80028747A: Diagnostic Error in Medicine: 5th International Conference - Pre-Conference Workshops

On-site only registration is available.


This page is dedicated to the pre-conference sessions of the Diagnostic Error in Medicine (DEM) conference that are scheduled for Sunday, November 11, 2012. The full DEM conference is scheduled for November 12 - 14, 2012.

To register for any of the Short Courses and/or Research Summit use the link at the top of this page. Note: You will need to log in using your CME ID or create a new one.

To register for the DEM Conference on November 12-14, 2012 please go to: http://www.hopkinscme.edu/CourseDetail.aspx/80028747



Sunday, November 11, 2012
MORNING
7:00 - 8:00 Registration and Continental Breakfast, Turner Concourse, Lower Level

8:00 - 12:00
SHORT COURSE 1: Introduction to Diagnostic Errors
Moderator: Hardeep Singh, MD, MPH, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX
Faculty:
Karen S. Cosby, MD, FACEP, Rush Medical College, Chicago, IL
Patrick Croskerry, MD, PhD, Dalhousie University, Halifax, Nova Scotia, Canada
Mark L. Graber, MD, RTI International, St. James, NY
Gordon D. Schiff, MD, Brigham and Women’s Hospital, Boston, MA

Introduction and Objectives, Hardeep Singh, MD, MPH
Epidemiology
Discuss several landmark papers and other related literature that helped define the field empirically in terms of magnitude of the problem (frequency/prevalence, harm, cost). Mark L. Graber, MD

Interactive Diagnostic Error M&M: How to Do Them and What Do We Learn Karen S. Cosby, MD, FACEP

Contributory Factors and Interventions
Cognitive: Review of concepts from clinical reasoning including the use of heuristics and biases and discuss some conceptual models of cognition in this area (e.g.; System I/II thinking). Discuss both tested and suggested interventions to improve physician knowledge and experience (simulation training, improved feedback); improve clinical reasoning and decision-making skills (metacognition training); and “assist” physicians in their diagnosis (such as access to experts, use of decision support interventions). Pat Croskerry, MD, PhD

Systems: Overview of concepts from the systems literature: organization factors, policies, procedures, handoffs, communication and other factors that affect diagnostic error. Review of the unique interaction between the cognition, the system and patients. Systems Interventions: Discuss both tested and suggested interventions related to health IT and electronic health records, communication and coordination strategies, patient-focused interventions, feedback systems, incident flags, improving processes of care, etc. Discuss challenges for the field. Gordon Schiff, MD

Wrap Up, Putting it all Together Hardeep Singh, MD, MPH and Mark L. Graber, MD

Learning Objectives:
After attending this activity, the participant will demonstrate the ability to:
• Describe the problem of diagnostic errors in terms of epidemiology, burden and processes involved
• Discuss an interactive case-based analysis illustrating the complexity of diagnostic error
• List systems and cognitive contributory factors and potential interventions to reduce diagnostic errors



8:00 - 12:00
SHORT COURSE 2: Introduction to Knowledge Translation
Faculty:
Lisa H. Lubomski, PhD, The Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD

Description:
The content and exercises are aimed at participants who want to learn how to do quality improvement/knowledge translation. The course provides an introduction to the basic principles of quality improvement/knowledge translation (QI/KT) and focuses on efforts aimed at increasing the extent to which patients receive evidence-based therapies. Using examples and methods from real-world QI/KT project, the course will consist of didactic presentations and discussion of the concepts, methods, and the application of QI/KT theory and practice. Attendees will be able to: analyze the unique perspective and importance of quality improvement/knowledge translation for policymakers, health care providers, administrators, and the public; discuss a framework for quality improvement/knowledge translation; use practical tools to improve quality improvement/knowledge translation and related activities.

