Types of therapeutic errors in the management of osteoporosis: Results of an experimental study

Introduction Clinical reasoning is of high importance in clinical practice and thus, also in medical education research. Regarding the clinical reasoning process the focus has primarily been on diagnostic competence and diagnostic errors, but only little research has been done on the subsequent therapeutic decision-making process, despite it is equally important. The aim of this study is to investigate the frequency of therapeutic decision errors and the cognitive factors leading to these errors in the exemplary context of osteoporosis, as this is known to be frequently associated with inadequate treatment decisions in clinical practice worldwide.

Methods In 2019, 19 medical students and – for comparison – 23 physicians worked on ten virtual cases with the medical encounter osteoporosis. A total of 254 cases were processed. The errors made in therapeutic decisions were quantitatively measured and the participants; reasons why they chose a particular treatment were qualitatively analyzed based on a modified taxonomy for diagnostic errors.

Results In 26% of cases, all treatment decisions were correct. In the other 74% of cases, multiple errors occurred; on average 3 errors per case. These 644 errors (223 physicians) were further classified regarding the cognitive nature of the error. The most common cognitive contributions causing errors were faulty context generation and interpretation (57% of students, 57% of physicians) and faulty knowledge (38% of students, 35% of physicians). Less common were errors made due to faulty metacognition (5% of students, 8% of physicians). Consequences of these errors were a false therapy (37% of cases), under-therapy (30% of cases) or over-therapy (2,5% of cases).

Discussion The study is the first to show that errors in therapy decisions can be distinguished and classified similar to the already known classification for errors in diagnostic reasoning. Not only the right diagnosis, but particularly the right therapy is decisive for the outcome of the patient.

Keywords Therapeutic errors, Clinical reasoning, diagnostic errors, medical education

Korrespondenzadresse Olivia Tausendfreund, Ludwig-Maximilians-Universität München, Daiserstraße 12, 81371 München, Deutschland, E-Mail: [e-mail]

Publication History

Article published online:
08 September 2022