Improving diagnostic performance through feedback: the Diagnosis Learning Cycle

Carolina Fernandez Branson, Michelle Williams, Teresa M. Chan, Mark L. Graber, Kathleen P. Lane, Skip Grieser, Zach Landis-Lewis, James Cooke, Divvy K. Upadhyay, Shawn Mondoux, Hardeep Singh, Laura Zwaan, Charles Friedman, Andrew P.J. Olson

Research output: Contribution to journalReview articleAcademicpeer-review

17 Citations (Scopus)
27 Downloads (Pure)


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 developed a model for improving diagnostic performance through feedback using a six-step qualitative research process, including a review of existing models from within and outside of medicine, a survey, semistructured interviews with individuals working in and outside of medicine, the development of the new model, an interdisciplinary consensus meeting, and a refinement of the model. RESULTS: We applied theory and knowledge from other fields to help us conceptualise learning and comparison and translate that knowledge into an applied diagnostic context. This helped us develop a model, the Diagnosis Learning Cycle, which illustrates the need for clinicians to be given feedback about both their confidence and reasoning in a diagnosis and to be able to seamlessly compare diagnostic hypotheses and outcomes. This information would be stored in a repository to allow accessibility. Such a process would standardise diagnostic feedback and help providers learn from their practice and improve diagnostic performance. This model adds to existing models in diagnosis by including a detailed picture of diagnostic reasoning and the elements required to improve outcomes and calibration. CONCLUSION: A consistent, standard programme of feedback that includes representations of clinicians' confidence and reasoning is a common element in non-medical fields that could be applied to medicine. Adapting this approach to diagnosis in healthcare is a promising next step. This information must be stored reliably and accessed consistently. The next steps include testing the Diagnosis Learning Cycle in clinical settings.

Original languageEnglish
Pages (from-to)1002-1009
Number of pages8
JournalBMJ quality & safety
Issue number12
Publication statusPublished - 1 Dec 2021

Bibliographical note

Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


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