Weekly Article: You Can Teach Clinical Reasoning

Dear All,

After skipping a week due to Sandy's visit, the EMTC Weekly Article is back!

As I was skimming through this November's issue of Pediatrics, I didn't go far before I fell on this article: You Too Can Teach Clinical Reasoning! (by Amy Fleming, William Cutrer, Tyler Reimschisel and Joseph Gigante. Pediatrics 2012;130;795)

I thought, "Really, I can?.. I'm not even sure what clinical reasoning means! But sure, let's see if I too can!"
So I went through this very easy to read article that I would now like to share with you. Why? See below.

1- As we move forward with the SOUND sign out model, I still thing many of the residents (not to blame us smart attendings) have difficulty doing the SYNTHESIS.
The 1st part of this article mentions the term semantic qualifiers.  "Semantic qualifiers are abstractions in medical rather than lay terminology and generally exist in divergent pairs, such as acute versus chronic and severe versus mild". For those of us who knew what synthesis means, but maybe weren't doing a good job explaining it with correct terms  to our med students and residents: read that section! I found it easy and helpful.

2- Illness Scripts: "the concept of illness scripts is abstract. Illness scripts are what experienced physicians unconsciously use when they assess and diagnose a patient".
They are basically what make us sound so smart in front of the med students! It is what we do when a student presents a case to us and we go down our check boxes (as I call it) or "illness script" (as they call it in this article) to narrow even sometimes pinpoint our diagnosis. It is also what we try to teach our students and residents. They describe 3 components of a clinical script in this article: predisposing conditions, pathophysiolgic insults, and clinical consequences. I may not have termed them that way, but I do think it is more or less what we all go through in our heads. Read table 1, it will help you teach students (and word it) how to do it too!

Enjoy reading, and keep your eye's opening for next week's EMTC weekly article by Dr. Tat!

Rasha