Reflective portfolios of errors in the development of diagnostic imaging skills in Family Medicine
Abstract
Introduction: The development of diagnostic imaging skills in Family Medicine has prioritized the evaluation of successes, while the systematic analysis of errors occupies a secondary place.
Objective: To analyze the types and underlying reasoning processes of errors in the interpretation of basic imaging studies by Family Medicine residents.
Methods: A mixed-methods study with a nested design and qualitative dominance (QUAL-quan) was conducted at the Juana Naranjo León University Polyclinic between January and April 2025. The quantitative component analyzed 175 reports from 35 residents on 5 cases, classifying errors, using an expert-validated taxonomy, into four main categories. The dominant qualitative component applied thematic content analysis to 35 individual reflective portfolios, developed after receiving guided, non-corrective feedback. Data were integrated through methodological triangulation, contrasting frequencies with narratives with the help of specialized software.
Results: A total of 247 errors were identified, with an average of 1.41 errors per report and a standard deviation of 0.89. Interpretation errors accounted for 42.1% (104/247; 95% CI: 36.1–48.3), cognitive errors for 28.3% (70/247; 95% CI: 23.1–34.3), perceptual errors for 22.7% (56/247; 95% CI: 17.9–28.3), and technical errors for 6.9% (17/247; 95% CI: 4.3–10.7). The quantitative classification demonstrated substantial inter-rater reliability (Kappa = 0.85). Qualitative analysis identified four main processes: rigid application of heuristics, lack of systematicity, difficulty integrating clinical and imaging information, and inhibitory affective response. According to this sampling and design, no significant differences were found by year of residency (χ²(6, N=175)=9.87; p=.130).
Conclusion: Reflective portfolios reveal cognitive patterns of error that guide personalized educational strategies.
Downloads
References
1. Sánchez Mengana A, Milián Vázquez PM, Iglesias León M, Vázquez Montero L, Cambil Martín J. Formación de la habilidad diagnóstico imagenológico de la radiografía de tórax en estudiantes de medicina. Educación Médica Superior [Internet]. 2025 [citado 8 Ene 2026];39. Disponible en: https://ems.sld.cu/index.php/ems/article/view/4856
2. Sendra Portero F, Domínguez Pinos D, Souto Bayarri M. La situación actual de la formación de Radiología en los estudios de medicina en España. Radiología [Internet]. 2023 [citado 20 Oct 2025]; 65:580-92. Disponible en: https://doi.org/10.1016/j.rx.2023.07.003
3. Ivanovic V, Hacein-Bey L, Chang YM, Rawson JV. Actionable strategies to minimize diagnostic errors in radiology. Neuroradiol J [Internet]. 2025 [citado 4 Ene 2026]. Disponible en: https://doi.org/10.1177/19714009251395719
4. Zhang L, Wen X, Li JW, Jiang X, Yang XF, Li M. Diagnostic error and bias in the department of radiology: a pictorial essay. Insights [Internet]. 2023 [citado 12 Nov 2025];14(1). Disponible en: https://doi.org/10.1186/s13244-023-01521-7
5. Minúe Lorenzo S, Astier-Peña MP, Coll Benejam T. El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia. Atención Primaria [Internet]. 2021 [citado 10 Jul 2025]; 53:102227. Disponible en: https://doi.org/10.1016/j.aprim.2021.102227
6. Adkins S, Alta’any R, Brar K, Kauser H, Hughbanks S, Rabah K, Flowers S. Medical error: using storytelling and reflection to impact error response factors in family medicine residents. J Med Educ Curric Dev [Internet]. 2024 [citado 5 Mar 2025];11. Disponible en: https://doi.org/10.1177/23821205241272358
7. Febles G. Análisis del error en el diagnóstico por imágenes. Rev Imagenol [Internet]. 2025 [citado 8 Ene 2026]; 27(2):55-60. Disponible en: https://sriuy.org.uy/ojs/index.php/Rdi/article/view/152
