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Clinical reasoning is the process by which clinicians differentiate between various diagnoses that can present in a similar manner. Does the infant with emesis have viral gastroenteritis, physiologic reflux, or pyloric stenosis? Does the toddler with fever and conjunctivitis have adenovirus infection or Kawasaki disease? Does the teenager with sore throat and fever have a viral upper respiratory infection, group A strep pharyngitis, or infectious mononucleosis? Expert clinical reasoning steps do not come naturally to novice clinicians.
Clinical reasoning is the process by which clinicians differentiate between various diagnoses that can present in a similar manner. Does the infant with emesis have viral gastroenteritis, physiologic reflux, or pyloric stenosis? Does the toddler with fever and conjunctivitis have adenovirus infection or Kawasaki disease? Does the teenager with sore throat and fever have a viral upper respiratory infection, group A strep pharyngitis, or infectious mononucleosis? Expert clinical reasoning steps do not come naturally to novice clinicians.
The GREAT thing, however, is that novice clinicians can increase their diagnostic accuracy AND be more efficient by deliberately following the expert clinical reasoning process.
The GREAT thing, however, is that novice clinicians can increase their diagnostic accuracy AND be more efficient by deliberately following the expert clinical reasoning process.
Individual Study
Individual Study
Chief Complaint Translation exercise
Translate patient or family words (chief complaints) into medical language (reasons for presentation)
Come up with 2-3 potential diagnoses based on the chief complaint
*The core topic quiz for clerkship students will be over the materials covered in the topic introduction
Student Academic Half day*: Clinical reasoning, Dr. King.
If you plan to use a laptop during the session, please pull up two exercise worksheets we will use during the sessions. We will also have extra copies available
*Attendance required for clerkship students. Others welcome!
Practice and Coaching
Practice and Coaching
With every ill visit or admission
Before seeing the patient, take a few minutes to:
“Translate” the chief complaint (pt and family words) into reasons for presentation (medical language)
Identify a syndrome: a combination of pt’s age and reason for presentation
Think of 2-3 possible diagnoses
Recall illness scripts for the diagnoses on the differential: predisposing conditions, pathologic cause or insult, clinical consequences, complications, management and fill out the differential diagnosis table
Use history, physical exam, and diagnostic studies for hypothesis testing: confirming working diagnosis and ruling out competing diagnoses
Formulate a problem representation: 1-2 sentence summary of a case
Commit to a working diagnosis
Perform a “textbook” challenge
Continue refining assessment based on time and new information
With every well visit
Before seeing the patient, take a few minutes to think of developmental milestones, anticipatory guidance, and common/important challenges
Read horizontally: instead of reading about a single diagnosis, simultaneously read about several diagnoses that could present the same way
With every problem based visit or admission
With every problem based visit or admission
Before seeing the patient, take a few minutes to:
“Translate” the chief complaint (pt and family words) into reasons for presentation (medical language)
Identify a syndrome: a combination of pt’s age and reason for presentation
Think of 2-3 possible diagnoses
Recall illness scripts for the diagnoses on the differential: predisposing conditions, pathologic cause or insult, clinical consequences, complications, management and fill out the differential diagnosis table
Use history, physical exam, and diagnostic studies for hypothesis testing: confirming working diagnosis and ruling out competing diagnoses
Formulate a problem representation: 1-2 sentence summary of a case
Commit to a working diagnosis
Perform a “textbook” challenge
Continue refining assessment based on time and new information
With every well visit
With every well visit
Before seeing the patient, take a few minutes to think of developmental milestones, anticipatory guidance, and common/important challenges
Read "horizontally"
Read "horizontally"
Instead of reading about a single diagnosis, simultaneously read about several diagnoses that could present the same way
Skill Assessment
Skill Assessment
Clinical reasoning is really one of the core things we as physicians do which means it transcends a lot areas
Clinical performance assessment
Clinical encounter observation, medical documentation review, verbal patient presentations
OSCE (clerkship students)
Medical knowledge exams: questions above simple recall assess clinical reasoning
Pediatric NBME (clerkship students)
USMLE 1, 2, 3. Pediatric board exam
Additional Resources
Additional Resources
Develop a problem representation for two common pediatric syndromes: teenager with pharyngitis and infant with emesis
Review expert answer key
Illness Script Table exercise (used during group session)
Fill out an illness script table for two common pediatric syndromes: teenager with pharyngitis and infant with emesis
Review expert answer key
illness script table blank for use with problem based visits and admissions
Additional resources including exercise answer keys
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