The Misdiagnosis Tracker: Enhancing Diagnostic Reasoning Through Cognitive Bias Awareness and Error Analysis

Abstract

Introduction: Diagnostic accuracy is essential for good-quality medical practice, and yet diagnostic errors remain widespread, influencing patient outcomes, healthcare costs, and clinician confidence. "Misdiagnosis Tracker" aims to instil error analysis into medical education and shift the focus toward the learning of lessons from errors in diagnosis. This study investigates how systematic review of diagnostic errors enhances medical students' competence in diagnostic reasoning, identification of cognitive bias, and identification of atypical presentations. Methods: A cohort of 65 final-year medical students participated in a structured three-phase educational intervention comprising preparation, case study analysis, and reflection. Students examined 20 diagnostic error case studies to identify contributory factors, such as cognitive biases, atypical presentations, and systemic barriers. Quantitative data were obtained from pre- and post-study surveys assessing confidence and knowledge, while qualitative insights were gathered through group reports, reflective journals, and debriefing sessions. Results: The results indicated significant improvements in confidence in diagnostic reasoning (3.0 to 4.4, p < 0.01), awareness of cognitive bias (2.9 to 4.5, p < 0.01), and recognition of atypical presentations (3.1 to 4.6, p < 0.01). Qualitative results highlighted increased insight into red flags, systemic issues, and reflective development. Actionable recommendations made by the students were systematic diagnostic frameworks, better interprofessional communication, and focused education on cognitive bias. Conclusion: This study illustrates how the "Misdiagnosis Tracker" greatly enhances medical students' reflective and diagnostic reasoning skills and better prepares them for clinical practice. By fostering an environment of learning from diagnostic mistakes, this approach could ultimately result in fewer diagnostic errors and improved patient outcomes. Longitudinal studies are essential to determine the long-term effect of this model on clinical competence and its application in different education settings.

Keywords: atypical presentations; cognitive bias; diagnostic reasoning; medical education; misdiagnosis; reflective learning.

Figure 1

Comparison of mean pre- and post-intervention scores (Likert scale: 1 = lowest, 5 = highest) for diagnostic reasoning confidence, cognitive bias awareness, and recognition of atypical presentations. Error bars represent standard deviations, demonstrating significant increases across all categories after the educational intervention.

Figure 2

Pie chart illustrating the proportional distribution of diagnostic errors identified through analysis of 20 diagnostic error case studies. Cognitive biases (anchoring, premature closure, confirmation bias), atypical presentations, and systemic factors represent the main categories of error contributing to misdiagnosis in the study cohort.

Figure 3

Horizontal bar graph illustrating the relative frequency with which key qualitative themes were identified in students’ reflective journals. Higher frequency indicates themes that students emphasised most strongly as critical insights gained from analysing diagnostic errors during the educational intervention.