8. Carvallo Valenzuela A. Ensayo El error en medicina. Más allá de una reflexión ético clínica. Rev Chil Reumatol [Internet]. 2024 [citado 22 Nov 2025]; 40(1):13-20. Disponible en: https://doi.org/10.58450/rcr.v34i1.97
9. Amaró Garrido MA, Díaz Quintanilla CL, Hernández González T, Nápoles Valdés MB, Morales Tamayo NM, Rodríguez Expósito AE. La habilidad diagnóstico imagenológico de médicos en la Atención Primaria de Salud. Gac méd espirit [Internet]. 2024 [citado 26 Oct 2025]; 26. Disponible en: https://revgmespirituana.sld.cu/index.php/gme/article/view/2627
10. Amaró-Garrido M, Díaz-Quintanilla C, Hernández-González T, Solenzal-Álvarez Y. Intervención educativa para el diagnóstico imagenológico en médicos del primer nivel de atención. Rev Cubana Medicina [Internet]. 2024 [citado 16 Feb 2025]; 63. Disponible en: https://revmedicina.sld.cu/index.php/med/article/view/3428
11. López JM, Gómez A. Razonamiento clínico y el error diagnóstico. Odontoestomatología [Internet]. 2025 [citado 5 Ene 2026];27(45): e340. Disponible en: https://doi.org/10.22592/ode2025n45e340
12. González Mares M. Hernández-Sampieri, R. & Mendoza, C (2018). Metodología de la investigación. Las rutas cuantitativa, cualitativa y mixta. Rev Univ Digit Cienc Soc (RUDICS) [Internet]. 2019 [citado 8 Ene 2026];10(18):92-5. Disponible en: https://doi.org/10.22201/fesc.20072236e.2019.10.18.6
13. Calle Mollo SE. Diseños de investigación cualitativa y cuantitativa. Ciencia Latina [Internet]. 2023 [citado 9 Mar 2025]; 7(4):1865-79. Disponible en: https://ciencialatina.org/index.php/cienciala/article/view/7016
14. Driessen E, Van Tartwijk J, Van Der Vleuten C, Wass V. Portfolios in medical education: why do they meet with mixed success? A systematic review. Med Educ [Internet]. 2007 [citado 9 Mar 2025];41(12):1224-33. Disponible en: https://doi.org/10.1111/j.1365-2923.2007.02944.x
15. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol [Internet]. 2020 [citado 8 Feb 2025]:1-25. Disponible en: https://doi.org/10.1080/14780887.2020.1769238
16. World Medical Association Declaration of Helsinki. JAMA [Internet]. 2024 [citado 15 Oct 2025]; 23(18): e21972. Disponible en: https://doi.org/10.1001/jama.2024.21972
17. Chen J, Gandomkar Z, Reed WM. Investigating the impact of cognitive biases in radiologists’ image interpretation: a scoping review. Eur J Radiol [Internet]. 2023 [citado 8 Mar 2025]:111013. Disponible en: https://doi.org/10.1016/j.ejrad.2023.111013
18.Malling BV, Skipper M, Matthiesen SS, Flemming R, Nielsen LM, Hansen MB, Møller JE. Residents' perspectives on their training in managing errors in health care: an explorative qualitative study. Int J Med Educ [Internet]. 2025 [citado 8 Ene 2026]; 16:148-55. Disponible en: https://doi.org/10.5116/ijme.68d1.1e73
19. Lim AJ, Hong DZ, Pisupati A, Ong YT, Yeo JY, Chong EJ, et al. Portfolio use in postgraduate medical education: a systematic scoping review. Postgrad Med J [Internet]. 2023 [citado 15 Feb 2025]. Disponible en: https://doi.org/10.1093/postmj/qgac007
20. Talat H, Zahra A, Sohail H, Naveed Manji S, Haider Naqvi MM, Azhar T. E-Portfolios in medical education: a reflective exploration of learning experiences from faculty perspective. Pak J Health Sci [Internet]. 2024 [citado 15 Ene 2026]:103-8. Disponible en: https://doi.org/10.54393/pjhs.v5i12.2574
Published
How to Cite
Issue
Section
License
Copyright (c) 1970 Miguel Angel Amaró Garrido, Carmen Lydia Díaz Quintanilla , Andel Pérez González , Carlos Lázaro Jiménez Puerto, Eliecer González Valdéz, Jim Alex González Consuegra
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.
Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.
(Download Statement of potential conflicts of interest)
The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).
This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/
22 julio 2025