Pediatric clinician perspectives on communicating diagnostic uncertainty.

OBJECTIVE: Diagnosis often evolves over time, involves uncertainty, and is vulnerable to errors. We examined pediatric clinicians' perspectives on communicating diagnostic uncertainty to patients' parents and how this occurs. DESIGN: We conducted semi-structured interviews, which were audiotaped, transcribed, and analyzed using content analysis. Two researchers independently coded transcripts and then discussed discrepancies to reach consensus. SETTING: A purposive sample of pediatric clinicians at two large academic medical institutions in Texas. PARTICIPANTS: Twenty pediatric clinicians participated: 18 physicians, 2 nurse practitioners; 7 males, 13 females; 7 inpatient, 11 outpatient, and 2 practicing in mixed settings; with 0-16 years' experience post-residency. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pediatric clinician perspectives on communication of diagnostic uncertainty. RESULTS: Pediatric clinicians commonly experienced diagnostic uncertainty and most were comfortable seeking help and discussing with colleagues. However, when communicating uncertainty to parents, clinicians used multiple considerations to adjust the degree to which they communicated. Considerations included parent characteristics (education, socioeconomic status, emotional response, and culture) and strength of parent-clinician relationships. Communication content included setting expectations, explaining the diagnostic process, discussing most relevant differentials, and providing reassurance. Responses to certain parent characteristics, however, were variable. For example, some clinicians were more open to discussing diagnostic uncertainty with more educated parents- others were less. CONCLUSIONS: While pediatric clinicians are comfortable discussing diagnostic uncertainty with colleagues, how they communicate uncertainty to parents appears variable. Parent characteristics and parent-clinician relationships affect extent of communication and content discussed. Development and implementation of optimal strategies for managing and communicating diagnostic uncertainty can improve the diagnostic process.

Preparing for the changing role of instructional technologies in medical education.

As part of an international faculty development conference in February 2010, a working group of medical educators and physicians discussed the changing role of instructional technologies and made recommendations for supporting faculty in using these technologies in medical education. The resulting discussion highlighted ways technology is transforming the entire process of medical education and identified several converging trends that have implications for how medical educators might prepare for the next decade. These trends include the explosion of new information; all information, including both health knowledge and medical records, becoming digital; a new generation of learners; the emergence of new instructional technologies; and the accelerating rate of change, especially related to technology. The working group developed five recommendations that academic health leaders and policy makers may use as a starting point for dealing with the instructional technology challenges facing medical education over the next decade. These recommendations are (1) using technology to provide/support experiences for learners that are not otherwise possible-not as a replacement for, but as a supplement to, face-to-face experiences, (2) focusing on fundamental principles of teaching and learning rather than learning specific technologies in isolation, (3) allocating a variety of resources to support the appropriate use of instructional technologies, (4) supporting faculty members as they adopt new technologies, and (5) providing funding and leadership to enhance electronic infrastructure to facilitate sharing of resources and instructional ideas.