SHM Converge Scientific Abstract ePoster Gallery-A Novel Tool for Diagnostic Reflection and Calibration

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The DRAFTing in the Moonlight project introduced the DRAFT tool, a structured method for diagnostic reflection and calibration used by second-year residents on night float. Residents voluntarily tracked three admissions per night by recording their working diagnosis and confidence at admission, then revisited the chart 72 hours later to note any diagnostic changes. Investigators reviewed cases and classified changes as no change, diagnostic refinement, disease evolution, or major change. Nocturnists were available to support discussion and reflection.<br /><br />The rationale was that tracking patient outcomes can improve diagnostic reasoning by giving clinicians feedback and helping them calibrate confidence, but residents do not consistently do this in practice. The pilot aimed to assess residents’ attitudes and diagnostic practices before and after participation, and to examine whether confidence aligned with later diagnostic change.<br /><br />Results showed a notable calibration gap: 6.5% of high-confidence cases had a major diagnostic change, while 35% of low-confidence cases had no change. Pre-intervention surveys suggested most residents felt only somewhat or not at all confident in their diagnostic accuracy. Although many already tracked outcomes, this was usually limited to memorable or “interesting” cases, and a major barrier was the lack of a reliable tracking system.<br /><br />Future plans include integrating DRAFT into the electronic medical record, creating an EMR dashboard to prompt 72-hour reflection, incorporating patient identity factors that may affect diagnostic accuracy and bias, improving communication among admitting clinicians, and making structured diagnostic reflection a required part of residency training.

Asset Subtitle

Catherine E. Glatz

Meta Tag

Author List Brendan W. Robinson, Catherine E. Glatz, Christopher J. Mooney, Ellie Garbade, Jennifer K. Readlynn, Michael Rothberg, Valerie J. Lang

Category Innovations

Concept Drafting

Concept Diagnostic Reflection

Concept Calibration

Concept Diagnostic Change

Concept Diagnostic Accuracy

Distinguished Non-Finalist

Presenter Organization University of Rochester

Presenting Author Catherine E. Glatz

Track Education

Keywords

diagnostic reflection

resident training

night float

confidence calibration

working diagnosis

diagnostic change

electronic medical record

outcome tracking

diagnostic reasoning

EMR dashboard

Drafting

Diagnostic Reflection

Calibration

Diagnostic Change

Diagnostic Accuracy