About
103
Publications
16,682
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,378
Citations
Introduction
Additional affiliations
May 2016 - present
October 2014 - May 2016
October 2005 - October 2014
Publications
Publications (103)
Objectives
Time pressure and time constraints have been shown to affect diagnostic accuracy, but how they interact is not clear. The current study aims to investigate the effects of both perceived time pressure (sufficient vs. insufficient time) and actual time constraints (lenient vs. restricted time limit) with regard to diagnostic accuracy.
Met...
Objectives
To investigate longitudinal trends in the incidence, preventability, and causes of DAEs (diagnostic adverse events) between 2008 and 2019 and compare DAEs to other AE (adverse event) types.
Methods
This study investigated longitudinal trends of DAEs using combined data from four large Dutch AE record review studies. The original four AE...
Introduction
Diagnostic errors are often attributed to erroneous selection and interpretation of patients' clinical information, due to either cognitive biases or knowledge deficits. However, whether the selection or processing of clinical information differs between correct and incorrect diagnoses in written clinical cases remains unclear. We hypo...
Diagnostic errors comprise the leading threat to patient safety in healthcare today. Learning how to extract the lessons from cases where diagnosis succeeds or fails is a promising approach to improve diagnostic safety going forward. We present up-to-date and authoritative guidance on how the existing approaches to conducting root cause analyses (R...
Crowdsourcing a solution to an open-ended question often results in a wide range of answers. A challenge then is to identify the correct or most accurate answer. We propose a simple strategy: select the answer of the person who responded fastest. Using answers of TV game show contestants to quiz questions and diagnoses of physicians assessing a ser...
Objectives
Diagnostic errors contribute substantially to preventable medical errors. Especially, the emergency department (ED) is a high-risk environment. Previous research showed that in 15%–30% of the ED patients, there is a difference between the primary diagnosis assigned by the emergency physician and the discharge diagnosis. This study aimed...
Introduction
Shared decision-making (SDM) is considered the preferred communication model for medical decisions under conditions of uncertainty, yet it is not commonly used in the diagnostic process. Our aim is to analyze diagnostic malpractice claims and to consider diagnostic decision types where SDM may be of value.
Methods
A retrospective obse...
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...
Background
Formulating a thoughtful problem representation (PR) is fundamental to sound clinical reasoning and an essential component of medical education. Aside from basic structural recommendations, little consensus exists on what characterizes high‐quality PRs.
Objectives
To elucidate characteristics that distinguish PRs created by experts and...
Background
Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role...
Diagnostic 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 poorl...
Background
Diagnostic errors in internal medicine are common. While cognitive errors have previously been identified to be the most common contributor to errors, very little is known about errors in specific fields of internal medicine such as endocrinology. This prospective, multicenter study focused on better understanding the causes of diagnosti...
Objectives
Diagnostic errors, that is, missed, delayed, or wrong diagnoses, are a common type of medical errors and preventable iatrogenic harm. Errors in the laboratory testing process can lead to diagnostic errors. This retrospective analysis of voluntary incident reports aimed to investigate the nature, causes, and clinical impact of errors, inc...
Purpose
Diagnostic errors are a large burden on patient safety and improving clinical reasoning (CR) education could contribute to reducing these errors. To this end, calls have been made to implement CR training as early as the first year of medical school. However, much is still unknown about pre-clerkship students’ reasoning processes. The curre...
Introduction
Although diagnostic errors have gained renewed focus within the patient safety domain, measuring them remains a challenge. They are often measured using methods that lack information on decision-making processes given by involved physicians (eg, record reviews). The current study analyses serious adverse event (SAE) reports from Dutch...
Purpose:
Deliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty.
Method:
One-hundred-nineteen medical students solved cases either with del...
Background
Using malpractice claims cases as vignettes is a promising approach for improving clinical reasoning education (CRE), as malpractice claims can provide a variety of content- and context-rich examples. However, the effect on learning of adding information about a malpractice claim, which may evoke a deeper emotional response, is not yet c...
Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical inter...
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:...
Introduction
Computerised diagnostic decision support systems (CDDS) suggesting differential diagnoses to physicians aim to improve clinical reasoning and diagnostic quality. However, controlled clinical trials investigating their effectiveness and safety are absent and the consequences of its use in clinical practice are unknown. We aim to investi...
Diagnostic reasoning is an important topic in General Practitioners' (GPs) vocational training. Interestingly, research has paid little attention to the content of the cases used in clinical reasoning education. Malpractice claims of diagnostic errors represent cases that impact patients and that reflect potential knowledge gaps and contextual fact...
