Nephrology · Vol. 2, No. 1 · 2016 · pp. 14–16 · e-ISSN 2380-0445

Suggestions to Improve Medical Education in China-Learning from Diagnostic Errors of Kidney Diseases

Jiuhong Li, MBBS, Pengfei Wei, MMed, Zhenfu Zhao, MD, Meng Li, MSc, Jin-Wen Hua, BSc, Ni Xie, MD, Xiaohua Xie, MMed, Sheng Lang Zhu, MD, Kunmei Ji, PhD

Department of Biochemistry and Molecular Biology, Health Science Center of Shenzhen University, Shenzhen, China; Department of Nephrology, Nanshan Hospital, Affiliated Hospital of Shenzhen University, Shenzhen, ChinaChina
Department of Biochemistry and Molecular Biology, Health Science Center of Shenzhen University, Shenzhen, ChinaChina
Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaChina
Department of Nephrology, Nanshan Hospital, Affiliated Hospital of Shenzhen University, Shenzhen, ChinaChina

DOI: https://doi.org/10.17140/npoj-2-113 · Published 2016-06-24 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2016 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

A correct diagnosis is key to deliver the safe and effective medical interventions. However, diagnostic errors that can jeopardize patients’ safety are common in clinical settings. Herein, we analyzed diagnostic errors in kidney disease cases based on our clinical experience, explored the factors underlying diagnostic errors, and discussed ways to improve medical education in China. In kidney disease, diagnosis is complicated by the kidney’s physiological characteristics and the lack of sensitive early diagnostic methods. Additionally, there are shortcomings in Chinese healthcare service patterns and the Chinese medical education. There are not enough qualified General Practitioners (GPs) in China, resulting in a low-efficiency referral system. Clinical training for postgraduates is hindered by the pressure to publish papers. Continuing medical education in China seems to be oriented improperly, with insufficient focus on the progress of clinical practice. We believe that targeted measures should be enacted to address the aforementioned problems in China. Specifically, we recommend that medical education should incorporate evidence-based diagnostic mind maps and lessons from diagnostic errors.

Keywords: Medical education; Diagnostic error; Kidney disease; Diagnostic mind map; Medical education; Diagnostic error; Kidney disease; Diagnostic mind map

Conclusions

In the past six decades, improvement of Chinese mass population’s healthcare system is partially due to medical education. Here, we analyzed cases of misdiagnosis of kidney diseases in China and discussed the potential shortcomings in Chinese medical education system. Therefore, we suggest that China enhance general medical education, emphasize clinical training in postgraduate education, standardize medical residency training, and renew the clinical knowledge of all licensed physicians through CME. In addition, it would be worthwhile to help medical students establish evidence-based diagnostic mind maps and learn from prior diagnostic error experiences.

Acknowledgements

This study was supported in part by research funding from the Natural Science Funding of Guangdong Province (No. 2016A030313039, No. 2014566) Science and Technology Funding of Shenzhen (No. JCYJ20150626141652681, No. CXZZ20140418182638770), Shenzhen University Funding (2011) and Discipline Construction Funding of Shenzhen (2016).

Conflicts Of Interest

The authors declare that they have no conflicts of interest.

References

  1. Institute of Medicine Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC, USA: National Academies Press; 2000
  2. ZhangLWangFWangL. Prevalence of chronic kidney disease in China: A cross-sectional survey. Lancet. 2012; 379(9818): 815-822. doi: 10.1016/S0140-6736(12)60033-610.1016/s0140-6736(12)60033-6 https://doi.org/10.1016/s0140-6736(12)60033-6
  3. FanFLongG. Analysis of misdiagnosis of chronic kidney failure in 808 cases [In Chinese]. China Medicine. 2008; 3(6): say ME, Resar RK. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004; 30(1): 5-14. Web site. http://www.ingentaconnect.com/content/jcaho/ jcjqs/2004/00000030/00000001/art00001. Accessed May 22, 2016
  4. CoderreSMandinHHarasymPHFickGH. Diagnostic reasoning strategies and diagnostic success. Medical Education. 2003, 37(8): 695-703. doi: 10.1046/j.1365-2923.2003.01577.x10.1046/j.1365-2923.2003.01577.x https://doi.org/10.1046/j.1365-2923.2003.01577.x
  5. ZhuSLWeiPFChenJHZhaoZFXuQNYeL. Diagnosis and treatment of a patient with Kimura’s disease associated with nephrotic syndrome and lymphadenopathy of the epitrochlear nodes. BMC Nephrol. 2015; 16: 10. doi: 10.1186/s12882-015- 0007-710.1186/s12882-015-0007-7 https://doi.org/10.1186/s12882-015-0007-7