Learning Objectives:
After attending this activity, the participant will demonstrate the ability to:
• Summarize the importance of and point of view regarding quality improvement/knowledge translation for policymakers, providers, and the public
• Describe one framework for quality improvement/knowledge translation research
• Identify and assess barriers and facilitators for quality improvement/knowledge translation research
• Discuss issues regarding the selection, tailoring, and implementation of quality improvement/knowledge translation interventions


AFTERNOON
12:00 - 1:00 Lunch (on your own)
12:00 - 1:00 Registration, Turner Concourse, Lower Level

1:00 - 5:00
SHORT COURSE 3: Decision Support Technology
Clinical Decision Support: From Patient Presentation to Diagnosis and Treatment
Moderator: Art Papier, MD, University of Rochester Medical Center, Rochester, MN
Faculty:
Nikola Baumann, PhD, DABCC, Mayo Clinic, Rochester, MN
Pedro Caraballo, MD, Mayo Clinic, Rochester, MN
Noah Craft, MD, PhD, UCLA, Los Angeles, CA
Brian R. Jackson, MD, MS, ARUP, Salt Lake City, UT

Description:
The widespread availability of electronic health records, computer interfaces and use of smartphones by clinicians is bringing clinical decision support (CDS) into the clinical workflow and “thoughtflow”. Diagnosis can be impacted by CDS from the moment of patient contact through the timeline of the clinical encounter and subsequent decision-making process. This course will use the timeline of the patient encounter as an organizational theme to define and describe how CDS can improve diagnostic accuracy. Emphasis will be placed on challenges, current solutions and future opportunities. Graphical data representation to support Type 1 thinking will be a focus, as well as real-time clinical diagnostic solutions. The risks associated with ordering inappropriate laboratory tests and CDS for highlighting significant laboratory findings and triggering appropriate actions will be discussed. Practical approaches to implementing and maintaining CDS will be shared. This course is an ideal overview for clinicians, laboratorians, researchers and inventors. Clinical decision support is poised for exponential growth. Join us and participate in the future of a critical area of digital healthcare.

Learning Objectives:
After attending this activity, the participant will demonstrate the ability to:
• Describe practical applications of clinical decision support currently being used in healthcare
• Identify opportunities for CDS to improve diagnostic accuracy during the patient encounter
• Discuss how CDS can guide appropriate laboratory testing


1:00 - 5:00
SHORT COURSE 4: Evidence-Based Diagnosis
Faculty:
Michael A. Kohn, MD, MPH, University of California, San Francisco, CA
Thomas B. Newman, MD, MPH, University of California, San Francisco, CA

Description:
This hands-on workshop is based on real examples from the medical literature. We will review multiple studies of diagnostic tests and show how the data can be (but often are not) presented to maximize the information to be gained from the test. We will also discuss various common but under-recognized biases and how they affect results.

Learning Objectives:
After attending this activity, the participant will demonstrate the ability to:
• Apply the principles of diagnostic test assessment, including the calculation and use of interval likelihood ratios and the relationship between these likelihood ratios and the ROC curve
• Rationalize how to go beyond the area under the curve to get the most out of published ROC curves
• Determine when odds ratios are preferable to likelihood ratios and vice versa
• Describe underappreciated flaws, biases, and limitations in studies of diagnostic tests
• Minimize or resolve limitations and best present diagnostic test information to experienced clinicians

Format and Requirements:
The workshop will consist of brief didactic presentations followed by small groups solving and discussing illustrative problems based on studies of diagnostic tests. Among other tests, the problems will discuss: a rapid antigen detection test for influenza; BNP for congestive heart failure; ultra-sensitive Troponin I for acute coronary syndrome; B-Hcg for ectopic pregnancy, and the JAMA “Rational Clinical Examination” papers on diagnosing appendicitis and UTI in children. At the end of the session, we will hand out the answers to the problems. Participants should be comfortable with the basics of diagnostic testing such as the definitions of sensitivity, specificity and predictive value, and should also have some initial exposure to receiver operating characteristic (ROC) curves and likelihood ratios.

