MedEdPORTAL (Feb 2016)
Diagnostic Reasoning Feedback: Improving Diagnostic Reasoning Skills and Feedback Satisfaction Through Structured Peer Feedback
Abstract
Abstract Introduction Residents on nightfloat rotations admit approximately 40% of patients who are then cared for by daytime ward teams. However, nightfloat residents typically receive little formal feedback from peers or supervisors regarding their diagnostic reasoning for these admissions. Feedback typically is best when it occurs on a regular basis, is as close to the event as possible, and comes from an individual who is viewed as an ally. Training programs lack regular, standardized, formal feedback regarding diagnostic reasoning. Methods This resource was designed to guide trainees in analyzing the diagnostic reasoning behind differential diagnoses'comparing the admission history and physical to subsequent progress notes'and to provide structured effective feedback to colleagues regarding the differences observed. The module includes a 30-minute lecture, implementation guide, diagnostic reasoning feedback form, and various other files needed to complete the activity. Surveys were conducted pre- and postpilot to assess trainees' confidence in conducting various diagnostic reasoning skills, assess changes in team discussions of diagnostic reasoning, assess comfort with giving and receiving feedback to colleagues, and determine satisfaction with the feedback tool and overall diagnostic reasoning feedback. Results A total of 21 trainees and four attending physicians completed 66 feedback forms during the pilot phase of the study. Participants rated their attending physicians as less frequently discussing why a particular differential diagnosis was established or prioritized after the project than before (3.95 vs. 3.43, p = .01). Additionally, trainees reported increased confidence in identifying strategies to mitigate cognitive bias in their own practice (3.05 vs. 3.50, p = .049) without any specific instructions regarding identification or mitigation strategies. We anticipate that overall satisfaction will increase as the program becomes part of the culture. Discussion After the pilot phase of this program, it was made a permanent part of inpatient hospital medicine training at the University of Minnesota. Discussion is currently under way to expand the program to include other training sites affiliated with the University of Minnesota's residency program and regarding implementing this program within subspecialty inpatient services and with interdisciplinary transfers. Further refinements will be made to this program as its usage expands and its continuing impact is monitored.
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