Medical Education Research Round-Up

A Peak Into Medical Malpractice Claims Involving Trainees

Malpractice — Medical malpractice claims involving trainees is the focus of this research.   Between 2012 and 2016, researchers looked at 581 malpractice claims(malpractice defined as “written requests for compensation due to injury”) from 32 teaching institutions and 9 states and found direct involvement of a resident in 81% of cases, a fellow in 13% of cases and both residents and fellows in 6% of cases. They further found that the most common diagnosis associated with malpractice claims was laceration during surgery (11%) in specialty fields such as oral surgery/dentistry and ob-gyn.  Inadequate supervision was a contributing factor in 24% of cases.  –DR MERL Editorial Team

Myers, Laura C. MD, MPH; Gartland, Rajshri M. MD, MPH; Skillings, Jillian; Heard, Lisa MSN, RN; Bittner, Edward A. MD, PhD; Einbinder, Jonathan MD, MPH; Metlay, Joshua P. MD, PhD; Mort, Elizabeth MD, MPH, An Examination of Medical Malpractice Claims Involving Physician Trainees, Academic Medicine, August 2020

Link To Article

Diagnostic Accuracy Improves Upon Reflection

Reflection Recognizing that diagnostic error is one of the most common and most harmful patient safety problems, researchers looked at reflection as a tool for improvement.   One hundred and sixty-seven (167) physicians in Bern, Switzerland were asked to reflect on patient cases (1) without instruction, (2) with confirmatory evidence, (3) with contradictory evidence, or (4) both.  Results found reflection in any mode helped improve diagnostic accuracy as measured by the set of cases presented to the physicians for this study.    — DR MERL Editorial Team

Mamede, Sílvia; Hautz, Wolf E.; Berendonk, Christoph; Hautz, Stefanie C.; Sauter, Thomas C.; Rotgans, Jerome; Zwaan, Laura; Schmidt, Henk G, Think Twice: Effects on Diagnostic Accuracy of Returning to the Case to Reflect Upon the Initial Diagnosis, Academic Medicine, August 2020

Link To Article

How Clinical Decision Rules Factor Into the Diagnostic Mix

Decision-Making — Sixteen emergency medicine physicians from 3 teaching hospitals in Canada were interviewed while diagnosing simulated patients with chest pain, breathlessness, or leg discomfort to see how clinical decision rules (CDR, using a given set of clinical predictors to estimate the probability of a diagnosis) factored into their thought process.   Analysis shows that physicians use dynamic and iterative clinical decision-making which contrasts with the static, linear approach found in CDR’s.   In the group studied, CDR’s were applied only after tests were ordered. — DR MERL Editorial Team

Chan, Teresa M.; Mercuri, Mathew; Turcotte, Michelle; Gardiner, Emily; Sherbino, Jonathan; de Wit, Kerstin, Making Decisions in the Era of the Clinical Decision Rule: How Emergency Physicians Use Clinical Decision Rules, Academic Medicine, 2020

Link To Article

Antimicrobial Therapy Under The Microscope

Thought-Process — In this qualitative study, investigators explore clinicians’ thought process involved in prescribing anti-microbials. Sixteen participants described 3 steps, 25 factors, 4 areas and 14 different drug characteristics that the authors developed into a framework which may provide be helpful in the development of education tools across medical disciplines. — DR MERL Editorial Team

Abdoler, Emily A. MD, MAEd; O’Brien, Bridget C. PhD; Schwartz, Brian S. MD, Following the Script: An Exploratory Study of the Therapeutic Reasoning Underlying Physicians’ Choice of Antimicrobial Therapy, Academic Medicine, 2020

Link To Article

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