Consensus Curriculum on Diagnosis

Transforming medical education

About the Project

In its seminal report, Improving Diagnosis in Health Care, the National Academy of Medicine (NAM) made eight recommendations on how to improve diagnosis. The top two recommendations focused in improving diagnosis-related education of all healthcare providers and improving teamwork in the diagnostic process.

With support from the Josiah Macy Jr. Foundation, SIDM staff and members led a three year Consensus Curriculum project to address these recommendations, with the goal of defining the key interprofessional competencies required for diagnostic quality and safety. The premise was that improving diagnosis-related education would improve the safety of diagnosis in practice (see the Driver Diagram), and that interprofessional education would familiarize providers with team-based, interprofessional practice.¹

The project involved 40+ educators (medicine, pediatrics, emergency medicine, nursing, pharmacy, laboratory medicine, radiology), students and patients. Beginning with an environmental scan, and through a series of consensus-building meetings, the group identified a set of 12 key competencies, relevant to the education of all healthcare professionals.²

The competencies are organized into three overall domains: Individual, System-Related, and Team-Based, and for each competency, there are related learning objectives, and milestones to assess learning. Access additional publications.

Graber M, Rencic J, Rusz D, et al. Improving diagnosis by improving education: A policy brief on education in healthcare professions. Diagnosis. 2018;5(3):107-118. Full text
Olson A, Rencic J, Cosby K, et al. Competencies for improving diagnosis: An interprofessional framework for education and training in healthcare. Diagnosis. 2019; Nov 26;6(4):335-341 Full text

Build Your Own Curriculum

Driver Diagram

A major conclusion was that improving education could provide an effective approach to improving diagnosis, clearly in line with the mandate from the National Academy. The driver diagram identifies 5 pathways through which education can ultimately improve the diagnostic process.

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Competencies & Learning Objectives

The project's consensus group agreed on a set of 12 key competencies to improve diagnosis. For each of the 12 competencies, key learning objectives are outlined, with extensive references to help with content development.

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Milestones for Assessing Competency

Assessing competency in each area can be facilitated by using milestones. Download the milestone rubrics to evaluate learners in each of the individual, system-based, and team-based competencies.

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multicultural students and teacher walking on street near medical university

Who's Using the Curriculum?

Learn more about the different sites engaging in the Macy Learning Collaborative and a description of their projects.

Participating Sites

University of Alabama at Birmingham
Addressing DX with clinical decision support: developing a set of online video lectures narrated by a professional narrator and will include quizzes and application exercises. Materials will focus on general and diagnostic clinical decision support (CDS) systems and use of specific resources including checklists, consultation and second opinions at the University of Alabama at Birmingham.

Lewis Katz School of Medicine at Temple University (Philadlephia, PA)
Clinical reasoning curriculum with an Intern workshop on dual process theory, problem representations and illness scripts. This will be followed by our bi-weekly clinical reasoning conferences (CPC, M/M, Journal Club, morning report, chiefs case conference) at Lewis Katz School of Medicine at Temple University, Philadelphia PA.

University of Illinois (Chicago, IL)
Faculty at the University of Illinois, Chicago (UIC) Family Nurse Practitioner (FNP) program propose to integrate the diagnostic reasoning competencies into the FNP program’s existing didactic and precepted clinical courses.

University of Utah
Plan to add individual competencies (Use decision support tools, including point-of-care resources, checklists, consultation, and second opinions to improve diagnostic accuracy and timeliness) and System-Related Competencies for Diagnosis to the graduate level “Clinical Decision Support” course and to the SOM curriculum at University of Utah.

Yale School of Medicine
Gather a group of 9-15 medical students and 3-5 faculty members to conduct a preliminary trial to assess competencies one and four through the completion of a task intended to assess the two aspects of diagnostic error explicated by these competencies: information gathering and information integration at the Yale School of Medicine.