Topics:
• Review of dichotomous tests, sensitivity, specificity, LR(+), LR(-), and the false negative rate confusion (rapid antigen testing for H1N1 influenza)
• Multilevel and continuous tests, interval likelihood ratios and the perils of making multi-level tests dichotomous (B-type natriuretic peptide for congestive heart failure)
• Going beyond the area under the ROC curve and getting the most out of published ROC curves (peripheral WBC count for meningitis in infants; ultrasensitive troponin I for acute coronary syndrome)
• Studies of diagnostic test accuracy -- beyond the check list: incorporation and spectrum biases (BNP revisited; using B-HCG levels in the diagnosis of ectopic pregnancy)
• Studies of diagnostic test accuracy: verification and double gold standard biases (JAMA Rational Clinical Examination: Does this Child Have Appendicitis?)
• Odds ratios vs. likelihood ratios: Which to use? (JAMA Rational Clinical Examination: Does this Child Have a Urinary Tract Infection?)


GENERAL INFORMATION

The Society to Improve Diagnosis in Medicine and Johns Hopkins University School of Medicine are pleased to announce the 5th international conference on DIAGNOSTIC ERROR IN MEDICINE (DEM) – 2012. This pre-conference day on Sunday, November 11, 2012 will provide four half day Short Courses and a half day Research Summit in the afternoon.

PURPOSE AND SCOPE
The ultimate goal of this conference is to improve patient safety by reducing the likelihood of diagnostic error in medicine. Minimizing diagnostic error is an essential component of safe patient care, and towards this end the conference activities are organized to summarize the current state of the field, review active research, and consider emerging educational and research themes that should be implemented to minimize diagnostic error.

WHO SHOULD ATTEND
This activity is intended for practicing clinicians, nurses, and other members of the patient care team including laboratory, radiology, pharmacology, etc. . . . As well as cognition scientists, safety officers and risk managers, informatics professionals, clinical and basic investigators, educators, healthcare providers, payers, policy and risk managers and trainees.
Patients who may have experienced diagnostic error who wish to contribute to a positive dialogue are especially welcome.

OBJECTIVES
The conference goal is to build a scientific and practical understanding of diagnostic error in medicine and foster the development of solutions. After attending this activity, the participant will demonstrate the ability to:
• Focus attention on the frequency, impact, and public health significance of medical misdiagnosis
• Develop a core constituency of committed advocates from diverse backgrounds and perspectives
• Discuss the nature, causes, and remedies for diagnostic error in medicine
• Share research methods and results relevant to clinical reasoning, diagnostic error, and misdiagnosis-related harm

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this live activity for a maximum of 9.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

LOCATION
Thomas B. Turner Building
Johns Hopkins University School of Medicine
720 Rutland Avenue
Baltimore, Maryland 21205

The Turner Building is located on Rutland Avenue at Monument Street. Directions and campus parking information are available on our website under the contact and travel section at www.HopkinsCME.edu. Handicapped parking is available in the nearby Rutland Garage. Complimentary round-trip transportation for attendees staying at conference headquarters hotel will be provided. Johns Hopkins is smoke-free.


HOTEL AND TRAVEL INFORMATION
We strongly encourage you to book your accommodations at the Courtyard by Marriott, which is the conference headquarters hotel. The Johns Hopkins Office of CME makes every effort to secure the best rate for overnight accommodations. The rate is part of a negotiated conference package that incorporates many services. By staying at the host hotel and booking within the room block, you help us maintain current conference benefits and keep future registration fees reasonable. Please consider this when making your overnight accommodations decision.

