The Impact of Diagnostic Errors and Malpractice Claims on Anxiety and Diagnostic Accuracy in Clinical Reasoning Education of General Practitioners

Abstract Purpose Erroneous and malpractice claim cases reflect knowledge gaps and complex contextual factors. Incorporating such cases into clinical reasoning education (CRE) can enhance learning and diagnostic skills. However, they may also elicit anxiety among learners, potentially hindering 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 diagnostic accuracy and anxiety in CRE, compared to neutral cases. Methods 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 solved six cases exclusively in the version of their assigned condition, with anxiety levels measured before and after. In the second session, they solved six different cases with identical diagnoses, along with four fillers, allowing to compare diagnostic accuracy and confidence between case versions. The third session measured the longer-term impact on the participants. Results There were no significant differences in anxiety levels and diagnostic accuracy scores between the conditions. Additionally, the long-term impact scores did not differ significantly between conditions. Conclusion Case vignettes with an error or malpractice claim were as effective as neutral case vignettes, yielding similar diagnostic accuracy and without inducing more anxiety. This suggests these cases can be integrated into CRE programs, offering a valuable source of diverse, context-rich examples without causing anxiety in learners.