MONOGRAPH A Dual Processing Theory Based Approach to Instruction and Assessment of Diagnostic Competencies Frank Joseph Papa 1 # International Association of Medical Science Educators 2016 Abstract Evidence suggests that diagnostic error plays a major role in America’ s suboptimal patient care. Evidence also suggests that generalizable problem solving or clinical reasoning skills are not the primary determinant of diagnostic accuracy. Rather, knowledge-based constructs likely play a greater role in diagnos- tic performance. Dual processing theory (DPT) posits how knowledge-based constructs and information processing (problem solving or reasoning) mechanisms work together to enable cate- gorization tasks such as differential diagnosis. This manuscript describes how medical educators might use DPT to create training and testing methods to improve the diagnostic capabilities of to- morrow’ s practitioners and subsequently patient care outcomes. Keywords Dual processing theory . Differential diagnosis . Diagnostic reasoning . Clinical reasoning . Clinical problem solving . Learning sciences . Best evidence based medical education . Medical education Introduction Since the early 2000s, growing concerns regarding America’ s suboptimal patient care outcomes have led to two broad, quality improvement initiatives. The first, largely led by the Institute of Medicine (IOM), seeks to continually identify the Bgaps be- tween what is known to be good health care versus current practice norms,^ and thereby, enable practitioners to address deficiencies leading to suboptimal outcomes among their own patients. [1] The second, initially led by the Accreditation Council for Graduate Medical Education (ACGME), and now also supported by the Association of American Medical Colleges (AAMC), seeks the use of Bcompetence-oriented as- sessment measures^ during residency and undergraduate train- ing to identify and correct performance deficiencies before graduates assume independent patient care responsibilities [2]. In 2015, the IOM identified diagnostic error as perhaps the single leading cause of suboptimal patient care outcomes and called upon today’ s practitioners, health care systems, and quality assurance organizations to create diagnostic error detection and prevention mechanisms to improve diagnostic performance in the clinical environment [3]. However, while the ACGME and AAMC continue to pursue the use of increasingly granular, competence-oriented assessment rubrics (milestones for residents and entrustable professional activities for undergraduates), nei- ther of these organizations nor medical education Bwrit large^ has forwarded theory driven and evidence-based approaches to the instruction and assessment of diagnostic capabilities [4, 5]. This manuscript introduces a learning sciences-based, theo- retical framework through which medical educators might bet- ter understand the cognitive factors underlying the development of diagnostic competencies. This framework can subsequently be used as an evidence-based approach to instruction and as- sessment of diagnostic competencies during undergraduate and residency training, and thereby achieve improvements in the diagnostic capabilities of tomorrow’ s practitioners. Medical Education’ s most Urgent Quality Improvement Challenge: Improving the Diagnostic Capabilities of Tomorrow’ s Health Care Providers Beginning with its first quality of care report in 2000, To Err is Human, the IOM sought to demonstrate the significant role medical errors play in the perceived decline in America’ s * Frank Joseph Papa frank.papa@unthsc.edu 1 University of North Texas Health Science Center, Fort Worth, TX, USA Med.Sci.Educ. DOI 10.1007/s40670-016-0326-8