Albany Medical College

1
Albany Medical College
Diagnosing Differential Diagnostic Resources in
a Pediatric Clerkship Enid M. Geyer, MLS, MBA and
D. Elizabeth Irish, MLS Albany Medical College,
Schaffer Library of Health Sciences, Albany,
NY Richard H. Sills, M.D. Upstate Medical
University, Department of Pediatrics, Syracuse
NY.
OBJECTIVE To integrate the use of differential
diagnostic resources to support clinical decision
making in a third year pediatric clerkship
through (1) introducing Computer-assisted
Learning in Pediatrics Program (CLIPP) cases and
(2) comparing and analyzing the
differences/similarities between the CLIPP case
and DXplain diagnosis.

METHODS A collaboration was established between
the Library theme (LMI) and the Pediatrics
Clerkship. Students gained experience with
differential diagnostic (DDx) in the eight week
clerkship through the use of (1)
Computer-assisted Learning in Pediatrics Program
(CLIPP) cases and (2) assignments that had them
compare and analyze a CLIPP case and the
corresponding DXplain diagnosis. Since
September 2004, a one hour session is taught by
pediatric faculty or residents with library
faculty assistance. The physician guides the
students through a CLIPP case, soliciting
responses to questions and providing a framework
for the disease. The LMI assignment requires the
students to complete a CLIPP case, run the same
case through DXplain, and compare the results. At
the end of each rotation an evaluation is
distributed. In June 2006 the third and fourth
year students were surveyed to determine the
usefulness of the CLIPP cases.
RESULTS

• 331 assignments submitted between 2004 - 2006
  were reviewed
• 257 assignments compared the DDx of a CLIPP case
  to the same case run in DXplain
• 74 compared DDx of a real patient case to DXplain
  results.
• Of the CLIPP cases, 74 found the diagnosis
  within the top 5 of common or rare diseases
  in DXplain categories, while 66 running a real
  patient diagnosis in DXplain found the same
  diagnosis within the top 5.
• Students identified difficulty entering
  terminology and social history as reasons for not
  arriving at the same or similar DDx.
• Students recognized that DDx tools complement
  rather than replace physician expertise.

• CONCLUSIONS
• CLIPP cases are a valuable tool to build upon
  students DDx skills and clerkship knowledge
  base.
• DXplain helps students identify components needed
  to build a reliable DDx.
• DXplain combined with clinical judgment provides
  helpful guidance in formulating a DDx.

• STUDENT CLIPP SURVEY COMMENTS (conducted in
  2006)
• 73 found CLIPP cases useful or somewhat useful.
• 73 were satisfied or somewhat satisfied with
  CLIPP cases.
• 81 found the CLIPP cases easy or somewhat easy
  to use.
• 47 would recommend CLIPP cases to other
  students.
• 50 might recommend CLIPP cases to other
  students.