Schedule

Attendees will rotate through three stations, discussing theoretical underpinnings and rapidly implementable educational strategies. Topics will include accessible faculty development activities, emerging methods for learner assessment, and strategies for improving clinical reasoning teaching in existing educational conferences such as morning report.

Learning Objectives

• Discuss and critique methods for faculty development in clinical reasoning and diagnosis education.
• Identify and practice techniques for assessing learner competence in diagnostic reasoning.
• Identify rapidly implementable methods to improve clinical reasoning education in existing conferences.

This course will address the challenges and pitfalls of studying diagnostic error as well as the strengths and limitations of the most common research methods.

Learning Objectives

• Describe the challenges of studying diagnostic errors in medicine.
• Identify the strengths and weaknesses of research methods used in diagnostic error studies.

Dr. Danielle Ofri will examine the ways that refocusing conversations between doctors and their patients can lead to improved diagnoses. The Summit also will also highlight disparities and the role that age, race/ethnicity, gender, and other patient characteristics play in missed and delayed diagnosis, as well as cognitive blind spots that may be induced by unexpected or unexplained symptoms or conditions. Proactive solutions to prevent diagnostic error due to disparities and cognitive bias will be explored.

Learning Objectives

• Explore ways in which better communication can improve diagnostic outcomes.
• Examine specific ways diagnosis may fail under different circumstances and in different populations.
• Propose actions that patients and health care professionals can take to reduce diagnostic error relating to specific populations and diagnoses.

Participants will gain an understanding of diagnostic error; the definition, how it impacts patients and health systems, how common factors combine to cause diagnostic error, and interventions for preventing error. Internationally recognized experts in the field will share their knowledge and answer questions.

Learning Objectives

• Describe the problem of diagnostic errors in terms of epidemiology and burden involved.
• Learn about common cognitive- and system-related factors contributing to diagnostic error.
• Understand evidence for effectiveness of interventions to decrease diagnostic error.
• Participate in an interactive case-based analysis illustrating the complexity of diagnostic error.

We are early in the development of effective interventions. In this workshop, we will share case studies of what works and in a highly interactive session, determine strategies for implementing diagnostic error quality improvement in your clinical setting now.

Learning Objectives

• Define interventions for reducing diagnostic error in clinical settings.
• Identify techniques critical to the effective implementation of diagnostic error quality improvement.

Different types of research will be addressed, including basic approaches in cognitive psychology, development and validation of assessment tools, and comparative effectiveness studies. After an introduction, attendees will have the opportunity to engage with experts in the field to design their own educational research study.

Learning Objectives:

• Demonstrate the ability to craft a formal and focused research question in health professions education.
• Identify common pitfalls and strategies to avoid them in conducting research in health professions education.
• Develop and receive feedback on a proposal for educational research.

However, medicine is fundamentally a human endeavor. Without attention to the human aspects of the medical enterprise - emotions, cognitive abilities, biases, communication - crucial aspects of patient safety will remain beyond our grasp.

Learning Objectives:

• Explain how the culture of medicine can endanger the health and safety of patients.
• Describe the role of emotions, cognition, and communication regarding medical error.
• Explore opportunities to improve the delivery of care while navigating an imperfect health care environment.

The speaker will highlight common challenges and deficiencies in physical examination and present the results of studies focused on improving clinicians' examination skills.

Learning Objectives:

• Identify challenges and common pitfalls in the physical examination.
• Describe emerging techniques for training clinicians to perform physical examinations.
• Explain the importance of multiple types of feedback in improving physical examination performance.

Problems can occur when there is a misunderstanding of what would be the best imaging choice for an individual patient. Diagnostic errors can also result when the clinical history given to radiologists is miscommunicated, or when the findings of imaging studies are miscommunicated, including the significance of "incidental" findings. In this workshop, co-sponsored by the American College of Radiology (ACR), we will explore examples of these miscommunications, and discuss potential strategies for improving communication between radiologists and other caregivers, including the ACR's "Imaging 3.0" initiative.

Learning Objectives:

• Describe the scope of the problem of miscommunication between radiologists and other caregivers.
• Analyze the variety of situations in which miscommunication can occur involving diagnostic imaging.
• Explain the role of clinical decision support in tailoring imaging to the needs of patients and how this can reduce miscommunication and diagnostic error.
• Articulate strategies to improve communication between radiologists and other caregivers so that diagnostic errors are reduced or avoided.

