Internal Medicine

  • Master Clinician Program

    Tips for Facilitating Diagnostic Reasoning Sessions

    1. Picking the Case: Pick well-suited cases that force clinicians to revise and explain their working hypotheses, including evolving stories that draw on broad differential diagnoses.
    2. Use Artistic License: A balance needs to be achieved between information that makes the case realistic and challenging and excluding details of day-to-day care that can be distracting and potentially unfair, having nothing to do with the final diagnosis
    3. Time Management: Cases should be 25-30  minutes, providing time for discussion, questions, and concluding remarks.
    4. Avoid Premature Closure: Do not include clinical information on the initial slide. All that is necessary is the title "clinical problem solving or diagnostic reasoning" and the identifying information of the discussant.
    5. Start Simple: The first case slide should be a succinct statement about the patient with the chief complaint and demographic or clinical information.
    6. Present Data as an "Infusion," not a "Bolus:" A discussion break should follow every two to four slides of clinical data.
    7. Mind the Gap: A blank slide can serve as a buffer to prevent inadvertent divulgence of subsequent information compromising the analysis of the previous slide's data.
    8. Keep the Didactics Short: While a brief didactic session at the end of the presentation can promote additional understanding of the case or diagnosis, audiences learn more if two or three slides at the conclusion include three key points.
    9. Find a Peer Reviewer: It is easy for a presenter to understand the difficulty of a case. Having an experienced clinician review the presentation before it is presented can avert errors in content and organization.
    10. Keep it Real: Just give the facts without any interpretation. Do not fabricate a response based on what the presenter expects it to have been.
    11. The Postscript: The audience should comment on the diagnosis and its thought process after the diagnosis is revealed. The value of the exercise lies in the process that took place before the diagnosis was revealed rather than on the diagnosis itself.
    12. Increase Interactivity: An audience response system where questions are posed to the attendees at multiple junctures during the case is effective and enjoyable to increase interactivity

     

    Dhaliwal G, Sharpe BA. Twelve tips for presenting a clinical problem solving exercise. Medical Teacher. 31:1056-1059,2009.