Learning from diagnostic errors and malpractice claims: Enhancing clinical reasoning education in general practitioner training

Diagnostic errors—missed, delayed, or miscommunicated diagnoses—are a leading cause of preventable patient harm and malpractice claims, especially in general practice where clinical uncertainty is high. These errors arise from a complex interplay of cognitive, contextual, and systemic factors, yet are often underrepresented in medical education. This thesis explores whether clinical reasoning education can be improved by using real-world examples of diagnostic errors and malpractice claims, and how such cases might best be integrated into the curriculum without negatively affecting learning outcomes.
Through five empirical studies, the thesis investigates: (1) how malpractice databases can inform the content of the clinical reasoning curriculum, (2) how the framing of cases (neutral, erroneous, or malpractice-linked) influences diagnostic accuracy, emotional response, and memory, and (3) how outcome bias affects the nature and tone of feedback on clinical reasoning. Across multiple experiments with GP residents and supervisors, malpractice cases proved equally effective—and acceptable—for clinical learning, without increasing anxiety or impairing diagnostic performance. However, case framing did shape what learners remembered, suggesting that emotionally salient details from malpractice scenarios may enrich learners’ illness scripts and promote diagnostic vigilance.
The findings support the structured integration of real-world diagnostic errors into advanced clinical reasoning education, balancing typical cases with atypical, complex scenarios. While the emotional impact of malpractice cases appears manageable, thoughtful feedback strategies and case framing remain essential. By learning from mistakes—especially those that have real consequences—medical trainees can develop the reflective capacity and --adaptive expertise needed to reduce diagnostic errors and improve patient safety.