A Novel Metric and Feedback Template Improves Differential Diagnosis Formation Capabilities in Pre-Clinical Medical Students.

Abstract

The ability to form an accurate differential diagnosis is of paramount importance to the physician in training, but is a skill often relegated to practice during the clinical years of the traditional medical school curriculum. Further complicating matters is the subjective nature of what constitutes an accurate differential and the fact that a widely accepted metric or template for feedback does not currently exist. Our group created a collaborative metric that assessed differential diagnosis formation and provided feedback to 47 first-year, preclinical medical students through their practice of various clinical vignettes as part of the Mayo Medical School Pathology course. We found that first-year students not only improved significantly in their ability to form a more accurate differential but also reported engagement in self-directed learning as well as developing positive attitudes toward early clinical integration. Given the importance of these skills for future physicians, and the successes of our intervention, we propose that such metrics be used for guiding feedback to students learning to create differentials in the early undergraduate medical curriculum.

Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making

“…The first volunteer patient presented his history of liver cirrhosis secondary to alpha-1 antitrypsin deficiency during the first week of the course. The differential assignments were graded by teaching assistants using the grading rubric shown in Figure 1 and using a previously described grading methodology (Martin et al, 2014). The first assignment resulted in an average score of 8.8 ± 3.1 out of 18 (Figure 2).…”

“…The first assignment resulted in an average score of 8.8 ± 3.1 out of 18 (Figure 2). During the pathology course, lectures, assignments, and teaching assistant feedback was devoted to helping students learn how to develop differential diagnoses, including the VITAMIN CDE methodology (Martin et al, 2014), how to ask appropriate questions of patients, and how to make basic diagnostic decisions.…”

“…Consequently, the cases and the grading rubric allowed for a wider variability in the differential diagnoses compared with simpler medical case presentations. Teaching assistants utilized an established grading rubric and grading methodology used in other differential diagnosis assignments in the course to grade the assignments on an 18-point scale ( Figure 1) (Martin et al, 2014). Student scores on the assignments were compared using ANOVA with Tukey-Kramer post-processing at the 0.05 α level.…”

“…Students are taught how to form differential diagnoses and begin the initial steps of clinical decision-making (Martin et al, 2014). In the past, differential diagnosis was taught in the context of short patient cases that illustrated common human pathologies.…”

Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making

“…At the Mayo Medical School, we have been teaching differential diagnosis in the context of the first-year Pathology course for a number of years. Students are taught how to form differential diagnoses and begin the initial steps of clinical decision-making (Martin et al, 2014).…”