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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.

Author information

1
Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
2
Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
3
Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Japan.
4
Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan.
5
Muribushi Okinawa for Teaching Hospitals, Urasoe City, Okinawa, Japan. yasuharu.tokuda@gmail.com.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
29256086
PMCID:
PMC5880762
[Available on 2019-04-01]
DOI:
10.1007/s11606-017-4248-y

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