Learning after referral: referral outcome review as a post-referral diagnostic teaching method in GP specialty training

Delayed diagnosis in primary care is usually discovered after the consultation has moved on: when a referral is accepted, redirected, rejected, delayed, or returned with an unexpected diagnosis. This Teaching Exchange describes the Referral Outcome Review, a tutorial method for GP specialty trainees that starts after the referral outcome has arrived rather than at the first consultation. The method was developed from routine one-to-one supervision and uses anonymised recent cases. Each case is discussed through six questions: (i) what was the initial diagnostic frame, (ii) what referral question was asked, (iii) what response came back, (iv) what uncertainty remained, (v) who owned the next step, and (vi) what patient-facing wording would be used next time? The approach is deliberately not an audit, dataset, complaint review or learning or significant event analysis. It is a formative educational conversation designed to reveal the diagnostic afterlife of referrals. By focusing on rejected referrals, normal investigations, advice-and-guidance replies, non-attendance and specialist discharge, the method helps trainees recognise false closure, referral drift and missed re-entry points. It offers a practical, low-cost way to teach diagnostic safety as a longitudinal primary care skill within routine supervision, without formal data collection or additional infrastructure and without waiting for rare adverse events.