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Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
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Improving Resident Feedback on Diagnostic Reasoning after Handovers: The LOOP Project.

Kathleen P Lane1, Catherine Chia1, Juan N Lessing2

  • 1Department of Medicine, University of California Davis, Sacramento, California.

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Structured feedback on clinical reasoning during overnight admissions improved resident self-efficacy and diagnostic calibration. A significant rate of diagnostic changes occurred during care transitions, highlighting the need for improved physician training.

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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.