Department of Medicine, Maine Medical Center, , Portland, Maine, USA.
BMJ Qual Saf. 2013 Oct;22 Suppl 2(Suppl 2):ii28-ii32. doi: 10.1136/bmjqs-2012-001622. Epub 2013 Jun 13.
Diagnostic errors are a major patient safety concern. Although the majority of diagnostic errors are partially attributable to cognitive mistakes, the most effective means of improving clinician cognition in order to achieve gains in diagnostic reliability are unclear. We propose a tripartite educational agenda for improving diagnostic performance among students, residents and practising physicians. This agenda includes strengthening the metacognitive abilities of clinicians, fostering intuitive reasoning and increasing awareness of the role of systems in the diagnostic process. The evidence supporting initiatives in each of these realms is reviewed and a course of future implementation and study is proposed. The barriers to designing and implementing this agenda are substantial and include limited evidence supporting these initiatives and the challenges of changing the practice patterns of practising physicians. Implementation will need to be accompanied by rigorous evaluation.
诊断错误是一个主要的患者安全问题。尽管大多数诊断错误部分归因于认知错误，但为了提高诊断可靠性而改善临床医生认知的最有效方法尚不清楚。我们为提高医学生、住院医师和执业医师的诊断能力提出了一个三部分的教育议程。该议程包括增强临床医生的元认知能力、培养直觉推理能力以及提高对系统在诊断过程中作用的认识。审查了在这些领域中开展各项举措的证据，并提出了未来实施和研究的方案。设计和实施这一议程存在重大障碍，包括这些举措的证据有限以及改变执业医师实践模式的挑战。实施需要与严格的评估相结合。
