van Sassen Charlotte, van den Broek Walter, Bindels Patrick, Zwaan Laura
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Perspect Med Educ. 2025 Apr 29;14(1):194-207. doi: 10.5334/pme.1730. eCollection 2025.
Integrating diagnostic error and malpractice cases into clinical reasoning education may enhance diagnostic reasoning by highlighting atypical presentations and diagnostic risks in complex contexts. While emotionally engaging, these cases might also affect information retention. This study examines how malpractice, error, and neutral case presentations influence recall for different information types and their interaction with learners' interest, satisfaction and anxiety levels.
In this two-phase between-subjects experiment, 89 first-year general practice (GP) residents reviewed four clinical vignettes in either malpractice, diagnostic error, or neutral formats. Vignettes were structurally identical, with claim-related details in malpractice versions replaced by general medical information in others. Anxiety was measured pre- and post-exercise. After a one-hour filler task, participants completed a free recall task, and their interest and satisfaction levels were assessed. Recalled idea units (clinical case-specific, medical-theoretical, claim-specific) were analyzed using ANOVAs.
Anxiety, interest, and satisfaction levels remained similar across conditions. The proportion of total recalled idea units did not differ significantly (malpractice 11.38%, neutral 12.91%, error 13.12% = 0.57). However, malpractice participants recalled fewer clinical case-specific units (malpractice 12.19%, neutral 19.43%, error 15.87% = 0.007) while recalling more claim-specific units compared to medical-theoretical units in the other conditions (malpractice 7.23%, neutral 0.42%, error 1.3% < 0.001).
GP residents retained fewer clinical case-specific details from malpractice claim vignettes than from neutral vignettes, with the missing information substituted by claim-specific details, without an increase in anxiety or interest. Further research is needed to understand the long-term impact of these differences on future diagnostic accuracy in clinical practice.
将诊断错误和医疗事故案例融入临床推理教育中，通过在复杂情境中突出非典型表现和诊断风险，可能会增强诊断推理能力。虽然这些案例在情感上具有吸引力，但也可能影响信息保留。本研究探讨医疗事故、错误和中性案例呈现方式如何影响不同信息类型的记忆，以及它们与学习者的兴趣、满意度和焦虑水平之间的相互作用。
在这个两阶段的被试间实验中，89名一年级全科医生（GP）住院医师分别以医疗事故、诊断错误或中性格式回顾了四个临床案例。案例在结构上相同，医疗事故版本中与索赔相关的细节在其他版本中被一般医学信息所取代。在练习前后测量焦虑水平。经过一小时的填充任务后，参与者完成了自由回忆任务，并评估了他们的兴趣和满意度水平。使用方差分析对回忆的观念单元（临床案例特定、医学理论、索赔特定）进行分析。
不同条件下的焦虑、兴趣和满意度水平保持相似。总回忆观念单元的比例没有显著差异（医疗事故11.38%，中性12.91%，错误13.12% = 0.57）。然而，与其他条件相比，医疗事故组的参与者回忆的临床案例特定单元较少（医疗事故12.19%，中性19.43%，错误15.87% = 0.007），而回忆的索赔特定单元更多（医疗事故7.23%，中性0.42%，错误1.3% < 0.001）。
与中性案例相比，全科医生住院医师从医疗事故索赔案例中记住的临床案例特定细节更少，缺失的信息被索赔特定细节所取代，且焦虑或兴趣没有增加。需要进一步研究以了解这些差异对未来临床实践中诊断准确性的长期影响。
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