To date, little research has focused on how these factors influence diagnosis. In this session, we will summarize new findings about diagnostic performance disparities from multiple sources (literature, malpractice claims data, patient interviews) and different perspectives. Facilitated discussion will follow to address questions such as, what is missing from the knowledge base? What other data sources and perspectives are needed? What solutions are needed to avoid pitfalls?

Learning Objectives:

• Participate in a patient-partnered initiative to protect patients from cognitive and system pitfalls in diagnoses that occur due to visible patient factors (e.g., age, sex and race/ethnicity).
• Suggest one way to protect decision-making from cognitive pitfalls related to patient age, sex and racial/ethnic biases (e.g., "too young" to have colon cancer).
• Perform a disparities risk analysis for the "Big 3" conditions (i.e., cancer, cardiovascular and infection).

Clinicians must create a differential diagnosis (Ddx), then collect and analyze data that increases or decreases the probability of the diseases that are listed in their Ddx. It is difficult to measure these clinical reasoning decisions; data collection and analysis is resource heavy. Decisions you make, such as assigning data to increase or decrease the probability of diseases will be measured with high fidelity. How and when you order tests and your interpretation of the results is also measured. You will provide your level of uncertainty/confidence in your final diagnosis at the end of the case. Your decisions will be compared to expert opinion and you will receive feedback (to simulate what a learner would experience). De-identified data of all participants will be shared with the group as a demonstration of the data collection process. A discussion will follow an analysis of the data. Sample data from a real cohort of medical students will also be presented and analyzed.

Learning Objectives:

• Identify the discrete decisions that are made during clinical reasoning during the diagnostic process.
• Participate in an innovative "open universe" diagnostic simulation with high fidelity data collection.
• Analyze and understand the real time data collected in the simulation, including your own potential sources of error.

In addition to solving the case, the presenters will identify and highlight the methods used in solving cases as well as approaches that can be put rapidly into practice.

Learning Objectives:

• Experience the joy of discovery that comes when solving clinical cases.
• Describe common approaches for avoiding diagnostic errors when solving cases.
• Identify methods for teaching clinical reasoning through solving cases.

This workshop will describe our institution's approach. As a result of the attention our educational programs garnered throughout the institution, institutional leaders became increasingly engaged in supporting additional interventions to improve diagnostic reliability in our institution including: funding for a clinical decision support system, research and performance improvement interventions to improve diagnostic outcomes, and development of a smartphone-based diagnostic error reporting App.

Learning Objectives:

• Describe the development and implementation of a comprehensive, institution-wide, interdisciplinary diagnostic reasoning education program.
• Develop an action plan to implement one or more of the components of a comprehensive diagnostic reasoning education program in participants' home institutions.
• Discuss how educational efforts to improve diagnosis in an institution can lead to efforts to improve diagnosis in SIDM's other strategic areas including: public and staff awareness and engagement, research on diagnostic outcomes, practice improvement efforts, and patient engagement in diagnostic improvement efforts.

The National Academy of Medicine's report, Improving Diagnosis Healthcare, emphasized the need to better include patients and nurses as diagnostic team members. This session will review the efforts of the PARTNERED Project (Patients Aligned with Research Teams with Nurses and ER providers to Enhance Diagnosis), a PCORI-funded effort to train patients and nurses in partnering with diagnostic researchers to improve diagnosis. Two PARTNERED graduates will discuss the research questions or projects they developed. A research team including a diagnostic researcher, Patient Partner and Nursing Partner will discuss their experiences collaborating in a recent diagnostic research project.

Learning Objectives:

• Describe the value of patients and nurses partnering in diagnostic research and how to facilitate those partnerships.
• Discuss how patients and nurses can use their unique perspectives on healthcare to co-create diagnostic research.
• Identify what training is beneficial for patients and nurses in order to partner with diagnostic researchers.

The 2015 follow-up, Improving Diagnosis in Health Care, focused on diagnosis as key in patient safety. Advances in health IT offer the potential to reduce misdiagnosis, but many experts are concerned that they are not facilitating the diagnostic process and may even be contributing to diagnostic errors. This workshop will explore strategies to ensure that health IT in the diagnostic process exhibits usability, incorporates human factors knowledge, fits well within clinical workflow, and facilitates the timely flow of information. Case studies will be used to demonstrate the application of signal detection theory, user-centered design, and workflow analysis.

