Diagnostic Scheming

Martin, Marlene; Manesh, Reza; Henderson, Mark C.; Critchfield, Jeffrey M.

doi:10.1007/s11606-015-3478-0

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…3 A schema is a systematic approach to analyze a defined clinical problem (e.g., acute kidney injury) that provides a framework (e.g., pre-renal, intra-renal, and postrenal) to categorize relevant illness scripts. 4,5 Although the script and schema concepts have been utilized widely to characterize diagnostic decision-making, recent work has also emphasized the role of these knowledge structures in guiding management reasoning. [6][7][8][9] Scripts and schemas reside in long-term memory, guide the selection and analysis of data in a patient encounter, drive clinical decisions, and continuously evolve as they are repeatedly accessed and utilized.…”

Section: Learning Science Principlesmentioning

confidence: 99%

How to Keep Training—After Residency Training

Krimmel-Morrison

Dhaliwal

2022

J GEN INTERN MED

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Lifelong learning in medicine is an important skill and ethical obligation, but many residents do not feel prepared to be effective self-directed learners when training ends. The learning sciences offer evidence to guide selfdirected learning, but these insights have not been integrated into a practical and actionable plan for residents to improve their clinical knowledge and reasoning. We encourage residents to establish a self-directed learning plan, just as an athlete employs a training plan in the pursuit of excellence. We highlight four evidence-based learning principles (spaced practice, mixed practice, retrieval practice, and feedback) and four training strategies comprising a weekly training plan: case tracking, simulated cases, quizzing, and new evidence integration. We provide tips for residents to implement and refine their approach and discuss how residency programs can foster these routines and habits. By optimizing their scarce selfdirected learning time with a training plan, residents may enhance patient care and their career satisfaction through their pursuit of clinical mastery.

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Section: Learning Science Principlesmentioning

confidence: 99%

How to Keep Training—After Residency Training

Krimmel-Morrison

Dhaliwal

2022

J GEN INTERN MED

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“…Diagnostic schemas are cognitive frameworks that provide a structured approach to different clinical scenarios-chief complaints (e.g., altered mental status), abnormal laboratory values (e.g., anemia), or physical findings (e.g., neuromuscular weakness). 3 In medical education, schemas help learners understand key concepts, and further serve as invaluable tools in clinical reasoning. By providing a conceptual framework coded in long-term memory, schemas also facilitate an analytical approach to complex scenarios.…”

Section: Commentarymentioning

confidence: 99%

“…In such instances, the use of diagnostic schemas-conceptual frameworks that provide a structured approach to an abnormality-can facilitate a more analytic method of problem solving. 3 As an example, the discussant uses his schema for causes of jaundice, which in addition to providing a structure to think through a single problem, has the added benefit of containing a Bdo not miss^diagnostic checklist. In creating a structured and more manageable approach to problem solving, schemas reduce the cognitive load and provide increased bandwidth for more effective reasoning.…”

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confidence: 99%

Putting Schemas to the Test: An Exercise in Clinical Reasoning

et al. 2018

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A 70-year-old previously healthy man presented to the emergency department with 6 weeks of fatigue, fevers, and chills. He had abdominal fullness, early satiety, and 20-pound weight loss over the preceding 8 months. He did not have headache, night sweats, cough, dyspnea, diarrhea, dysuria, or rash. His family noticed yellowing of his skin and eyes over the previous week. He had immigrated from Vietnam to the USA 30 years prior. He lived in Northern California and had traveled to Minnesota 1 month earlier. He previously worked as a landscaper and had been retired for 10 years. He denied tobacco, alcohol, or recreational drug use.

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“…Listeners are encouraged to think along with discussants. CPSolvers emphasizes teaching diagnostic schemas, conceptual frameworks that provide a structured approach to specific clinical problems [13,14].…”

Section: Introductionmentioning

confidence: 99%

Morning report for all: a qualitative study of disseminating case conferences via podcasting

Shipley

Nematollahi

et al. 2021

BMC Med Educ

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Background Despite its long-established importance, diagnostic reasoning (DR) education has suffered uneven implementation in medical education. The Clinical Problem Solvers (CPSolvers) podcast has emerged as a novel strategy to help teach DR through case conferences with expert diagnosticians and trainees. CPSolvers has 25,000 listeners in 147 countries. The aim of this study was to evaluate the podcast by eliciting the developers’ goals of the podcast, then determining to what extent they aligned with the listeners’ actual usage habits, features they valued, and perceptions of the podcast. Methods We conducted semi-structured interviews with 3 developers and 8 listeners from April–May 2020, followed by qualitative thematic analysis. Results Three major developer goals with sub-goals resulted: To teach diagnostic reasoning in a case-based format by (1a) teaching schemas, (1b) modeling expert diagnostic reasoning, (1c) teaching clinical knowledge, and (1d) teaching diagnostic reasoning terminology. To change the culture of medicine by (2a) promoting diversity, (2b) modeling humility and promoting psychological safety, and (2c) creating a fun, casual way to learn. To democratize the teaching of diagnostic reasoning by leveraging technology. Listeners’ usage habits, valued features, and perceptions overall strongly aligned with all these aspects, except for (1c) clinical knowledge, and (1d) diagnostic reasoning terminology. Listeners identified (1a) schemas, and (2c) promotion of psychological safety as the most valuable features of the podcast. Conclusion CPSolvers has been perceived as a highly effective and novel way to disseminate DR education in the form of case conferences, serving as an alternative to traditional in-person case conferences suspended during COVID-19. CPSolvers combines many known benefits of in-person case conferences with a compassionate and entertaining teaching style, plus advantages of the podcasting medium — democratizing morning report for listeners around the world.

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Diagnostic Scheming

Cited by 12 publications

References 11 publications

How to Keep Training—After Residency Training

How to Keep Training—After Residency Training

Putting Schemas to the Test: An Exercise in Clinical Reasoning

Morning report for all: a qualitative study of disseminating case conferences via podcasting

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