Background:
It is important to understand knowledge about diagnostic error, such as cognitive bias and heuristics, for preventing a diagnostic error. However, it is unclear whether Japanese residents learn this knowledge. We aimed to assess diagnostic error knowledge in residents throughout Japan and compare it to the benchmark of the previous US score. In addition, we evaluated the associations among diagnostic error knowledge, learning environment and clinical knowledge in Japanese residents.
Methods:
For postgraduate year 1 and 2 (PGY-1 and 2) residents at teaching hospitals throughout Japan, we investigated the knowledge of diagnostic errors using the Diagnostic error Knowledge Assessment Test (D-KAT), which is a 13-item multiple-choice test and developed and validated by Reilly JB et al in 2010. We also provided a clinical knowledge evaluation by the General Medicine In-Training Examination (GM-ITE). The mean D-KAT scores were compered between Japan and US. In addition, we analyzed associations among D-KAT score, learning environment, and the GM-ITE score.
Results:
A total of 1,123 PGY-1 and 1,529 PGY-2 residents from 258 teaching hospitals participated in the study. The mean D-KAT score in Japanese PGY-2 residents was 6.24 ±1.67 and was significantly lower than that (8.26 ±1.45) in US PGY-2 counterparts (p<0.001). The mean D-KAT score in Japanese PGY-2 residents was greater than that (6.09 ± 1.59) in Japanese PGY-1 (p=0.018). By generalized estimation equation model, the D-KAT score were not associated with emergency department duty workload, inpatient caseload or the average daily hours for self-study. The correlation between the D-KAT and the GM-ITE scores were weak (Pearson correlation coefficient=0.18).
Conclusions:
Diagnostic Error Knowledge in Japanese residents was relatively poor compared to that in US residents. Japanese residents did not learn it through existing learning programs. Opportunity for learning diagnostic error knowledge is needed for Japanese residents.