Diagnostic errors by medical students: results of a prospective qualitative study

Leah T. Braun, Laura Zwaan, Jan Kiesewetter, Martin R. Fischer, Ralf Schmidmaier

Diagnostic errors occur frequently in daily clinical practice and put patients' safety at risk. There is an urgent need to improve education on clinical reasoning to reduce diagnostic errors. However, little is known about diagnostic errors of medical students. In this study, the nature of the causes of diagnostic errors made by medical students was analyzed. In June 2016, 88 medical students worked on eight cases with the chief complaint dyspnea in a laboratory setting using an electronic learning platform, in summary 704 processed cases. The diagnostic steps of the students were tracked and analyzed. Furthermore, after each case the participants stated their presumed diagnosis and explained why they came to their diagnostic conclusion. The content of these explanations was analyzed qualitatively. Based on the diagnostic data gathering process and the students' explanations, eight different causes could be identified of which the lack of diagnostic skills (24%) and inadequate knowledge base (16%) were the most common. Other causes that often contributed to a diagnostic error were faulty context generation (15%) and premature closure (10%). The causes of misdiagnosis varied per case. Inadequate skills/knowledge and faulty context generation are the major problems in students' clinical reasoning process. These findings are valuable for improving medical education and thus reducing the frequency of diagnostic errors in students' later everyday clinical practice.