gms | German Medical Science

4th Research in Medical Education (RIME) Symposium 2015

19.03-21.03.2015, München

Diagnostic competence: Sources of cognitive diagnostic errors and strategies to improve clinical teaching

Meeting Abstract

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  • corresponding author presenting/speaker Silvia Mamede - Erasmus University Rotterdam, Institute of Medical Education Research, Rotterdam, The Netherlands

4th Research in Medical Education (RIME) Symposium 2015. München, 19.-21.03.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocKN3

doi: 10.3205/15rime03, urn:nbn:de:0183-15rime033

Veröffentlicht: 12. März 2015

© 2015 Mamede.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen. Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden. Lizenz-Angaben siehe



A major goal of medical education is to develop in its students the knowledge and skills enabling them to diagnose clinical problems. Diagnostic competence depends largely on achieving a high level of mastery in diagnostic reasoning, the thinking and reasoning processes through which a physician gains an understanding of his or her patient’s problem. Research on diagnostic error has indeed shown that diagnostic reasoning critically defines physicians’ performance and the quality of care provided to their patients. The US Institute of Medicine for instance reported that up to 98,000 people die annually in the US due to preventable medical mistakes, a large proportion of them involving diagnostic errors [1]. Many diagnostic errors may be corrected in time or produce minor effects, but a substantial fraction is likely to have serious consequences. A recent study of autopsies in the Netherlands found discrepancies in the major diagnosis in 39% of the cases, and in almost half of them treatment might have been different if the correct diagnosis was known [2]. While multiple factors may interact to produce diagnostic errors, most of these errors derive from physicians’ faulty reasoning [3], [4]. In fact, a study of diagnostic errors in American academic hospitals showed flaws in physicians’ cognitive processes in 74% of the cases [3]. Most of these flaws were produced by faulty reasoning rather than by lack of knowledge. The sources of faulty reasoning and how to counteract them have been a source of much debate but scarce empirical investigation. In this talk I will

describe empirical findings from research on the effects of different forms of diagnostic reasoning on the quality of diagnostic decisions,
examine factors that influence physicians' reasoning mode and may lead to cognitive errors;
describe empirical findings of interventional studies aimed at fostering learners' diagnostic competence.


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