"The 2-Dimensional Approach": a novel tool to help learners organize their knowledge and improve their clinical...

This article was migrated. The article was marked as recommended. Background: Clinical reasoning is an essential competence of a physician. Particularly, pathophysiological understanding is the key for novices to organize their knowledge and improve clinical reasoning. To this end, we propose a "2-Dimensional (2D) Approach" that visualizes pathophysiology by using a matrix of organs and systems. Methods: This study was a prospective observational study of 100 residents (PGY-1), who attended a lecture on the 2D Approach. They underwent a pre- and post-test that assessed their ability to list differentials for various symptoms and to choose the most likely diagnosis for a case vignette. We stratified the participants according to their baseline knowledge level on the pretest into 2 groups (high-knowledge and low-knowledge). In each of the 2 groups, we compared the change in the pre- and post-test scores between participants who used the 2D Approach during the posttest and those who did not. Results: In the high-knowledge group (n=59), the change in the pre- and post-test scores was significantly larger in the 2D Approach users than non-users (p=0.046), while in the low-knowledge group (n=41), there was no significant difference in the change of the scores between the 2D Approach users and non-users. Conclusions: On condition that residents have sufficient knowledge, the 2D Approach helps them organize their knowledge and improve their clinical reasoning skills, through visualization of pathophysiology on a matrix of organs and systems.