Competency Summary List

Inter-Professional Consensus Curriculum on Diagnosis and Diagnostic Error

Improving Diagnosis by Improving Education

The Curriculum to Improve Diagnosis is organized into three overall domains: Individual, System-Related, and Team-Based. These are generic competency concepts applicable to each member of the inter-professional team, and should be adapted to each profession’s specific roles.

Individual competencies relate to the knowledge, skills, and attitudes that a healthcare professional must demonstrate on an individual level in order to contribute in their specific role to the diagnostic process.

Team-based competencies relate to the knowledge, skills, and attitudes that a healthcare professional must demonstrate in collaboration as a member of the diagnostic team.

Systems-based competencies relate to the knowledge, skills, and attitudes that a healthcare professional must demonstrate in relation to how the diagnostic process operates within a particular healthcare system.

 

Individual Competencies for Diagnosis

Demonstrate clinical reasoning to arrive at a justifiable diagnosis (an explanation for a health-related condition)

  • Accurately and efficiently collect key clinical findings needed to inform diagnostic hypotheses.
    Use these tools appropriately and efficiently in the diagnostic process: Effective interpersonal communication skills, history-taking, the physical examination, and record review; diagnostic testing; and the electronic health record and health IT resources.
  • Formulate, or contribute to, an accurate problem representation expressed in a concise summary statement that includes essential epidemiological, clinical, and psychosocial information.
  • Produce, or contribute to, a correctly prioritized, relevant differential diagnosis, including can’t-miss diagnoses.
  • Explain and justify the prioritization of the differential diagnosis by comparing and contrasting the patient’s findings and test results with accurate knowledge about prototypical or characteristic disease manifestations and atypical presentations, and considering pathophysiology, disease likelihood, and clinical experience.
  • Use decision support tools, including point-of-care resources, checklists, consultation, and second opinions to improve diagnostic accuracy and timeliness.
  • Use reflection, surveillance, and critical thinking to improve diagnostic performance and mitigate detrimental cognitive bias throughout the clinical encounter. Discuss and reflect on the strengths and weaknesses of cognition, the impact of contextual factors on diagnosis, and the challenges of uncertainty. Demonstrate awareness of atypical presentations, information that is missing, and key findings that don’t "fit."

 

Team-Based Competencies for Diagnosis

Partner effectively as part of an inter-professional diagnostic team. Communicate effectively and solicit information from all members of the team (including the patient and family) to create a shared mental model of a patient’s illness and the plan for diagnostic evaluation.

  • Engage and collaborate with patients and families, in accordance with their values and preferences when making a plan for diagnostic evaluation. Listen actively, encourage questions, and be alert to new or changing information. Explain the diagnostic process, including the patient’s and family’s role in helping to identify the most likely diagnosis. Share appropriately when diagnostic uncertainty exists.
  • Collaborate with other healthcare professionals (including nurses, physicians, physician assistants, radiologists, laboratory professionals, pharmacists, social workers, physical therapists, medical librarians, and others) and communicate effectively throughout the diagnostic process. Acknowledge and challenge authority gradients, especially between clinicians and patients' families, constructively.
  • Apply effective strategies at transitions of care to facilitate accurate and sufficient information transfer about the diagnosis, including any pending workup and areas of uncertainty. Close the loop on test result communication and clarify expectations with the team for test result follow-up.

 

System-Related Competencies for Diagnosis

Identify and understand the systems factors that facilitate and contribute to timely, accurate diagnoses and error avoidance.

  • Discuss how human factors contribute to diagnostic safety and error by identifying how the work environment influences human performance. Take steps to mitigate common systems factors that detract from diagnostic quality and safety. Use local resources (including people, teams, and technology, especially the electronic health record) effectively and efficiently to optimize patients’ access to care, diagnostic testing services, and appropriate experts for consultation.
  • Advance a culture of diagnostic safety that encourages open dialogue and continuous learning from analysis and discussion of excellent diagnostic performance, near misses, and errors.

    Give and receive feedback at an individual and team level to improve subsequent diagnostic performance.

  • Disclose diagnostic errors and missed opportunities transparently and in a timely manner to patients, families, team members, supervisors, and appropriate quality and risk management staff.
More from the Consensus Curriculum on Diagnosis and Diagnostic Error:
Medical Educator Teaching Student
Resources for Educators

Check out the Society to Improve Diagnosis in Medicine (SIDM)'s resources for trainees, practitioners, and educators examining clinical reasoning, critical thinking, and systems factors that underlie diagnostic error.