Improving Resident Feedback on Diagnostic Reasoning after Handovers: The LOOP Project

Area of Science:

• Medical Education
• Clinical Reasoning
• Patient Safety

Background:

• Physician competence relies on accurate clinical reasoning calibration.
• Transitions of care, particularly overnight admissions, pose challenges to maintaining diagnostic accuracy.
• Lack of structured feedback hinders the calibration of clinical reasoning skills.

Purpose of the Study:

• To implement structured feedback for residents on clinical reasoning during overnight admissions.
• To quantify diagnostic changes occurring after overnight admissions.
• To assess the impact of feedback on resident self-efficacy and diagnostic calibration.

Main Methods:

• Residents provided feedback on clinical reasoning via secure electronic health record messaging.
• Feedback forms were analyzed to identify diagnostic changes.
• Surveys measured resident comfort with feedback, self-efficacy, and perceived educational value.

Main Results:

• A 43.7% diagnostic change rate was observed between night-shift and day-shift providers.
• Major diagnostic changes occurred in 12.7% of cases.
• Resident self-efficacy and comfort with feedback significantly improved post-implementation.

Conclusions:

• Structured feedback on clinical reasoning for overnight admissions is effective.
• This approach enhances resident diagnostic calibration and self-efficacy.
• Addressing diagnostic changes during care transitions is crucial for patient safety.