“Learning bystander activation”: resident-led diagnostic error case conferences and sustained reflective engagement among junior residents

Abstract

OBJECTIVES: Diagnostic errors are a major patient safety concern, particularly in emergency settings where junior residents frequently perform initial evaluations. Diagnostic error case conferences are used as educational interventions, but their impact on sustained learning behaviors remains unclear. This study examined whether participation in resident-led conferences is associated with changes in reflective and self-directed learning. METHODS: This single-center mixed-methods study involved junior residents participating in weekly diagnostic error case conferences. Pre- and post-intervention surveys assessed awareness of diagnostic errors and cognitive biases, and engagement in reflective and self-directed learning. Quantitative data were analyzed using Fisher's exact test, and qualitative responses were analyzed thematically. RESULTS: Recognition of diagnostic errors increased from 62.5 to 100 % (p=0.006), and awareness during emergency practice from 58.3 to 100 % (p=0.003). The proportion reviewing more than 70 % of their cases increased from 54.2 to 87.5 % (p=0.040). Qualitative analysis identified heightened diagnostic vigilance, emotional engagement, and environment-driven reflective pressure, even among residents not directly involved in the cases. CONCLUSIONS: Resident-led diagnostic error case conferences were associated with increased reflective engagement. We propose the concept of "learning bystander activation," defined as the activation of reflective and self-directed learning behaviors through exposure to a shared learning environment, even without direct involvement in the clinical case.