Observations on diagnostic skills in paediatric medicine and their perceived learning

An attempt was made to review the diagnostic or problem-solving skills of a group of four students as they interviewed children and their parents, who presented with common paediatric problems. The students were instructed to complete a pro forma stating the most likely diagnosis with their reasons; their answers to be given as the interview proceeded and after completion of the patient encounter. The students entertained up to six diagnoses and despite considering the correct diagnosis early in the interview, often arrived at an incorrect final diagnosis. Some improvement was noted in the students' performance when the exercise was repeated at the end of their 10 week paediatric term. The students tended to follow a disengaged enquiry, in part related to an inadequate knowledge base. By way of comparison, four consultants were put through the same exercise and arrived at the correct diagnosis after considering only one or two diagnoses. The students were also asked how they considered they had acquired those skills. As part of their answers, all included "formal learning". The majority also suggested the observation of a suitable clinical model. When the consultants were asked the same questions all included "independent learning". All subjects came from traditional medical schools. The relevance of these findings is discussed in terms of patient management and the teaching of problem-solving skills to undergraduate and postgraduate students.