How Malpractice and Error Cases Influence Information Recall in General Practice Residents, a Vignette Study

Abstract

Purpose: Integrating diagnostic error and malpractice cases into clinical reasoning education may enhance diagnostic reasoning by highlighting atypical presentations and diagnostic risks in complex contexts. While emotionally engaging, these cases might also affect information retention. This study examines how malpractice, error, and neutral case presentations influence recall for different information types and their interaction with learners’ interest, satisfaction and anxiety levels. Methods: In this two-phase between-subjects experiment, 89 first-year general practice (GP) residents reviewed four clinical vignettes in either malpractice, diagnostic error, or neutral formats. Vignettes were structurally identical, with claim-related details in malpractice versions replaced by general medical information in others. Anxiety was measured pre-and post-exercise. After a one-hour filler task, participants completed a free recall task, and their interest and satisfaction levels were assessed. Recalled idea units (clinical case-specific, medical-theoretical, claim-specific) were analyzed using ANOVAs. Results: Anxiety, interest, and satisfaction levels remained similar across conditions. The proportion of total recalled idea units did not differ significantly (malpractice 11.38%, neutral 12.91%, error 13.12% p = 0.57). However, malpractice participants recalled fewer clinical case-specific units (malpractice 12.19%, neutral 19.43%, error 15.87% p = 0.007) while recalling more claim-specific units compared to medical-theoretical units in the other conditions (malpractice 7.23%, neutral 0.42%, error 1.3% p < 0.001). Conclusion: GP residents retained fewer clinical case-specific details from malpractice claim vignettes than from neutral vignettes, with the missing information substituted by claim-specific details, without an increase in anxiety or interest. Further research is needed to understand the long-term impact of these differences on future diagnostic accuracy in clinical practice. © 2025 The Author(s).

Keywords

Author Keywords

Not provided

Index Keywords

adult female human male medical education procedures psychology questionnaire Humans Internship and Residency Surveys and Questionnaires education general practice diagnostic error malpractice Diagnostic Errors recall Mental Recall

Author Affiliations

Department of General Practice, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Evidence Based Medical Education, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Department of General Practice, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Funding & Acknowledgements

ZonMw

Grant: 839130012

This study was funded by ZonMW, grant number 839130012, from the HGOG funding program for Research of Medical Education. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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How Malpractice and Error Cases Influence Information Recall in General Practice Residents, a Vignette Study

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