• Susrutha Kotwal, Mason Howell, Laura Zwaan, and Scott M Wright.
• Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Skotwal1@jhmi.edu.
• J Gen Intern Med. 2024 Jun 1; 39 (8): 138613921386-1392.

BackgroundDiagnostic errors cause significant patient harm. The clinician's ultimate goal is to achieve diagnostic excellence in order to serve patients safely. This can be accomplished by learning from both errors and successes in patient care. However, the extent to which clinicians grow and navigate diagnostic errors and successes in patient care is poorly understood. Clinically experienced hospitalists, who have cared for numerous acutely ill patients, should have great insights from their successes and mistakes to inform others striving for excellence in patient care.ObjectiveTo identify and characterize clinical lessons learned by experienced hospitalists from diagnostic errors and successes.DesignA semi-structured interview guide was used to collect qualitative data from hospitalists at five independently administered hospitals in the Mid-Atlantic area from February to June 2022.Participants12 academic and 12 community-based hospitalists with ≥ 5 years of clinical experience.ApproachA constructivist qualitative approach was used and "reflexive thematic analysis" of interview transcripts was conducted to identify themes and patterns of meaning across the dataset.ResultsFive themes were generated from the data based on clinical lessons learned by hospitalists from diagnostic errors and successes. The ideas included appreciating excellence in clinical reasoning as a core skill, connecting with patients and other members of the health care team to be able to tap into their insights, reflecting on the diagnostic process, committing to growth, and prioritizing self-care.ConclusionsThe study identifies key lessons learned from the errors and successes encountered in patient care by clinically experienced hospitalists. These findings may prove helpful for individuals and groups that are authentically committed to moving along the continuum from diagnostic competence towards excellence.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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