Learning Objectives:

• Discuss guidelines, assessment tools, and clinical decision support for patients and providers to address diagnostic error.
• Describe strategies that meet the IOM/NAM "Improving Diagnosis in Health Care" recommendation to ensure that health IT used in the diagnostic process demonstrates usability, incorporates human factors knowledge, fits well within clinical workflow, and facilitates the timely flow of information among patients and clinicians.
• Re-envision the diagnostic process to include thoughtful and sophisticated clinical decision support to improve communication and collaboration.

We will define diagnostic value and illustrate the principle that healthcare innovations which succeed in improving diagnosis will almost invariably yield gains in quality of care and simultaneous reductions in total costs.

Learning Objectives:

• Summarize the public health burden & financial impact of diagnostic error and misdiagnosis-related harms.
• Explain the 'Diagnostic Value Equation' and how improving diagnosis always increases quality and reduces costs.
• Describe the role of diagnostic innovation in an evolving financial landscape for healthcare.

Recent advances in technology and big data have created opportunities, but how does one decide when to use AI in diagnosis? How does one evaluate its diagnostic accuracy and limitations? In what areas can AI be applied now and in the future? This interactive workshop will review these and other complex issues.

Learning Objectives:

• Discuss the historical factors (the "why now") that have led to the current focus on machine learning and artificial intelligence in healthcare.
• Give examples of important caveats and limitations in machine learning and artificial intelligence.
• Identify recent research that suggests important opportunities for artificial intelligence and machine learning to influence the practice of medicine.

In the hospital environment, peer feedback is particularly challenging given the rapid turnover of physicians and lack of long-term follow-up. Clinicians may feel uncomfortable addressing diagnoses with their colleagues. In this workshop, we will discuss the role of diagnostic feedback on personal performance calibration as well as principles of effective peer-to-peer feedback. Through the use of real cases and iterative role-play, we will practice strategies for providing feedback to colleagues and will build a set of tools to improve our performance.

Learning Objectives:

• Identify the role of diagnostic feedback in personal performance calibration.
• Explain the principles of effective peer-to-peer diagnostic feedback.
• Describe and demonstrate a communication approach to giving peer-to-peer diagnostic feedback.

In this workshop, we will describe approaches and methods to guide clinicians and safety professionals on how to analyze cases to identify diagnostic errors (defined as missed opportunities to make a correct and timely diagnosis) and related process breakdowns. This step is necessary to create a learning healthcare system around diagnosis.

Learning Objectives:

• To learn about methods that health systems can use to identify diagnostic errors for learning and improvement.
• To identify and understand use of a structured approach for comprehensive and objective analysis of cases to determine presence/absence of diagnostic errors.

In addition, Congress has asked the AHRQ to convene a Federal Interagency Task-Force to help align and augment other health care research-funding agencies efforts to improve diagnostic safety and quality. Come learn how the AHRQ and its fellow agencies are thinking about funding and programming priorities for diagnosis research and the dissemination of proven strategies to improve safety.

Learning Objectives:

• Attendees will be able to articulate how diagnostic safety fits within agencies' mission-based research funding strategies.
• Attendees will be able to articulate how and where their own work to improve diagnosis aligns with these strategies.
• Attendees will be able to anticipate and identify promising areas for fund-able research in diagnostic quality and safety.

Leaders from the Joint Commission, National Quality Forum, and National Committee for Quality Assurance will weigh in on: 1) What process measures are needed to hold health care systems accountable for putting protocols in place to reduce diagnostic error? and 2) What innovations are already in place?

Learning Objectives:

• Participants will determine one or more process measurements appropriate to implement in their practice setting.
• Participants will be able to advocate with health system leadership about the importance of implementing process change to improve outcomes at their organization.
• Participants will identify a potential policy around implementing process measures to improve diagnostic quality.

The audience will engage with presenters in discussing the highlights from the literature and asking the "big questions and ideas" in the field.

Learning Objectives:

• Critique important papers in improving diagnosis from the last year.
• Identify challenges in improving diagnostic performance.

Yet there is no unifying model of best practices for teaching and communicating about diagnostic uncertainty. This workshop will 1) Identify the complex nature of diagnostic uncertainty, and discuss its impact on clinicians and patients, 2) Propose a 2 x 2 model of diagnostic accuracy and certainty that can be used in discussions with trainees, 3) Describe an approach for communicating diagnostic uncertainty with patients and modify it on the basis of participant feedback.

