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J Gen Intern Med. 2018 Apr;33(4):445-448. doi: 10.1007/s11606-017-4248-y. Epub 2017 Dec 18.

Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study.

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Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Japan.
Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan.
Muribushi Okinawa for Teaching Hospitals, Urasoe City, Okinawa, Japan.



Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience.


Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores.


The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p < 0.001). GM-ITE scores correlated with ED rotations (≥6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p < 0.001), and average daily minutes of self-study (≥91 min: 2.05; 0.56-3.53; p = 0.01). SEM revealed that D-KAT scores were directly associated with GM-ITE scores (ß = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations (ß = 0.06, 95% CI: 0.02-0.10), inpatient caseload (ß = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study (ß = 0.13, 95% CI: 0.09-0.17).


Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.


Diagnostic Error Knowledge Assessment Test (D-KAT); General Medicine In-Training Examination (GM-ITE); postgraduate education

[Available on 2019-04-01]

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