What doctors should know when they don’t know: A new educational intervention for pediatric residents aims to improve their skills in communicating about diagnostic uncertainty.
By Maren Olson
Uncertainty is a fact of life and medicine is not immune to this reality. Patients, families, and health care providers experience uncertainty every day as they navigate diagnosis, prognosis, and decisions about what therapies to pursue. Unfortunately, when physicians are uncomfortable with uncertainty, they may order unnecessary or inappropriate tests, jump to conclusions about what is going on with a patient, and ultimately make an incorrect diagnosis. However, uncertainty is rarely addressed in medical education.
To help address that void, a workshop-based curriculum for residents training in pediatrics was created at the University of Minnesota. As part of the study, recently published in the journal Diagnosis, residents engaged in clinical scenarios of pediatric patients whose cases involved significant diagnostic uncertainty: there was no way to figure out exactly what was wrong with the child. The residents’ task was to navigate conversations about the cases with the patient’s parents, who were played by actors. Afterwards, the residents participated in a short debrief with the faculty observers and the actor-parent to talk about how the conversation went and to get feedback about their ability to talk about uncertainty with patients and families.
Six months later, the residents came back for a second workshop with two new cases. Their abilities to discuss uncertainty had improved and many of them expressed how much they appreciated the chance to practice these challenging conversations in a safe environment. According to the researchers behind the study, “this is an important step to improving diagnosis through specifically discussing diagnostic uncertainty with patients and families.”
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