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Original article
peer-reviewed

Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty



Abstract

Introduction

Diagnostic uncertainty is common in healthcare encounters. Effective communication is important to help patients and providers navigate diagnostic uncertainty, especially at transitions of care. This study sought to assess the experience and training of emergency medicine (EM) residents with communication of diagnostic uncertainty.

Methods

This was a survey study of a national sample of EM residents. The survey questions elicited quantitative and qualitative responses about experiences with and educational preparation for communication with patients in the setting of diagnostic uncertainty.

Results

A sample of 263 emergency medicine residents who had trained at over 87 medical schools and 37 residency programs responded to the survey. Nearly half of participants noted they frequently encountered challenges with these conversations;  63% reported having been “somewhat” or less trained to have these conversations during residency, and 51% expressed a strong desire for more training in how to approach these discussions. Survey respondents reported that prior educational experiences in the communication of diagnostic uncertainty were largely informal and that many residents experience frustration in clinical encounters due to inability to meet patients’ expectations of reaching a diagnosis at the time of discharge.

Conclusion

This study found that emergency medicine residents frequently struggle in communicating with patients when there is diagnostic uncertainty upon emergency department discharge and perceived the need for training in how to communicate in these situations. The development of targeted educational strategies for improving communication in the setting of diagnostic uncertainty is consistent with emergency medicine core competencies and may improve patient and provider satisfaction with these clinical encounters.



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Original article
peer-reviewed

Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty


Author Information

Kristin L. Rising

Department of Emergency Medicine, Thomas Jefferson University

Dimitrios Papanagnou Corresponding Author

Department of Emergency Medicine, Thomas Jefferson University

Danielle McCarthy

Department of Emergency Medicine, Northwestern University Feinberg School of Medicine

Alexzandra Gentsch

Department of Emergency Medicine, Thomas Jefferson University

Rhea Powell

Department of Medicine, Thomas Jefferson University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of Thomas Jefferson University issued approval 16E.484. The study was reviewed by the Institutional Review Board (IRB) of the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania. After IRB review, the study was deemed compliant with all ethical requirements, and was granted approval by the Board.

All participants who completed the electronic survey did so anonymously; no identifying information was collected. Please note that the study did not involve animal or human tissue.
. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty


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Original article
peer-reviewed

Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty

  • Author Information
    Kristin L. Rising

    Department of Emergency Medicine, Thomas Jefferson University

    Dimitrios Papanagnou Corresponding Author

    Department of Emergency Medicine, Thomas Jefferson University

    Danielle McCarthy

    Department of Emergency Medicine, Northwestern University Feinberg School of Medicine

    Alexzandra Gentsch

    Department of Emergency Medicine, Thomas Jefferson University

    Rhea Powell

    Department of Medicine, Thomas Jefferson University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of Thomas Jefferson University issued approval 16E.484. The study was reviewed by the Institutional Review Board (IRB) of the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania. After IRB review, the study was deemed compliant with all ethical requirements, and was granted approval by the Board.

    All participants who completed the electronic survey did so anonymously; no identifying information was collected. Please note that the study did not involve animal or human tissue.
    . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 19, 2018

    DOI

    10.7759/cureus.2088

    Cite this article as:

    Rising K L, Papanagnou D, Mccarthy D, et al. (January 19, 2018) Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty. Cureus 10(1): e2088. doi:10.7759/cureus.2088

    Publication history

    Received by Cureus: January 05, 2018
    Peer review began: January 10, 2018
    Peer review concluded: January 15, 2018
    Published: January 19, 2018

    Copyright

    © Copyright 2018
    Rising et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

Diagnostic uncertainty is common in healthcare encounters. Effective communication is important to help patients and providers navigate diagnostic uncertainty, especially at transitions of care. This study sought to assess the experience and training of emergency medicine (EM) residents with communication of diagnostic uncertainty.

Methods

This was a survey study of a national sample of EM residents. The survey questions elicited quantitative and qualitative responses about experiences with and educational preparation for communication with patients in the setting of diagnostic uncertainty.

Results

A sample of 263 emergency medicine residents who had trained at over 87 medical schools and 37 residency programs responded to the survey. Nearly half of participants noted they frequently encountered challenges with these conversations;  63% reported having been “somewhat” or less trained to have these conversations during residency, and 51% expressed a strong desire for more training in how to approach these discussions. Survey respondents reported that prior educational experiences in the communication of diagnostic uncertainty were largely informal and that many residents experience frustration in clinical encounters due to inability to meet patients’ expectations of reaching a diagnosis at the time of discharge.

Conclusion

This study found that emergency medicine residents frequently struggle in communicating with patients when there is diagnostic uncertainty upon emergency department discharge and perceived the need for training in how to communicate in these situations. The development of targeted educational strategies for improving communication in the setting of diagnostic uncertainty is consistent with emergency medicine core competencies and may improve patient and provider satisfaction with these clinical encounters.



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