Using clinical cases with diagnostic errors and malpractice claims: impact on anxiety and diagnostic performance in GP clinical reasoning education

Erroneous and malpractice claim cases reflect knowledge gaps and complex contextual factors. Incorporating such cases into clinical reasoning education (CRE) may enhance learning and diagnostic skills. However, they may also elicit anxiety among learners, potentially impacting learning. As a result, the optimal utilization of such cases in CRE remains uncertain. This study aims to investigate the effect of erroneous and malpractice claim case vignettes on anxiety and future diagnostic performance in CRE and explores possible underlying factors that may influence learning, including self-reported confidence in the final diagnosis, learners' satisfaction, and retrospective impact of the cases. In this three-phase experiment, GP residents and supervisors were randomly assigned to one of three experimental conditions: neutral (without reference to an error), erroneous (involving a diagnostic error), or malpractice claim (involving a diagnostic error along with a malpractice claim description). During the first session, participants reviewed six cases exclusively in the version of their assigned condition, with anxiety levels measured before and after. In the second session, participants solved six neutral clinical cases featuring the same diagnoses as those in the learning phase but presented in different scenarios, along with four filler cases. Diagnostic performance and self-reported confidence in the diagnosis were assessed. The third session measured learners' satisfaction and longer-term impact on the participants. Case vignettes featuring diagnostic errors or malpractice claims did not lead to increased anxiety and resulted in similar future diagnostic performance compared to neutral vignettes. Additionally, self-reported confidence, learners' satisfaction and long-term impact scores did not differ significantly between conditions. This suggests these cases can be integrated into CRE programs, offering a valuable source of diverse, context-rich examples that broaden case libraries without interfering with diagnostic performance or causing anxiety in learners.