Sustained Impact: Long-Term Application of Diagnostic Uncertainty Communication Training

More than one-third of discharged emergency department (ED) patients leave without a clear diagnosis for their symptoms. In 2019-2020, we implemented a simulation-based mastery learning curriculum across two academic medical centers to train emergency medicine residents to discuss diagnostic uncertainty during ED discharge, guided by the Uncertainty Communication Checklist (UCC). We sought to assess if this cohort continues to apply skills learned and to obtain trainee insights into the most valuable checklist items.

A survey was emailed to all 109 participants who completed the training in 2019-2020. Questions assessed how often participants currently encountered uncertainty and used the skills learned in the curriculum. Additionally, participants rated how important it was to keep each of the 21 UCC items in future uncertainty communication training (4-point Likert scale: very important/important/low importance/not important). Means and proportions are reported.

Sixty-five individuals responded (60%). Mean age was 33; and 30.8% were female. More than 90% encountered diagnostic uncertainty more than once per shift, and 74% applied skills learned in the training "often" or "all the time." Seven of the 21 UCC items received endorsement by more than 70% of respondents as "very important" to retain in future trainings. The item receiving the most endorsement as "very important" (90%) was to "Clearly state that either 'life-threatening' or 'dangerous' conditions have not been found." Items with lower rankings related to generally accepted communication best-practices (e.g., "make eye contact").

Four years following diagnostic uncertainty training completion, most respondents frequently employ skills learned from uncertainty communication training.