TEACH ON THE RUN!

1. TEACH ON THE RUN! SESSION 3: HELPING LEARNERS THINK! DIAGNOSTIC REASONING Created by Dr. Leslie Ann Sadownik

2. I can be a better teacher… • By Inspiring learners • By Involving them • By teaching them how to think • By providing useful information to help them improve as clinicians.

3. 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

4. Clinical Reasoning Definition Defines the cognitive thinking process whereby aphysician gathers appropriate data; arrives at a diagnosis; identifies a ‘treatment of choice’ and gives a reasoned recommendation to the patient. ABC Educational Primer for Physicians

5. In medical school we teach …

6. Clinical Reasoning Process TIP! Use a Framework of Questions to Guide this Process. ABC Educational Primer for Physicians

7. Step 1: Data Gathering

8. 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. ABC Educational Primer for Physicians

9. Reasoning Framework • Start with an Anatomic /Physiologic Dx • Generate a Differential or Pathologic Dx • Arrive at a Clinical Dx • Review investigations • Consider factors from • History • Physical examination • Investigations • Arrive at a Provisional (working) Dx ABC Educational Primer for Physicians

10. 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 ABC Educational Primer for Physicians

11. Diagnostic Reasoning Review factors from History Examination Investigations Should support Provisional (working) Dx ABC Educational Primer for Physicians

13. The Case Presentation Practical teaching tip Teach around the traditional case presentation using practical teaching methods like the One Minute Preceptor or SNAPPS.

14. One Minute Preceptor Model* ABC Educational Primer for Physicians

16. Practical Tip Teach the learner to present the case using SNAPPs

17. SNAPPS

20. Teaching around the Patient

21. But… how do doctors think?

22. Dual Reasoning Process ABC Educational Primer for Physicians

23. Stages of Reasoning Low knowledge Acquired knowledge cluttered facts --- organized framework Experience Scripts ABC Educational Primer for Physicians

24. Application to Teaching ? ABC Educational Primer for Physicians

25. 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 ABC Educational Primer for Physicians

26. Reasoning Framework Diagnostic Reasoning Start with an Anatomic /Physiologic/PhenomenologicDx Generate a Differential pathologic Dx Arrive at a Clinical Dx Review investigations Consider factors from History Physical examination Investigations Arrive at a Provisional (working) Dx Therapeutic Reasoning Define the natural history of the disease Review treatment options and alternatives Consider expectations risks Decide upon a Treatment of Choice. ABC Educational Primer for Physicians