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
• a physician gathers appropriate data
• arrives at a diagnosis
• identifies a treatment of choice and
• gives a reasoned recommendation to the patient.

5
In medical school we teach
6
Clinical Reasoning Process
TIP! Use a Framework of Questions to Guide this
Process.
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.

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

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

11
Diagnostic Reasoning

• Review factors from
• History
• Examination
• Investigations
• Should support
• Provisional (working) Dx

12
(No Transcript)
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
15
(No Transcript)
16
Practical Tip

• Teach the learner to present the case using
  SNAPPs

17
SNAPPS
18
(No Transcript)
19
(No Transcript)
20
Teaching around the Patient
21
But how do doctors think?
22
Dual Reasoning Process
23
Stages of Reasoning

• Low knowledge
• Acquired knowledge
• cluttered facts --- organized framework
• Experience
• Scripts

24
Application to Teaching ?
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

26
Reasoning Framework

• Therapeutic Reasoning
• Define the natural history of the disease
• Review treatment options and alternatives
• Consider
• expectations
• risks
• Decide upon a Treatment of Choice.

• Diagnostic Reasoning
• Start with an Anatomic /Physiologic/Phenomenologic
  Dx
• 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