Objectives
Checklists that aim to support clinicians’ diagnostic reasoning processes are often recommended to prevent diagnostic errors. Evidence on checklist effectiveness is mixed and seems to depend on checklist type, case difficulty, and participants’ expertise. Existing studies primarily use abnormal cases, leaving it unclear how the diagnosis...
Diagnostic performance is uniquely challenging to measure, and providing feedback on diagnostic performance to catalyze diagnostic recalibration remains the exception to the rule in healthcare. Diagnostic accuracy, timeliness, and explanation to the patient are essential dimensions of diagnostic performance that each intersect with a variety of tec...
We describe deliberate practice and formative feedback of clinical reasoning skill development in medical students.
Background
Preventable diagnostic errors are a large burden on healthcare. Cognitive reasoning tools, that is, tools that aim to improve clinical reasoning, are commonly suggested interventions. However, quantitative estimates of tool effectiveness have been aggregated over both workplace-oriented and educational-oriented tools, leaving the impact...
Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice reside...
As big data becomes more publicly accessible, artificial intelligence (AI) is increasingly available and applicable to problems around clinical decision‐making. Yet the adoption of AI technology in healthcare lags well behind other industries. The gap between what technology could do, and what technology is actually being used for is rapidly wideni...
Problem:
Clinical reasoning is a core competency for physicians but also a common source of errors, driving high rates of misdiagnoses and patient harm. Efforts to provide training in and assessment of clinical reasoning skills have proven challenging because they are either labor and resource prohibitive or lack important data relevant to clinica...
Introduction:
Human error plays a vital role in diagnostic errors in the emergency department. A thorough analysis of these human errors, using information-rich reports of serious adverse events (SAEs), could help to better study and understand the causes of these errors and formulate more specific recommendations.
Methods:
We studied 23 SAE rep...
Background
Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians’ diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when referring a patient to secondary care. However, it remains unc...
When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate diagnostic calibration , diagnostic errors or overtesting can occur. A previous study showed that physicians’ diagnostic calibration for easy cases improved, after they received feedback on their previous diagnoses. We investigated whether diagnostic calibrati...
Background
Errors in reasoning are a common cause of diagnostic error. However, it is difficult to improve performance partly because providers receive little feedback on diagnostic performance. Examining means of providing consistent feedback and enabling continuous improvement may provide novel insights for diagnostic performance.
Methods
We dev...
It was recently shown that novice medical students could be trained to demonstrate the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. However, the effectiveness of this training can only be fully evaluated when considering the extent to which knowledge transfer and long-term retention occur as a result, the former of...
Jaap de Waard BSc coassistent en geneeskunde student aan het Erasmus MC, Rotterdam Charlotte van Sassen MD huisarts, docent huisarts geneeskunde en promovenda aan het Erasmus MC, Rotterdam dr. Maarten van Aken internistendocrinoloog, afdeling Interne Geneeskunde, Haga Ziekenhuis, Den Haag TUCHTRECHTSPRAAK Van tuchtzaken valt veel te leren SYSTEMATI...
Background
Diagnostic errors have been attributed to cognitive biases (reasoning shortcuts), which are thought to result from fast reasoning. Suggested solutions include slowing down the reasoning process. However, slower reasoning is not necessarily more accurate than faster reasoning. In this study, we studied the relationship between time to dia...
Background
Diagnostic errors are a major source of preventable harm but the science of reducing them remains underdeveloped.
Objective
To identify and prioritize research questions to advance the field of diagnostic safety in the next 5 years.
Participants
Ninety-seven researchers and 42 stakeholders were involved in the identification of the res...
Background
Although several interventions have been implemented successfully, handoff remains a vulnerable process because it relies on human memory. The aim of this study was to investigate the effect of deliberate cognitive processing (analytical, conscious, and effortful thinking) on recall of information.
Methods
Pediatric residents participat...
Background:
Bias in reasoning rather than knowledge gaps has been identified as the origin of most diagnostic errors. However, the role of knowledge in counteracting bias is unclear.
Objective:
To examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias.
Design...
Purpose
Flaws in physicians’ reasoning frequently result in diagnostic errors. The method of deliberate reflection was developed to stimulate physicians to deliberately reflect upon cases, which has shown to improve diagnostic performance in complex cases. In the current randomised controlled trial, we investigated whether deliberate reflection can...
Background
Diagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions to ‘immunise’ physicians against bias have focused on improving reasoning processes and have largely failed.
Objective
To investigate the effect of increasing physicians’ relevant knowledge on their susceptibility to availability bias.
Design...
Purpose:
Diagnostic errors have been attributed to failure to sufficiently reflect on initial diagnoses. However, evidence of the benefits of reflection is conflicting. This study examined whether reflection upon initial diagnoses on difficult cases improved diagnostic accuracy and whether reflection triggered by confrontation with case evidence w...
