EB: What is the purpose of the grant program on diagnostic excellence that was launched by the Council of Medical Specialty Societies (CMSS) with support from the Gordon and Betty Moore Foundation?

ML: CMSS received a grant from the Gordon and Betty Moore Foundation to promote diagnostic excellence across the field of medicine. With that funding, CMSS solicited applications from its member societies and awarded 10 grants in the amount of $100,000 each to support the development and dissemination of resources and programs on diagnostic excellence by specialty societies.

EB: What are the specific aims of the grant that was awarded to SGIM?

CG: In October 2022, CMSS awarded funding to SGIM for a project entitled “Crowdsourcing to Develop an Educational Intervention on the Diagnostic Process: Special Emphasis on Mitigating Racial Disparities in Diagnosis.” The specific aims of the project are to: 1) identify physician behaviors in a simulated patient encounter that lead to disparities in the diagnostic process and diagnostic errors and crowd source solutions to improve those behaviors; 2) explore lay community members’ perspectives of simulations and suggestions for instruction; and 3) develop and pilot a curriculum in equity in diagnostic excellence.

EB: How do you plan to achieve the aims of the project?

CG: To address aim 1, we chose a clinically ambiguous presentation of epigastric pain, nausea, and vomiting as the presentation of a standardized patient due to robust evidence for racial disparities in various disease processes that could precipitate that clinical presentation, as well as the clinical ambiguity itself presenting a diagnostic challenge.1 We will seek perspectives of physicians across the spectrum of training and practice to inform our educational innovation. To address aim 2, we will ask community members to observe selected simulations and offer their perspectives on how they view such behaviors. We will use focus groups to explore community members’ perspectives on the diagnostic process and solicit their suggestions for improving physician behaviors. To address aim 3, we will use what we learn from aims 1 and 2 to develop a curriculum and pilot it with SGIM members at SGIM’s regional meetings in 2023 and the national meeting in 2024.

EB: How do you plan to engage SGIM members in the project?

ML: In the first quarter of the project, we recruited Erika Baker as the program manager for this research and a core team of six SGIM members (Hadeel Alkhairw, MD; Eliana Bonifacino, MD, MS; Michael Fischer, MD, MS; Megha Garg, MD, MPH; Rita Lee, MD; and Eloho Ufomata, MD, MS) representing SGIM’s Health Equity Commission, Academic Hospitalist Commission, Clinical Practice Committee, Education Committee, Research Committee, Health Policy Committee, and Clinical Reasoning Interest Group. In the second quarter of the project, we will have oriented and trained the core team to review recorded simulated encounters to find representations of diagnostic error and diagnostic excellence, to inform the survey instrument we develop for the crowdsourcing. We have initiated conversations with SGIM’s Board of Regional Leaders to determine how we can incorporate our work and findings into upcoming regional meetings to engage even more members. We will also create a platform for crowdsourcing information from novices through clinical experts about the behaviors that promote diagnostic excellence and mitigate racial disparities in diagnostic decision making.

EB: What are your aspirations for the long-term success of the project?

CG: Ultimately, we hope the curriculum we create will become a valuable educational asset that can be used by members of SGIM and other medical specialty societies to improve training in the diagnostic process and reduce racial and ethnic bias in diagnostic decision making. Thus, we see the project as a great opportunity to advance SGIM ‘s vision for a just system of care in which all people can achieve optimal health.

References

  1. Burgess DJ. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med Decis Making. 2010; 30(2): 246-57. DOI:10.1177/0272989X09341751. Epub 2009 Sep 2.

Issue

Topic

Health Equity, Health Policy & Advocacy, Medical Education, SGIM

Author Descriptions

Dr. Bass (basse@sgim.org) is the CEO of SGIM. Dr. Gonzalez (Cristina.Gonzalez@nyulangone.org) and Dr. Lypson (mll2215@cumc.columbia.edu) are the principal investigators of the project.

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