1. Comments on HDHT SP Exercise  Congratulations SSOM 13’s on being the first group to participate in the Hypothesis Driven History Taking Project!  In reviewing your performance videos it was exciting to see you as First Year Students processing pertinent positive and negative data from your history into a provisional diagnostic hypothesis which you then shared with your patient. See Next Slide

2. Observation: You did well asking the cardinal questions about the patient’s presenting problem Concern: Some of you, once you heard a discriminating feature in the history (one associated with a specific diagnosis), failed to finish asking some of the necessary cardinal questions. Advice: Avoid premature closure in your history taking and your decision making! Diagnoses will rarely be quite as obvious as these scenarios seemed to you, so make sure you systematically ask all the related questions to gain all the pertinent information. See Next Slide Comments on HDHT SP Exercise

3. Observation: For some of you, your empathy skills took a back seat to your quest for a reaching a diagnosis. Comment: This is what typically happens (even with seasoned clinicians) when, in the press to make a diagnosis, we forget to relate to the patient as a person in a Patient Centered way! We designed the exercise hoping that you would see and experience how focusing solely on a diagnosis can work against empathetic Patient Centered care. Advice: At all times a good clinician must balance time between relating to the patient as person, while working to obtain necessary diagnostic information See Next Slide Comments on HDHT SP Exercise

4. Observation: Reviewing or summarizing what you have heard from the patient is a good habit to get in to. Comment: You have learned this already, but hopefully you have seen its importance in making sure you have the correct information (pertinent positives and negatives) to make your provisional diagnosis. Advice: Summarizing and taking time to review with the patient can be extremely helpful during the history taking process. See Next Slide Comments on HDHT SP Exercise

5. Observation: After asking the cardinal questions regarding a presenting problem, with your differential diagnosis in mind, you should explore with the patient the relevant pertinent negatives. -You’ve described your pain as “pressure,” is it ever a burning pain?” -You said it comes with exertion, does it ever come when you eat spicy foods?” Comment: This is the process of addressing the pertinent negatives. It gives you negative evidence that is meant to enhance your diagnostic accuracy. Advice: As you proceed in your training you should become comfortable eliciting the pertinent positive information as well as pertinent negatives. See Next Slide Comments on HDHT SP Exercise

6. Observation: Some of you found the quiz questions on the virtues associated with the five steps in clinical reasoning overly picky or not relevant. Comment: These virtues are the glue that ties the whole clinical reasoning process together and assures the effectiveness of your clinical decision-making. All of us are better at some things more than other things. But when it come to clinical reasoning we must be true to all steps: Be Attentive, Be Intelligent, Be Reasonable, Be Responsible, and Be Ethical. Advice: Your evaluators will be judging your proficiency in all of these areas. See Next Slide Comments on HDHT SP Exercise