SHM Converge Scientific Abstract ePoster Gallery-iDISCERN, a DIGITAL DIAGNOSTIC TIME-OUT APPLICATION

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The study evaluated <strong>iDISCERN</strong>, a digital Diagnostic Time-Out (DTO) application designed to help internal medicine residents improve clinical reasoning and manage diagnostic uncertainty. The DTO is a structured tool used in high-risk situations to summarize the problem, prioritize the differential diagnosis, and communicate uncertainty.

Researchers developed the tool using <strong>human-centered design principles</strong> within the <strong>REDCap</strong> platform. Internal medicine house staff at Vanderbilt received training through videos and live demonstrations, then used the DTO during inpatient rotations. Residents completed the <strong>Physicians’ Reaction to Uncertainty (PRU)</strong> scale before and after the intervention, and they also reported usability, workflow impact, and future intentions.

Of 146 invited residents, <strong>31 enrolled</strong> and <strong>21 completed 84 DTOs</strong>. After implementation, PRU scores decreased significantly overall, especially among residents who actually completed at least one DTO. This suggests reduced discomfort with uncertainty. Participants also reported improvements in <strong>clinical reasoning, communication of uncertainty, teaching, and job satisfaction</strong>, and most said they would likely continue using the DTO, teach it to peers, and seek help from colleagues or attendings when uncertain.

Process data showed the DTO was commonly used after rounds or during admission, most often triggered by <strong>diagnostic uncertainty</strong> or <strong>clinical deterioration</strong>. The tool frequently led to changes in management, including new labs, imaging, medications, and additional information gathering.

The main limitations were the lack of <strong>EMR integration</strong>, time burden during busy clinical work, and possible bias from the pre/post design. Overall, the DTO was found to be <strong>feasible and potentially effective</strong> as an educational strategy to address diagnostic uncertainty and support better clinical reasoning.

Asset Subtitle

Daniel Motta-Calderon

Meta Tag

Author List Chase J. Webber, Daniel Motta-Calderon, Maureen Fausone

Category Innovations

Concept Diagnostic Time-Out

Concept Differential Diagnosis

Concept Diagnostic Uncertainty

Concept Problem Representation

Concept Reaction to Uncertainty in Medicine Scale

Distinguished Non-Finalist

Presenter Organization Vanderbilt University Medical Center

Presenting Author Daniel Motta-Calderon

Track Quality Improvement

Keywords

iDISCERN

diagnostic time-out

clinical reasoning

diagnostic uncertainty

internal medicine residents

human-centered design

REDCap

Physicians’ Reaction to Uncertainty

workflow impact

feasibility

Diagnostic Time-Out

Differential Diagnosis

Diagnostic Uncertainty

Problem Representation

Reaction to Uncertainty in Medicine Scale