teach on the run! session 3: helping learners think! diagnostic reasoning created by dr. leslie ann...
TRANSCRIPT
TEACH ON THE RUN!SESSION 3:
HELPING LEARNERS THINK!
DIAGNOSTIC REASONING
Created by Dr. Leslie Ann Sadownik
I can be a better teacher…
By Inspiring learnersBy Involving them By teaching them how to thinkBy providing useful information to help
them improve as clinicians.
Learning objectives
Compare how experts versus novices think!
Apply a framework to guide learners through the steps of diagnostic reasoning
Compare and contrast the teaching methods: One Minute Preceptor and SNAPPS
Office for Faculty Development
ABC Educational Primer for Physicians
Clinical Reasoning Definition
Defines the cognitive thinking process whereby
1. a physician gathers appropriate data;
2. arrives at a diagnosis;
3. identifies a ‘treatment of choice’ and
4. gives a reasoned recommendation to the patient.
In medical school we teach …
• Identify Problems• Generate Hypothesis• Explain Mechanisms• Gather Data• Test Hypothesis• Apply to Problem
Steps of PBL inquiry
process
ABC Educational Primer for Physicians
Office for Faculty Development
Clinical Reasoning Process
• Clinical assessment of patient
Gather data
• Diagnostic Reasoning
diagnosis• Therapeutic
Reasoning
Identify a treatment
• Patient counseling
Plan
TIP! Use a Framework of Questions to Guide this Process.
Step 1: Data Gathering
Interview Physical Examination Investigation
Office for Faculty Development
ABC Educational Primer for Physicians
Step 2: Diagnostic Reasoning
Practical Tip
When you have time…
Use a clinical reasoning framework to
guide your learners thru this process
when discussing patient cases.
Office for Faculty Development
ABC Educational Primer for Physicians
Reasoning Framework
Start with an Anatomic /Physiologic DxGenerate a Differential or Pathologic DxArrive at a Clinical DxReview investigationsConsider factors from– History– Physical examination– Investigations
Arrive at a Provisional (working) Dx
Office for Faculty Development
ABC Educational Primer for Physicians
Diagnostic Reasoning
Start with an Anatomic/Physiologic Dx
Generate a Differential/Pathologic Dx
End with a Clinical Dx
Test Hypothesis
Arrive at a provisional (working) diagnosis
Office for Faculty Development
ABC Educational Primer for Physicians
Diagnostic Reasoning
Review factors from HistoryExaminationInvestigations
Should support Provisional (working) Dx
The Case Presentation
Practical teaching tip
Teach around the traditional case
presentation using practical teaching
methods like the One Minute Preceptor or
SNAPPS.
Office for Faculty Development
ABC Educational Primer for Physicians
One Minute Preceptor Model*
Practical Tip
Teach the learner to present the case using SNAPPs
SNAPPS
Summarize
Narrow
Analyze
Proble
Plan
Select
Teaching around the Patient
One Minute Preceptor
Uses traditional case presentation
Preceptor initiated
Higher Order Reasoning
SNAPPS
Uses selective case presentation
Learner needs to be taught
Critical analysis
Self Assessment
But… how do doctors think?
Analytical Non-analytical
Office for Faculty Development
ABC Educational Primer for Physicians
Dual Reasoning Process
Uses intuition (pattern recognition)
• diagnosis (illness/disease and instance/cases scripts)• treatment scripts
But once outside area of expertise or atypical case apply an analytical approach
Office for Faculty Development
ABC Educational Primer for Physicians
Stages of Reasoning
Low knowledge
Acquired knowledge– cluttered facts --- organized framework
Experience – Scripts
Application to Teaching ?
Office for Faculty Development
ABC Educational Primer for Physicians
Office for Faculty Development
ABC Educational Primer for Physicians
Summary
Use questions to facilitate reasoning
When you have time apply a “framework”
Teach around the case presentation (One Minute Preceptor or SNAPPS)
“think out loud” when problem solving
Office for Faculty Development
ABC Educational Primer for Physicians
Reasoning Framework
Diagnostic ReasoningStart with an Anatomic /Physiologic/Phenomenologic
DxGenerate a Differential pathologic DxArrive at a Clinical DxReview investigationsConsider factors from– History– Physical examination– Investigations
Arrive at a Provisional (working) Dx
Therapeutic ReasoningDefine the natural history of the diseaseReview treatment options and alternativesConsider
expectationsrisks
Decide upon a Treatment of Choice.