1. Clinical Reasoning and Problem Solving

2. The Clinical Teacher Diagnose the Diagnose the Learner Patient Level
Knowledge
Experience
Reasoning

3. Organization of knowledge
Classroom: Curriculum organ systems, pathology
Clinical knowledge: Based on
Clinical features---knowledge---experience

4. Thinking…. Classroom or clinical

5. Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience

6. Problem representation… Based on patient story, PE, data Translation of patient-specific into abstract terms

7. Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience

8. Reasoning… Described with semantic qualifiers Paired, opposing descriptors

9. Illness script… Recalled, structured knowledge Triggered by problem representation Clinically relevant information Outcomes, solutions Purposeful data gathering

10. Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience

11. Promote diagnostic reasoning:
Experience
Articulate problem representation
Prioritize and justify diagnostic possibilities
Develop illness scripts/disease concepts

12. What can we do as teachers?
Promote reasoning aloud
Ask
What are you unsure of?
What can’t you explain?
Use abstract qualifiers
Defining features
Discriminating features
Compare and contrast
Shorten and focus the differential list

13. Instruction-Related activities in Rounds
Listening
Planning
Reflecting
Thinking
interactively
Teaching
Diagnose patient
Diagnose learner