A modified murtagh-style safe diagnostic rubric for general practice training: preliminary validity evidence from a...

Area of Science:

• Medical Education
• Diagnostic Reasoning
• General Practice Training

Background:

• Safe diagnostic reasoning is crucial but challenging in general practice training, especially in resource-limited settings.
• Murtagh's diagnostic framework offers a structure, but its application in non-English speaking, low-resource environments needs exploration.
• Diagnostic errors in frontline settings have significant patient safety implications.

Purpose of the Study:

• To evaluate a modified Murtagh-style safe diagnostic rubric (MM-SAFE-Dx) for general practice training.
• To assess the rubric's application and educational utility in a real-world, low-resource context.

Main Methods:

• A single-centre retrospective implementation study involving 83 general practice trainees.
• Delivery of a modified Murtagh-style safe diagnostic training program across three rounds in 2025.
• Analysis of 145 scored encounters using nonparametric methods and examining preliminary validity evidence of the MM-SAFE-Dx rubric.

Main Results:

• The MM-SAFE-Dx rubric showed a modest but favorable educational signal, with improvements noted in subsequent training rounds.
• Initial exposure to the rubric did not significantly change baseline assessments, suggesting cumulative learning effects.
• Longitudinally informed stratification provided more interpretable results than uncorrected baseline stratification.

Conclusions:

• The MM-SAFE-Dx rubric demonstrated preliminary real-world validity and practical educational utility in a low-resource general practice training setting.
• Structured diagnostic tools require guided implementation and context-sensitive analytical calibration for meaningful interpretation in unfamiliar settings.
• Baseline measurements from first-time exposure may not reliably reflect underlying diagnostic competence.