Differential diagnosis checklists reduce diagnostic error differentially: A randomised experiment

• Published in: Medical education 2021-10, Vol.55 (10), p.1172-1182
• Main Authors: Kämmer, Juliane E., Schauber, Stefan K., Hautz, Stefanie C., Stroben, Fabian, Hautz, Wolf E.
• Format: Article
• Language: English
• Subjects: Accuracy; Checklist; Clinical Reasoning; Diagnosis, Differential; Diagnostic Errors; Humans; Medical diagnosis; Medical education; Medical students; Students, Medical
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1111/medu.14596

Introduction Wrong and missed diagnoses contribute substantially to medical error. Can a prompt to generate alternative diagnoses (prompt) or a differential diagnosis checklist (DDXC) increase diagnostic accuracy? How do these interventions affect the diagnostic process and self‐monitoring? Methods Advanced medical students (N = 90) were randomly assigned to one of four conditions to complete six computer‐based patient cases: group 1 (prompt) was instructed to write down all diagnoses they considered while acquiring diagnostic test results and to finally rank them. Groups 2 and 3 received the same instruction plus a list of 17 differential diagnoses for the chief complaint of the patient. For half of the cases, the DDXC contained the correct diagnosis (DDXC+), and for the other half, it did not (DDXC−; counterbalanced). Group 4 (control) was only instructed to indicate their final diagnosis. Mixed‐effects models were used to analyse results. Results Students using a DDXC that contained the correct diagnosis had better diagnostic accuracy, mean (standard deviation), 0.75 (0.44), compared to controls without a checklist, 0.49 (0.50), P