Evidence map›Paper›PMID 39899205›Full record

Trial reportAdvances in health sciences education : theory and practice2025

Using clinical cases with diagnostic errors and malpractice claims: impact on anxiety and diagnostic performance in GP clinical reasoning education.

Charlotte van Sassen, Silvia Mamede, Jacky Hooftman, Walter van den Broek, Patrick Bindels, Laura Zwaan

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Advances in health sciences education : theory and practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Charlotte van SassenDepartment of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. c.vansassen@erasmusmc.nl.
Silvia MamedeInstitute of Medical Education Research Rotterdam (iMERR), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jacky HooftmanInstitute of Medical Education Research Rotterdam (iMERR), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Walter van den BroekInstitute of Medical Education Research Rotterdam (iMERR), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Patrick BindelsDepartment of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Laura ZwaanInstitute of Medical Education Research Rotterdam (iMERR), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Funding

ZonMw 839130012
6 · The paper itself

Abstract

Erroneous and malpractice claim cases reflect knowledge gaps and complex contextual factors. Incorporating such cases into clinical reasoning education (CRE) may enhance learning and diagnostic skills. However, they may also elicit anxiety among learners, potentially impacting learning. As a result, the optimal utilization of such cases in CRE remains uncertain. This study aims to investigate the effect of erroneous and malpractice claim case vignettes on anxiety and future diagnostic performance in CRE and explores possible underlying factors that may influence learning, including self-reported confidence in the final diagnosis, learners' satisfaction, and retrospective impact of the cases. In this three-phase experiment, GP residents and supervisors were randomly assigned to one of three experimental conditions: neutral (without reference to an error), erroneous (involving a diagnostic error), or malpractice claim (involving a diagnostic error along with a malpractice claim description). During the first session, participants reviewed six cases exclusively in the version of their assigned condition, with anxiety levels measured before and after. In the second session, participants solved six neutral clinical cases featuring the same diagnoses as those in the learning phase but presented in different scenarios, along with four filler cases. Diagnostic performance and self-reported confidence in the diagnosis were assessed. The third session measured learners' satisfaction and longer-term impact on the participants. Case vignettes featuring diagnostic errors or malpractice claims did not lead to increased anxiety and resulted in similar future diagnostic performance compared to neutral vignettes. Additionally, self-reported confidence, learners' satisfaction and long-term impact scores did not differ significantly between conditions. This suggests these cases can be integrated into CRE programs, offering a valuable source of diverse, context-rich examples that broaden case libraries without interfering with diagnostic performance or causing anxiety in learners.

Indexed as

AnxietyClinical ReasoningDiagnostic ErrorsMalpracticeAdultClinical CompetenceFemaleHumansInternship and ResidencyMaleClinical reasoning educationDiagnostic errorsDiagnostic performanceEmotionsMalpractice claimPrimary care

Identifiers

PMID39899205
PMCPMC12572042

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.