1. For First Year Medical Students
Clinical Reasoning
For First Year Medical Students
Hypothesis-Driven History-Taking Project

2. Goals Provide the context & rationale for HDHT project
Situate the HDHT project within clinical education
Explain learning objectives of the Module
Show module
Explain SP exercise assessment
How to access? When available? SP exercise?

3. Clinical Reasoning Pattern recognition
“Expert clinicians begin to generate hypotheses regarding the suspected illness very quickly while gathering cues and information from the patient.”
Pattern recognition

4. I’m not sleeping very well…
Clinical Reasoning
“This hypothesis driven approach is a means of coping with the open-ended problem presented by a patient.”
There could be several explanations…Let me get some more information from you…
I’m not sleeping very well…

5. Clinical Reasoning
‘The function of early hypotheses, therefore, is to limit the size of the space that must be searched for solutions to the problem.’ ‘Some way of progressively constraining the size of the search space must be found or else a clinical workup could never end in the time that is actually available’

6. Clinical Reasoning
Hypotheses transform an open problem into one with several hypothetical solutions…
The goal of the interview and physical examination is to carry out a comparative evaluation of these competing ‘diagnoses’.
Differential Diagnosis

7. Creates a Tension ! Also a Problem…
“This hypothesis driven approach = means of coping with the open-ended problem presented by a patient.”
Creates a Tension !
Also a Problem…

8. Hypothesis Driven Approach
Patient Centered Approach

9. Patient Centered
Astute Diagnostician

10. Clinical Reasoning Unfortunately,
“Clinical educators insist that students carry out a history:
Following a formulaic path
Suspending, until the end, speculation on the illness in question.”

11. HPI Cardinal Questions Problem? Quality? Duration, time course?
Intensity?
Aggravating?
Alleviating?
Radiation?
Associated Symptoms?

12. Unfortunately..
“Clinical educators insist that students carry out a history and a review of systems by following a prescribed path suspending, until the end, all formulations of the illness in question.”
Patient: “What are you thinking?”
Physician: “Oh, I haven’t started thinking yet. First I gather all the information and then I think about it.”

13. Clinical Reasoning
“We detriment our students in the traditional training approach by teaching a scheme that is not actually the one we expect them to utilize a scant year or two later.”

14. Clinical Reasoning
What clinicians would actually admit that such is their method of reasoning!

15. Hypothesis Driven History

16. HPI History Taking Hypothesis Driven History Module:
Introduce Process
Case Profiles - illness scripts
Cardinal Questions:
Problem
Location
Severity
Aggravating
Alleviating
Radiating
Assoc Sxs
Cardinal Questions
Pertinent +/-
Year Year Year Year 4
Normal Pathology Patient Contact Develop Skills

17. Hypothesis Driven History Taking Project
Objectives
Enhance diagnostic abilities
Introduce pattern recognition
Maintain Patient-Centeredness
______________________________________________________________________
Learning Module
SP Exercise
Quiz

18. Hypothesis Driven History Taking Project
Module
Web module:
Clinical Reasoning - epistemology
Diagnostic scripts & pattern
Self-Assessment Questions/Answers

29. HDHT Timeline of Activities for Project Module Open for Study
February 17, 2010
To Access Module:
To be given out at lecture Feb 16th
SP Encounter & Quiz
March 23, 2010 (Entire Class)
Module’s Web link address