Zucker School of Medicine at Hofstra/Northwell and the Northwell Health System
Teach the ICE and Explanatory model (ICEE) exercise to an inter-professional group of trainees and professionals. The group members will be expected to ask the questions to several of their patients and participate in a debriefing session during a regularly scheduled weekly inter-professional huddle known as “Let’s Connect” at the Zucker School of Medicine at Hofstra/Northwell and the Northwell Health system.

Baystate Medical Center/University of Massachusetts Medical School-Baystate
Baystate Medical Center and the University of Massachusetts Medical School-Baystate campus Associate Designated Institutional Official (ADIO) position: primary responsibility is to develop system-wide inter-professional clinical reasoning education. The ADIO would like to incorporate the new Diagnostic Competencies into Baystate’s plans to expand education in clinical reasoning, diagnosis, and diagnostic error.

UCSD Hillcrest Medical Center/UCSD Jacobs Medical Center/VA San Diego
A combined curriculum of 4 didactic sessions, 10-15 distributed sessions of case-based practice, spaced individual practice through an app and podcast-based assignments, and interprofessional case discussion at UCSD Hillcrest Medical Center, UCSD Jacobs Medical Center, and the VA San Diego.

Uniformed Services University of Health Sciences F. Edward Hebert School of Medicine
Project that provides first and second year medical students with a novel instructional tool, the Clinical Reasoning Mapping Exercise to help foster their ability to develop and justify their differential diagnosis by comparing and contrasting the patient’s findings and test results about both prototypical and atypical disease manifestations at Uniformed Services University of Health Sciences F. Edward Hebert School of Medicine (USU) which is located on the grounds of Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Maryland.

Froedtert & the Medical College of Wisconsin
'Pause and reflect' oral case presentation where learners (a.) present the history of present illness, followed by a pause to generate a flexible problem representation, (b.) present the physical examination, followed again by a pause to modify the original problem representation, and (c.) present data, followed by a pause to further modify the problem representation at the Froedtert & the Medical College of Wisconsin.

University of Illinois College of Medicine – Peoria (UICOMP), and OSF St. Francis Medical Center, Departments of Internal Medicine
The Diagnostic Reboot: A guided reflection tool for use with hospitalized patients who do not have a clear diagnosis after 24 hours at University of Illinois College of Medicine – Peoria (UICOMP), and OSF St. Francis Medical Center, Departments of Internal Medicine.

Emory University School of Medicine
Develop, implement, and evaluate a longitudinal spiral curriculum in clinical reasoning and diagnostic error at the Emory University School of Medicine.

Boston University School of Medicine
Plan to create a new course called Introduction to Clinical Reasoning which will run through the 1st and 2nd year pre-clinical curriculum and will consist of 80-100 course hours at Boston University School of Medicine.

Mercy Hospital and Medical Center affiliated to the University of Chicago and the University of Illinois at Chicago
The I-REASON (Improving REASONing) curriculum to promote the synergy between diagnostic accuracy and high-value care practice at Mercy Hospital and Medical Center affiliated to the University of Chicago and the University of Illinois at Chicago.

Geisinger
A developmentally appropriate diagnostic error reduction curriculum for internal medicine residents. Three sessions will be delivered over the course of internship year at Geisinger.

UMN School of Nursing
Bringing the new information and insights of the Josiah Macy/SIDM 12 competencies (2018) to some or all of multiple APRN practice specialties (AGNP, FNP, WHNP, PNP, CNM, and/or CRNA) within the UMN School of Nursing DNP program.

Campbell University in North Carolina
Developing a program that will facilitate the education of groups regarding the competencies and practice of interprofessional education. The structure of this programming would involve webinars, assigned readings, group discussions, and live programming at Campbell University in North Carolina.

Yale School of Medicine
Based on the game show “Family Feud,” this educational intervention for medical students incorporates gamification, adult learning theory, and core clinical reasoning principles to reduce diagnostic error at the Yale School of Medicine.