Courtyard by Marriott
Baltimore Inner Harbor
1000 Aliceanna Street
Baltimore, Maryland 21202-4341
Toll Free: (800) 321-2211
Direct: (443) 923-4000
Fax: (443) 923-9970
Web Site: bit.ly/NhtBg

HOTEL RESERVATION Deadline for Group Rate : October 10, 2012

The hotel reservation deadline has been extended to 10/17/2012 for the group rate, based on availability.
R A limited block of sleeping rooms has been reserved for your convenience and will be available on a first come, first served basis. The Courtyard by Marriott Baltimore Inner Harbor is hospitality on the harbor. Nestled in the Harbor East neighborhood, it is one block from the picturesque waterfront and an easy stroll to the National Aquarium, Fells Point, Little Italy and other Inner Harbor attractions. Make your reservation online at bit.ly/NhtBg or call the hotel directly and specify that you are attending the Johns Hopkins Diagnostic Error in Medicine to receive the special group rate of $139, single or double, plus tax. Complimentary roundtrip transportation will be provided. Check-in time is 3:00 p.m. Check-out time is 12:00 noon.

FEES

EARLY BIRD REGISTRATION DEADLINE: OCTOBER 5, 2012

REGISTRATION CUT-OFF DATE: NOVEMBER 5, 2012

Methods of Payment: Payment by check or credit card must accompany the registration form prior to the activity. On-site payments by credit card only. Foreign payments must be by credit card or with a U.S. Dollar World Money Order. The registration fee includes instructional materials, continental breakfast and refreshment breaks.

You must register separately for the pre-conference sessions that include the Short Courses and Research Summit on Sunday, November 11, 2012. To register, please use the link at the top of this page. Note: You will need to log in using your CME ID or create a new one.



The fees for the pre-conference sessions are listed below.

SHORT COURSES: "S/C" November 11, 2012 #1/#2 8:00 A.M. - 12 P.M. #3/#4 1:00 - 5:00 P.M.	One Half Day Course*	Two Half Day Courses*
Early Bird Fee: on/prior to 10/5/12	$145	$199
Regular Fee: after 10/5/12	$185	$240
Trainees and Non-Physicians:
Early Bird Trainee Fee: on/prior to 10/5/12	$120	$175
Regular Trainee Fee: after 10/5/12	$155	$210

RESEARCH SUMMIT:
November 11, 2012 1:00 – 6:30 P.M.	$50

* Please indicate which short course(s) or which full day you will attend on the meeting registration form.

To register for the DEM Conference on November 12-14, 2012 please go to: http://www.hopkinscme.edu/CourseDetail.aspx/80028747


JHU Faculty/Staff Only: If you are using your Tuition Remission Benefit as payment, please complete the Tuition Remission Application and return it to the Office of CME, Turner 20 along with your completed meeting registration form that is available in the PDF brochure document. Please be sure to tally up your registration fee(s).

Trainees are considered undergraduate, graduate and doctoral students in clinical or non-clinical settings, and post-doctoral students, residents and fellows who are in academic settings. Faculty and full time research employees do not qualify as trainees.

You will receive a confirmation by e-mail if you have provided your e-mail address. Otherwise confirmation will be sent by mail. If you have not received it by November 5, 2012, call (410) 502-9634 to confirm that you are registered. A certificate of attendance will be sent by December 28, 2012 to the e-mail address you provide on the registration form.

The Johns Hopkins University reserves the right to cancel or postpone any activity due to unforeseen circumstances. In this event, the University will refund the registration fee but is not responsible for travel expenses. Additionally, we reserve the right to change the venue to a comparable venue. Under such circumstances registrants will be notified as soon as possible.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality and scientific integrity of this CME activity.

LATE FEE AND REFUND POLICY
A $50 late fee applies to registrations received after 5:00 p.m. EST on November 5, 2012. A handling fee of $50 will be deducted for cancellation. Refund requests must be received by fax or mail by November 5, 2012. No refunds will be made thereafter. Transfer of registration to another Johns Hopkins conference in lieu of cancellation is not possible.

Policy On Speaker And Provider Disclosure

It is the policy of the Johns Hopkins University School of Medicine that the speaker and provider disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). Johns Hopkins University School of Medicine OCME has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity. Detailed disclosure will be made in the activity handout materials.