Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study
- 1 April 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 33 (4), 445-448
- https://doi.org/10.1007/s11606-017-4248-y
Abstract
Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience. Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores. The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p < 0.001). GM-ITE scores correlated with ED rotations (6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p < 0.001), and average daily minutes of self-study (91 min: 2.05; 0.56-3.53; p = 0.01). SEM revealed that D-KAT scores were directly associated with GM-ITE scores ( = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations ( = 0.06, 95% CI: 0.02-0.10), inpatient caseload ( = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study ( = 0.13, 95% CI: 0.09-0.17). Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.This publication has 10 references indexed in Scilit:
- The global burden of diagnostic errors in primary careBMJ Quality & Safety, 2016
- Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in JapanInternational Journal of General Medicine, 2015
- How to improve the teaching of clinical reasoning: a narrative review and a proposalMedical Education, 2015
- The Relationship Between Internal Medicine Residency Graduate Performance on the ABIM Certifying Examination, Yearly In-Service Training Examinations, and the USMLE Step 1 ExaminationAcademic Medicine, 2015
- Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residentsBMJ Quality & Safety, 2013
- The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in JapanInternational Journal of General Medicine, 2013
- Association of Volume of Patient Encounters with Residents’ In-Training Examination PerformanceJournal of General Internal Medicine, 2013
- Cognitive interventions to reduce diagnostic error: a narrative reviewBMJ Quality & Safety, 2012
- Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training programBMC Medical Education, 2009
- Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performanceAdvances in Health Sciences Education, 2009