Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach

Area of Science:

• Medical Education
• Internal Medicine Residency Training
• Clinical Reasoning

Background:

• Diagnostic reasoning is crucial in medicine, but structured curricula for resident training and evaluation are scarce.
• Existing training often lacks a longitudinal approach to develop and assess diagnostic skills over time.

Purpose of the Study:

• To describe the implementation of a longitudinal diagnostic reasoning curriculum for internal medicine residents.
• To assess the curriculum's effectiveness using self-administered diagnostic thinking inventory (DTI) scores.

Main Methods:

• A "bolus/booster" curriculum was developed and implemented in an internal medicine residency program starting in 2015.
• Residents (R1, R2, R3) received initial "bolus" training annually, followed by "booster" sessions.
• Diagnostic Thinking Inventory (DTI) scores were collected pre-curriculum (2014-2015) and post-curriculum (2016-2017).

Main Results:

• Overall DTI scores improved significantly in the first-year resident (R1) cohort.
• R1 residents showed enhanced flexibility and structure in thinking, and improvements in data acquisition, problem representation, and hypothesis generation.
• Second-year residents (R2s) improved in structure of thinking and problem representation, while third-year residents (R3s) showed no significant improvements.

Conclusions:

• A longitudinal "bolus/booster" diagnostic reasoning curriculum was successfully implemented in an internal medicine residency program.
• The curriculum led to improved diagnostic reasoning skills, particularly evident in the R1 cohort's DTI scores.
• Further refinement may be needed to enhance skill development in more senior residents (R2s and R3s).