Learning Objectives:

• Reflect on personal reactions to diagnostic uncertainty and how those reactions may influence clinical practice.
• Apply a 2 x 2 model of diagnostic accuracy and certainty to teach about diagnostic uncertainty with trainees on rounds or in clinic.
• Practice a four-step approach for communicating with patients about diagnostic uncertainty.

One is a national multi-stakeholder work group that developed safe practice recommendations to support technology solutions for closing the loop to mitigate misdiagnosis. The other is a statewide collaborative improving the timely communication of test results to patients and families and engaging them as partners in the care team.

Learning Objectives:

• Identify how to best communicate the right information, to the right people (e.g., clinicians, organizations, patients or caregivers, and healthcare facilities), in the right format at the right time.
• Describe team-based strategies, solutions, and technology tools for overcoming common challenges in the diagnostic process and bridging gaps in care related to hand-off communication.
• Demonstrate the importance of engaging patient partners and using patient and family stories to drive improvement in the diagnostic process.

First, we will review the patient safety competencies recently released by the AAMC. Then, results from SIDM's "Consensus Curriculum" project funded by the Macy Foundation will be presented. A large interprofessional group identified 12 key competencies that should be acquired during professional training, and these will be reviewed. Twenty different schools have implemented small pilot programs to integrate one or more of these competencies in their current training programs, and we will present highlights from these first set of trials.

Learning Objectives:

• Identify newly published medical education competencies in quality improvement and patient safety (QIPS) that include diagnostic safety.
• List the 12 key competency elements relating to diagnostic quality and safety.
• Review the latest activities for teaching and assessing the new competencies.
• Discuss specific strategies for how medical trainees can develop competency in clinical reasoning and how faculty can role model diagnostic safety and performance.

In this workshop, participants will hear two approaches to setting up a learning system toward that end. One health system uses existing patient safety processes such as incident reporting systems, M&M conferences, and RCA as a source for identifying cases for learning. In the other, an international collaborative has instituted an identification and classification methodology across the medical records of entire patient populations.

Learning Objectives:

• Describe two ways to adapt current patient safety processes to improve diagnosis.
• Demonstrate a multidisciplinary modified Delphi approach to identify opportunities for improvement with a focus on Diagnosis and Diagnostic Errors.
• Describe two improvements to diagnostic process that emerged from learning systems at two different healthcare organizations.

This workshop will engage in interactive discussions about how to achieve an active collaboration in test selection and interpretation among laboratory physicians and clinicians to improve the diagnostic process. A focused discussion with attendees will occur on how to best evaluate and implement diagnosis management teams, multidisciplinary diagnostic conferencing, and direct to patient reporting of significant and unexpected findings from Pathologists.

Learning Objectives:

• Attendees will be able to describe how the laboratory affects diagnostic performance in both clinical and anatomic pathology, as well as what work is taking place at the federal level to improve diagnostic accuracy.
• Attendees will be able to explain the benefits and implementation challenges of diagnostic management teams, multidisciplinary tumor boards, and other novel strategies that laboratory professionals and pathologists have developed in collaboration with their clinical colleagues to improve diagnostic accuracy.

Learning Objectives:

• Describe how patients, family members, clinicians and policy makers have partnered to change policy for accurate, timely and communicated diagnosis.
• List the barriers and facilitators when advocating for policy change.
• Help DEM participants plan messages and approaches when participating in Hill Day.

How -- and how much -- will these changes improve the diagnostic process for clinicians and patients? What more is needed? How long might it take?

Learning Objectives:

• Attendees will be able to describe the new rules for HIT.
• Consider the implications for patients as agents of interoperability.
• Discuss aspects of the new rules most significant to diagnosis in their practices and systems.
• Articulate opportunities to improve upon the new rules.

These include more robust research funding, public awareness, optimized health IT systems, just culture for reporting, and appropriate structures and incentives for performance improvement in the diagnostic process, among others. This session will address the knowledge, attitudes, and skills needed to successfully educate public policymakers about opportunities and strategies to improve diagnosis. Lunch will be provided to attendees who will be visiting elected officials and staff later in the day.

Learning Objectives:

• Apply meeting skills to ensure a smooth and clearly communicated Congressional meeting.
• Describe policy issues relevant to improving the diagnostic process and reducing harm from diagnostic error.
• Understand the value of engaging the policy process and how they can continue to be involved.