Diagnostic Errors: Association with level of expertise, effect of time taken to reach the diagnosis and utilization of differential diagnosis checklists among postgraduate trainees

Objectives: The objectives of this study were to evaluate: (1) The association between level of training (expertise) and rate of diagnostic errors. (2) The effect of time taken to reach a diagnosis on the frequency of diagnostic errors. (3) The effect of utilization of differential diagnosis checklists in reducing the frequency of diagnostic errors.

Methods: The study was carried out from November 2020 till April 2021 in Peshawar. The participants included FCPS Part-II trainees of Maxillofacial Surgery undergoing training in five centres. Thirty written case scenarios were prepared and validated, ten scenarios for each of the three objectives. To evaluate the association between training level (expertise) and the rate of diagnostic errors, two groups of trainees (1st year group and 4th year group) were formed and given ten same case scenarios for diagnosis. To evaluate the effect of time taken to reach diagnosis on the frequency of diagnostic errors, two groups of 4th year trainees (fast group and slow group) were formed by random allocation of participants to groups and given ten similar case scenarios for diagnosis. Fast group was given 15-minutes whereas slow group was given 30-minutes to respond. To evaluate the effect of utilization of differential diagnosis checklists in reducing diagnostic errors, again two groups of 4th year trainees were formed by random allocation of participants to groups and given ten similar case scenarios for diagnosis. One group was given differential diagnosis checklists for the scenarios and the other none.

Results: In this study, participants included were 1st year (n=36) and 4th year (n=36) trainees of Maxillofacial Surgery. The results showed that training level or expertise was significantly associated with the rate of diagnostic errors (p = 0.002). Time taken to reach diagnosis and differential diagnosis checklists have no significant effect on the frequency of diagnostic errors (p = 0.74 and 0.56 respectively).

Conclusions: Training level (expertise) has significant effect on the frequency of diagnostic errors whereas no significant effect was recorded for time (time taken to reach diagnosis) and differential diagnosis checklists on the rate of diagnostic errors.