.
In the end, this is all about the patient. If we can help health professionals recognize that errors occur and how to avoid them in the future, patient safety and outcomes will ultimately improve.
To learn more about SIDM’s work, visit: http://www.improvediagnosis.org/.