Clinical Reasoning Toolkit
Browse current diagnostic error and improvement curricula, and proven teaching strategies.
Clinical Problem Solving (Coursera)
A comprehensive video set on clinical thinking, drawing on many concrete examples, as taught by UCSF's vice dean for education who is renowned for her grounding in the learning sciences.
A good starter video to learn about clinical reasoning from a researcher who studies expert diagnostic reasoning.
Cognitive Bias and Diagnostic Error for Medical Residents
University of Pennsylvania Curriculum
A great resource for educators jumping into teaching clinical reasoning and mitigation of common biases that impact reasoning, this folder contains "off-the-shelf" materials such as lecture slides, instructors guides, activities, and handouts. Be sure to compare it with the other curricula provided.
Cognitive Debiasing Workshop for Medical Residents
Sometimes we don't see what's right in front of us—the kind of errors that are most devastating to physicians. This teaching resource addresses the mental traps that can cloud physician judgement and shares strategies for reducing risk of diagnostic error. Generously shared by Brent Smith, this folder contains all materials to operationalize teaching and assessment of two-lecture workshop for residents.
Dalhousie University Critical Thinking Curriculum
This curriculum on critical thinking as a core competency of diagnostic excellence shares a program overview as well as materials for curricular integration and assessment.
Education for the Next Frontier in Patient Safety: A Longitudinal Resident Curriculum on Diagnostic Error
Emily Ruedginer, et al.
This highly-rated curriculum includes strategies to understand the medical decision-making process, build skills in critical thinking, and provide strategies for diagnostic error mitigation.
Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents
James Reilly, et al.
A longitudinal curriculum in cognitive bias and diagnostic error for residents designed to teach residents about recognition of cognitive biases. Includes a novel assessment tool.
Seen through their eyes: residents' reflections on the cognitive and contextual components of diagnostic errors in medicine
Alexis Ogdie, et al.
Sharing residents' reflections on the cognitive and contextual components of diagnostic errors in medicine, this article suggests how the process of reflective writing can help residents richly describe what and how they are learning about cognitive errors.
From Problem Lists to Illness Scripts
This presentation provides a clear approach for teachers to assess learners' thinking and effective ways of responding using several examples.
Becoming a Teacher of Clinical Reasoning
Robert Trowbridge and Andrew Olsen
Speaking directly to faculty engaged in guiding learners towards mastery in clinical reasoning, this piece shares wisdom and strategies applicable across sites. Authored by two physician-educators leading two different touchstone programs in clinical reasoning at different medical schools, this piece honors teaching that is closely in contact with research from the learning sciences.
You too can teach clinical reasoning!
Amy Fleming, et al.
This article outlines the pedagogical structure for one method of teaching reasoning in pediatrics.
Supervision of clinical reasoning: methods and a tool to support and promote clinical reasoning
Marie-Claude Audetat, et al.
This article shares methods and a tool that supervisors can use in cases when they did not directly observe the clinical interaction.
What every teacher needs to know about clinical reasoning
Advocating for the importance of flexibility when solving clinical problems, this article includes a brief review of research on teaching clinical reasoning then provides general recommendations for clinical teachers, with particular insight into the arts of balancing analytic and non-analytic reasoning, and of accounting for context.
Improving Diagnostic Reasoning
After reviewing the cognitive psychology of diagnostic reasoning, the authors propose steps that clinicians and healthcare systems can take to improve diagnostic accuracy.
Educational strategies to reduce diagnostic error: can you teach this stuff
How can medical novices transition to diagnostic expertise? This classic article helps educators support the development of reasoning and provides useful diagram examples of illness scripts.
Twelve tips for teaching avoidance of diagnostic errors
How can educators familiarize learners with the cognitive underpinnings of diagnostic error? This article describes how to teach several approaches to the diagnostic process that may lessen likelihood of error, emphasizing techniques for metacognition, the clinical examination, and simple strategies such as 'diagnostic time-outs,' and the practice of 'worst-case scenario' medicine.
Diagnostic error in medical education: where wrongs can make rights
Great resource in the service of destigmatizing error in order to promote learning.
Teaching clinical reasoning: case-based and coached
Drawing on a depth of literature from adult learning theory, this seminal article demystifies concepts such as hypothesis generation, pattern recognition, context formulation, diagnostic test interpretation, differential diagnosis, and diagnostic verification.
Minimizing diagnostic error: the importance of follow-up and feedback
This commentary discusses the lack of systematic feedback loops in health care and implications for physician’s ability to continually fine-tune diagnoses. Dr. Schiff proposes a new paradigm for reducing diagnostic error, shifting the focus from the cognitive process (physician overconfidence, cognitive biases, and heuristics) to the work environment (barriers to feedback and follow-up), and patient and family engagement (co-production of diagnoses and the treatment response).
The feedback sanction
This review article offers pointers on strong feedback loops and avoiding barriers in the ED.
Feedback in clinical medical education
This article presents guidelines for feedback drawing from the literature of business administration, psychology, and education, and it is adapted for clinical teachers.
Clinical Reasoning Education at US Med Schools
Joseph Rencic, et al.
A survey of clerkship directors with a high response rate found that less than half of schools have a formal curriculum on clinical reasoning, and that 80% were dissatisfied with student reasoning competency at the end of the clerkship.
How can students' diagnostic competence benefit most from practice with clinical cases? The effects of structured reflection on future diagnosis of the same and novel diseases
Mamede, et al.
A prospective educational study investigated the effects of reflection on cases compared with generating a single or differential diagnosis suggesting that reflection enriched mental representations of diseases, and also influenced the representations of adjacent, but different, diseases.
How to Improve the Teaching of Clinical Reasoning: a Narrative Review and a Proposal
H. Schmidt and S. Mamede
An important review performed by two thought leaders in diagnostic education concerned with real-world strategies educators can use to improve diagnostic education.
Drawing Boundaries: The Difficulty in Defining Clinical Reasoning
Meredith Young, et al.
In this research-based article, the authors acknowledge the challenges of defining concepts of clinical reasoning; much variability exists.
More from the Clinical Reasoning Toolkit
Tools for Educators
Check out all of the Society to Improve Diagnosis in Medicine (SIDM)'s resources from medical educators.