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Reasoning on Rounds: a Framework for Teaching Diagnostic Reasoning in the Inpatient Setting
John C Penner1,2, Lindsey C Shipley3, Daniel J Minter4,5
1Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA. john.penner@ucsf.edu.
Journal of General Internal Medicine
|August 14, 2023
Summary
Internal medicine trainees can improve diagnostic reasoning (DR) teaching skills. This framework offers practical strategies for educators to enhance DR instruction during inpatient rounds.
Area of Science:
- Medical Education
- Internal Medicine
- Clinical Reasoning
Background:
- Diagnostic reasoning (DR) is a critical competency for internal medicine trainees.
- Trainees may lack confidence or structured approaches to teaching DR.
- Inpatient rounds are a primary setting for clinical skill development.
Discussion:
- A structured framework can demystify teaching diagnostic reasoning.
- Focusing on the patient one-liner aids in concise case summarization.
- Structuring the assessment and plan (A&P) around reasoning is key.
- Day of discharge reflection reinforces learning and teaching opportunities.
Key Insights:
- Provides a practical, actionable framework for teaching diagnostic reasoning.
- Empowers resident clinical teachers to effectively mentor trainees.
- Enhances the quality of diagnostic reasoning education in inpatient settings.
Outlook:
- Potential for improved diagnostic accuracy and patient care.
- Further research into the framework's impact on trainee competency is warranted.
- Adaptable framework for other medical specialties and educational settings.
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