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Related Experiment Video

Updated: Nov 15, 2025

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Diagnostic Errors Induced by a Wrong a Priori Diagnosis: A Prospective Randomized Simulator-Based Trial.

Felix M L Meyer1, Mark G Filipovic2, Gianmarco M Balestra3

  • 1Department of Intensive Care, Kantonsspital Luzern, 6000 Luzern, Switzerland.

Journal of Clinical Medicine
|March 6, 2021
PubMed
Summary

A wrong initial diagnosis significantly hinders diagnostic accuracy. This study found that providing a incorrect a priori diagnosis, such as pulmonary embolism, drastically reduced correct acute myocardial infarction diagnoses in both students and physicians.

Keywords:
diagnostic errormyocardial infarctionpulmonary embolismrandomized controlled trialsimulation

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Area of Science:

  • Medical Education
  • Diagnostic Error Research
  • Clinical Decision-Making

Background:

  • Diagnostic errors are a significant concern in healthcare.
  • Understanding the cognitive mechanisms behind diagnostic errors is crucial for developing effective preventive strategies.
  • The influence of pre-existing diagnostic assumptions on subsequent clinical judgment requires further investigation.

Purpose of the Study:

  • To investigate the impact of a wrong a priori diagnosis on diagnostic accuracy in an acute myocardial infarction (AMI) scenario.
  • To compare the effect of a correct versus an incorrect initial diagnosis on diagnostic performance in medical trainees and practicing physicians.
  • To quantify the increased likelihood of diagnostic errors when a false preliminary diagnosis is provided.

Main Methods:

  • A randomized controlled trial involving 156 medical students (cohort 1) and 44 physicians (cohort 2).
  • Participants were assigned to groups receiving no diagnosis (control), a correct diagnosis (AMI), or an incorrect diagnosis (pulmonary embolism) prior to assessment.
  • The primary endpoint was the final presumptive diagnosis made by participants.

Main Results:

  • Medical students given a wrong diagnosis (pulmonary embolism) had significantly lower accuracy for AMI (27%) compared to control (92%) and correct diagnosis (94%) groups (p < 0.001).
  • Physicians presented with a wrong diagnosis showed reduced accuracy (65%) compared to the control group (95%) (p = 0.023).
  • In the wrong diagnosis group, a substantial proportion of students (60%) and physicians (19%) adhered to the initial incorrect diagnosis.

Conclusions:

  • A wrong a priori diagnosis significantly impairs diagnostic accuracy in simulated clinical encounters.
  • Cognitive biases, such as confirmation bias, likely contribute to diagnostic errors when an incorrect preliminary diagnosis is established.
  • Educational interventions aimed at mitigating the effects of premature diagnostic closure are warranted to improve patient safety.