Background
Diagnostic errors occur frequently, especially in the emergency room. Estimates about the consequences of diagnostic error vary widely and little is known about the factors predicting error. Our objectives thus was to determine the rate of discrepancy between diagnoses at hospital admission and discharge in patients presenting through th...
There is an ongoing debate regarding the cause of diagnostic errors. One view is that errors result from unconscious application of cognitive heuristics; the alternative is that errors are a consequence of knowledge deficits. The objective of this study was to compare the effectiveness of checklists that (a) identify and address cognitive biases or...
Due to an unfortunate turn of events, Fig. 3 was omitted from the original publication.
Purpose
The objective of this study was to determine the extent to which the dual‐process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored whether neurological correlates of system‐2 thinking could be located in the brain. It was hypothesised that system‐2 thinking could be observed as the activation of th...
Purpose: Diagnostic reasoning literature debates the significance of “dual-process theory” and the importance of its constituent types of thinking: System-1and System-2. This experimental study aimed to determine whether novice medical students could be trained to utilize System-1 thinking when making diagnoses based on chest X-rays.
Method: Second...
De afgelopen jaren is de potentieel vermijdbare sterfte in ziekenhuizen niet verder gedaald. Tussen half 2015 en half 2016 overleden circa 1.035 patiënten door zorggerelateerde schade die waarschijnlijk voorkomen had kunnen worden. Eerder was deze potentieel vermijdbare sterfte in ziekenhuizen sterk gedaald, onder andere door de invoering van het V...
Background: Diagnostic errors occur frequently in daily clinical practice and put patients’ safety at risk. There is an urgent need to improve education on clinical reasoning to reduce diagnostic errors. However, little is known about diagnostic errors of medical students. In this study, the nature of the causes of diagnostic errors made by medical...
Background
Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, th...
Purpose: Clinical reasoning forms the interface between medical knowledge and medical practice. However, it is not clear how to organize education to foster the development of clinical reasoning. This study compared two strategies to teach clinical reasoning. Method: As part of a regular clinical reasoning course 333 students participated in a two-...
Diagnostic errors in radiology are frequent and can cause severe patient harm. Despite large performance differences between radiologists and non-radiology physicians, the latter often interpret medical images because electronic health records make images available throughout the hospital. Some people argue that non-radiologists should not diagnose...
Objectives:
Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with stage I non-small cell lung cancer (NSCLC). Shared decision making (SDM) has been advocated in this patient group. This study explored clinician decision making in relation to the stated treatment preferences of patients.
Method...
Objectives To minimise adverse events in healthcare, various large-scale incident reporting and learning systems have been developed worldwide. Nevertheless, learning from patient safety incidents is going slowly. Local, unit-based reporting systems can help to get faster and more detailed insight into unit-specific safety issues. The aim of our st...
Background
Non-technical skills (NTS) such as leadership and team work are important in providing good quality of care. One system to assess physicians’ NTS is the Anesthesiologists’ Non-Technical Skills (ANTS) system. The present study evaluates the ANTS system on the interrater reliability and usability for research purposes. Methods
Ten anesthes...
Background Many authors have implicated cognitive biases as a primary cause of diagnostic error. If this is so, then physicians already familiar with common cognitive biases should consistently identify biases present in a clinical workup. The aim of this paper is to determine whether physicians agree on the presence or absence of particular biases...
Surgery is the standard of care in stage I non-small cell lung cancer (NSCLC), but stereotactic ablative radiotherapy (SABR) is increasingly used to treat patients at high-risk for surgical complications. We studied which patient- and clinician-related characteristics influenced treatment recommendations.
A binary choice experiment with hypothetica...
Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In...
Diagnostic errors in medicine occur frequently and the consequences for the patient can be severe. Cognitive errors as well as system related errors contribute to the occurrence of diagnostic error, but it is generally accepted that cognitive errors are the main contributor. The diagnostic reasoning process in medicine, is an understudied area of r...
Purpose: The aim of this study was to investigate what treatment options thoracic oncologists of different specialties choose for different patient cases, and how these decisions are influenced by several patient characteristics and patient's treatment preference.
Methods: A conjoint analysis study was carried out among pulmonologists, surgeons a...
Cardiopulmonary resuscitation is perceived as a stressful task. Additional external distractors, such as noise and bystanders, may interfere with crucial tasks and might adversely influence patient outcome. We investigated the effects of external distractors on resuscitation performance of anaesthesia residents and consultants with different levels...
Over the last 50 years diagnostic testing has improved dramatically and we are now able to diagnose patients faster and more precisely than ever before. However, the incidence of diagnostic errors, particularly of common diseases, has remained relatively stable over time. In this paper, I argue that the intrinsic limitations of human information pr...
Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diag...
