Clinical Diagnostic Reasoning

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Abstract
Bowen's review of educational strategies that can be used to promote clinical diagnostic reasoning (Nov. 23 issue)1 does not sufficiently emphasize the concept of premature closure. Acceptance of a diagnosis before sufficient verification has occurred and failure to consider plausible alternatives once a diagnosis has been reached2,3 are common causes of diagnostic error and can occur at any level of training.3,4 One possible effect of anchoring — the inability to assimilate subsequent or evolving data — is a particularly important contributing factor in premature closure and may lead to faulty synthesis of information.5 The risk of premature closure may be greatest when learners are pressed for time or expected to have a level of expertise they have not yet attained. Premature closure may be just as likely to result from an “unlucky” adherence to an illness script as from gaps in knowledge. Clinical educators should encourage learners to continuously integrate new information into the decision-making process.

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