Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.

This study explored beginning special education teacher quality and the role that knowledge and skill for teaching reading plays in defining quality. The authors examined the relationship between beginning teachers' knowledge for teaching reading and their classroom practices during reading instruction and, further, relationships between classroom practices and student achievement gains on various reading measures. Findings revealed special education beginning teachers were somewhat knowledgeable about teaching reading, but this knowledge did not contribute a significant portion of variance to classroom practice. Practices in classroom management, decoding practices, and providing explicit, engaging instruction accounted for a significant portion of variance in student reading gains. Implications for further research and the preparation and induction of beginning teachers are provided.

Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. We analyzed a unique new data source of patient-and family-reported error narratives to explore factors that contribute to diagnostic errors. From reports of adverse medical events submitted in the period January 2010-February 2016, we identified 184 unique patient narratives of diagnostic error. Problems related to patient-physician interactions emerged as major contributors. Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients' knowledge, disrespecting patients, failing to communicate, and manipulation or deception. Patients' perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. Health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error. D iagnostic errors pose a significant risk to patient safety, affecting an estimated twelve million US adult outpatients annually 1 and leading to an estimated 6-17 percent of all adverse events in hospitalized patients. 2,3 The 2015 National Academies of Science, Engineering, and Medicine report titled Improving Diagnosis in Health Care defined diagnostic error as "the failure to (a) establish an accurate and timely explanation of the patient's health problem(s) or (b) communicate that explanation to the patient." 2(p xiii) This definition signals a shift in focus that includes the patient's perspective in diagnostic error literature and highlights the fact that communication of a health issue to the patient is a fundamental part of the diagnostic process, as patients bear the most risk for harm. 2 Within the diagnostic process, patient-centered care requires strong communication; a willingness to engage patients as participants; and the ability to be responsive to patients' preferences, needs, and values. 2 Continued movement away from disease-or physician-centered care toward more patient-centric care models can foster a trusting and healing relationship between clinicians and patients. 4

Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses. Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.