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.

Background: Most people experience a diagnostic error at least once in their lifetime. Patients' experiences with their diagnosis could provide important insights when setting research priorities to reduce diagnostic error. Objective: Our objective was to engage patients in research agenda setting for improving diagnosis. Patient involvement: Patients were involved in generating, discussing, prioritizing, and ranking of research questions for diagnostic error reduction. Methods: We used the prioritization methodology based on the Child Health and Nutrition Research Initiative (CHNRI). We first solicited research questions important for diagnostic error reduction from a large group of patients. Thirty questions were initially prioritized at an in-person meeting with 8 patients who were supported by 4 researchers. The resulting list was further prioritized by patients who scored questions on five predefined criteria. We then applied previously determined weights to these prioritization criteria to adjust the final prioritization score for each question, resulting in 10 highest priority research questions. Results: Forty-one patients submitted 171 research questions. After prioritization, the highest priority topics included better care coordination across the diagnostic continuum and improving care transitions, improved identification and measurement of diagnostic errors and attention for implicit bias towards patients who are vulnerable to diagnostic errors. Discussion: We systematically identified the top-10 patient generated research priorities for diagnostic error reduction using transparent and objective methods. Patients prioritized different research questions than researchers and therefore complemented an agenda previously generated by researchers. Practical value: Research priorities identified by patients can be used by funders and researchers to conduct future research focused on reducing diagnostic errors. Funding: This project was funded by the Gordon and Betty Moore Foundation.