Rooted in reasoning: a clinical reasoning curriculum using diagnostic RCAs.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL

Diagnosis Pub Date : 2025-10-07 DOI:10.1515/dx-2025-0089

David Klimpl, Stacey Staudinger

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引用次数: 0

Abstract

Objectives: Clinical reasoning skills are required for safe care, yet they are not consistently taught to advanced practice providers (APPs). In hospital medicine, where APPs work semi-independently, gaps in clinical reasoning can increase the likelihood of error. To address this, we developed a module that uses diagnostic root cause analysis (RCA) to teach clinical reasoning skills to hospital medicine APP fellows.

Methods: The curriculum was delivered from July 2021 to March 2025. Fellows selected real-world diagnostic errors encountered during clinical rotations, created cognitive fishbone diagrams, and presented their analysis in small-group.

Results: Twenty-seven fellows completed the module and pre-post assessment surveys. Statistically significant improvements were observed across all six domains of knowledge and confidence related to identifying error contributors, analyzing cases, and setting goals. Free-text responses highlighted the module's emotional safety, peer learning value, and normalization of diagnostic reflection. Two learners published their projects as academic posters, and one graduate now co-facilitates the sessions.

Conclusions: This module offers a scalable, time-efficient approach to clinical reasoning education that is adaptable across learner levels and specialties. Its peer-led design fosters psychological safety, reflective practice, and creates a natural pathway for APPs to engage in microscholarship - addressing a critical gap in both education and academic inclusion.

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扎根推理：临床推理课程使用诊断rca。

目的：临床推理技能是安全护理所必需的，但并没有始终教授给高级实践提供者（app）。在医院医学中，应用程序是半独立工作的，临床推理中的空白可能会增加出错的可能性。为了解决这个问题，我们开发了一个模块，使用诊断根本原因分析（RCA）向医院医学APP研究员教授临床推理技能。方法：课程于2021年7月至2025年3月交付。研究员选择在临床轮转中遇到的真实诊断错误，创建认知鱼骨图，并在小组中展示他们的分析。结果：27名研究员完成了模块和前后评估调查。在识别错误贡献者、分析案例和设定目标相关的所有六个知识和信心领域中，都观察到统计学上显著的改进。自由文本回答强调了模块的情感安全、同伴学习价值和诊断反思的规范化。两名学员以学术海报的形式发布了他们的项目，一名毕业生现在共同主持会议。结论：该模块为临床推理教育提供了一种可扩展，省时的方法，可适应学习者水平和专业。它以同行为主导的设计促进了心理安全、反思实践，并为app参与微奖学金创造了一条自然的途径——解决了教育和学术包容方面的关键差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnosis MEDICINE, GENERAL & INTERNAL-

CiteScore

7.20

自引率

5.70%

发文量

期刊介绍： Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.　 Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error