Online Course

Online Modules Overview

The Diagnostic Error and Medical Decision Making (DEMDM) online course consists of 11 interactive modules which cover the core principles of clinical reasoning. Modules are case-based and require approximately 20-30 minutes to complete. The first 6 modules introduce the concept of diagnostic error and explore concepts like inductive and analytical reasoning, dual process theory, heuristics, and bias. The final 5 modules discuss the use of cognitive forcing functions to help promote analytical reasoning and avoid cognitive bias.

A list of learning objectives from each module is shown below:

Module 1 – Diagnostic Error Prevalence and Consequences

  1. Give examples of why education in diagnostic error is necessary.
  2. Define what constitutes a diagnostic error.
  3. List questions to ask oneself to optimize diagnostic testing.
  4. Identify how diagnostic error can increase cost of care.

Module 2 – The Cognitive Psychology of Decision Making

  1. Describe metacognition.
  2. Understand the dual processing theory of human cognition. Explain how we use it in human decision making.
  3. Learn the characteristics of System 1 thinking compared to System 2 thinking.
  4. Describe an example of System 1 and of System 2 thinking that would be encountered in everyday life.
  5. Define biases and understand how can they impair our decision-making accuracy.

Module 3 – How Do Doctors Think?

  1. List the common steps in problem representation in the diagnostic process.
  2. Understand key clinical findings and how to choose them.
  3. Define semantic qualifiers and understand their importance in diagnosis.
  4. Describe the characteristics of effective summary statements and explain why summary statements are critical in diagnosis.
  5. Describe what illness scripts are and how they are developed and expanded.
  6. Define horizontal and vertical reading.

Module 4 – Heuristics: A Powerful Cognitive Tool for Efficient Decision Making

  1. Define the general term “heuristics” and identify how heuristics can improve the efficiency of the diagnostic process.
  2. List 3 specific examples of heuristics, and identify how faulty application of each could lead to diagnostic error.

Module 5 – Cognitive Biases: Premature Closure and Confirmation Bias

  1. Define premature closure, and describe how it can adversely impact diagnostic reasoning.
  2. List three biases that can be considered to be in the category of premature closure.
  3. Define confirmation bias, and explain how it can adversely influence clinical reasoning.
  4. Describe who Dr. Simmelweis was and how the Simmelweis effect can impact perception of information and adversely impact clinical reasoning.
  5. Define metacognition.

Module 6 – Cognitive Biases: Overconfidence, Probability Estimation, and Emotional Bias

  1. Recognize the disposition to respond to information in ways that can lead to diagnostic error.
  2. Identify biases that steer the physician away from making a reasonable estimation of the pre-test probability of a particular diagnosis.
  3. Described how our natural emotions about patient characteristics, the presentation, or the setting in which the presentation occurs, can interfere with sound clinical reasoning.

Module 7 – Two Steps Back Checklist Part One

The Two Steps Back Checklist is a collection of questions that we all know to ask ourselves during the diagnostic process but which we sometimes forget. The basic cognitive concepts of medical decision making that were covered in the first six modules of this curriculum were integrated into the checklist to serve as reminders of the underlying concepts that apply throughout the diagnostic process.

Module 8 – Two Steps Back Checklist Part Two

  1. List three key features of a summary statement. Identify how it facilitates getting to the correct diagnosis.
  2. List three questions to consider in making a preliminary diagnosis.
  3. Describe the features of diagnostic coherence and adequacy and list a bias that they help to avoid.
  4. Define base rate neglect.

Module 9 – Two Steps Back Checklist Part Three

  1. Define causal reasoning and identify how the use of physiologic- / pathophysiologic-based reasoning can aid the diagnostic process.
  2. List the logical questions that can be used to prompt causal reasoning and identify how use of these questions can impact the differential diagnosis.

Module 10 – Two Steps Back Checklist Part Four

  1. Recognize when diagnostic testing may or not be indicated depending on the question you are trying to answer with the test.
  2. List four simple common sense questions that can be helpful in deciding if a diagnostic test is appropriate and likely to be beneficial to the patient.
  3. Understand the value of systematically utilizing these common sense, logical questions in ordering tests with a goal of improving diagnostic accuracy and cost efficiency.

Module 11 – Two Steps Back Checklist Part Five

  1. List three logical questions to consider when ordering a test to help decide if the test will answer the question that you are asking. Identify how application of these questions can improve the efficiency and effectiveness of the diagnostic process.
  2. Define sensitivity and specificity as they relate to diagnostic tests and identify how variations in these parameters can influence interpretation of test results.
  3. List patient/population characteristics that influence pretest probability of disease and identify how assessment of these characteristics can influence interpretation of test results.
  4. Define likelihood ratios and list the characteristics of positive and negative likelihood ratios that make a given diagnostic test more or less helpful in ruling in or ruling out a disease.