• Kathleen P Lane, Catherine Chia, Juan N Lessing, Julia Limes, Benji Mathews, Julie Schaefer, L Barry Seltz, Grant Turner, Brittany Wheeler, David Wooldridge, and Andrew Pj Olson.
• Department of Medicine, University of California Davis, Sacramento, California.
• J Hosp Med. 2019 Oct 1; 14 (10): 622-625.

AbstractAppropriate calibration of clinical reasoning is critical to becoming a competent physician. Lack of follow-up after transitions of care can present a barrier to calibration. This study aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. Trainees shared feedback via a structured form within their electronic health record's secure messaging system. Forms were analyzed for diagnostic changes. Surveys evaluated comfort with sharing feedback, self-efficacy in identifying and mitigating cognitive biases' negative effects, and perceived educational value of night admissions-all of which improved after implementation. Analysis of 544 forms revealed a 43.7% diagnostic change rate spanning the transition from night-shift to day-shift providers; of the changes made, 29% (12.7% of cases overall) were major changes. This study suggests that structured feedback on clinical reasoning for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.

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