Graber Mark L
Medical Service, VAMC Northport, Northport, NY, USA.
Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:63-9. doi: 10.1007/s10459-009-9178-y. Epub 2009 Aug 11.
Diagnostic error typically involves both system-related and cognitive root causes. Educational interventions are proposed to address both of these dimensions: In regard to system-related origins, education should focus on communication skills, including handoffs. In regard to cognitive shortcomings, educators need to consider both normative approaches to decision making, as well as the 'flesh and blood' processes used by experienced clinicians. In the long term, the goal of education should be to promote expertise, based on the assumption that experts make the fewest mistakes. In the short term, education should emphasize the importance of reflective practice, and consider use of a checklist for diagnosis to improve reliability.
诊断错误通常涉及与系统相关的和认知方面的根本原因。建议采取教育干预措施来解决这两个方面的问题：对于与系统相关的根源，教育应侧重于沟通技巧，包括交接班。对于认知缺陷，教育工作者需要考虑规范的决策方法以及经验丰富的临床医生所采用的实际过程。从长远来看，教育的目标应该是培养专业技能，基于专家犯错最少这一假设。从短期来看，教育应强调反思性实践的重要性，并考虑使用诊断清单来提高可靠性。
