Overview: How the Course Works
The course is divided into fourteen modules, each of which focuses on a common clinical scenario. These scenarios include chest pain, dyspnea, acute kidney injury, gastrointestinal bleeding, back pain, weakness, mental status changes, fever in a child, limp in a child, headache, syncope, amenorrhea, uncertainty, and abdominal pain. The modules are scheduled to coincide with or follow other coursework on similar topics (e.g., chest pain and the Cardiovascular course). Each of the modules on a particular condition has two central components:
- Pre-class online case
- In-class discussion sessions
Pre-Class Online Cases
The online cases are to be completed before the discussion sessions. These cases introduce students to both the clinical content for the week and specific aspects of the clinical reasoning process. For most pre-class cases, there is pre-reading that should be completed before starting the case. This prereading will help students in completing the case. There are additionally optional podcasts focusing on the clinical content for the week.
Students are encouraged to complete the cases in collaboration with small groups (2-3 students) of classmates. Completing and discussing the cases as a group allows for peer-teaching and for each student to contribute to the process. Discussion questions based on the cases will be assigned and each student should be prepared to discuss their answers at the outset of the subsequent small group sessions with faculty. These questions will be distributed in the email announcing that the case is open on Canvas.
By the end of the case, students should have a basic understanding of how to approach a patient with the specific clinical concern as well as some new knowledge about the clinical reasoning process. These cases will be discussed in first portion of the small group sessions and students are expected to be able to participate in this discussion. Expertise in clinical reasoning is largely dependent on practice, and these cases were chosen because they demonstrate important clinical content and reasoning processes.
In-Class Case Discussions
The in-class discussion sessions are facilitated by expert clinicians. The sessions are mandatory and each student is expected to participate in the discussions. Each session is centered on the detailed discussion of two patients presenting with the specific concern that is the focus for the week. The discussion quality depends on the thoroughness with which students complete the pre-class on-line cases. The student who did not spend time learning the week’s clinical material beforehand may be quickly left behind during these sessions. The overall goal of these sessions is to have students begin to test their diagnostic abilities under the tutelage of an expert diagnostician.
Other Course Components
Videotaped Lectures
The following concepts are covered in brief videotaped didactic sessions that are available on Canvas: “Introduction to Clinical Reasoning”, “Determination of Pre-Test Probability”, “Likelihood Ratios”, “Thresholds”, “Uncertainty” and “Diagnostic Error”. These didactics cover core topics in clinical reasoning that will be stressed repeatedly throughout the course in both the pre-class and in-class sessions. They are meant to provide a basic level of instruction in these core topics and to serve as a reference. They are assigned during specific weeks and accessing them before the applicable in-class sessions will help significantly with student understanding of this important material.
Quizzes
With the exception of the first week, there will be a brief quiz on Canvas to be completed by 8AM on Tuesday of the discussion week. These quizzes, which are mandatory, serve to reinforce the central clinical and reasoning concepts covered during the previous sessions. The medical education literature suggests that completing quizzes enhances long-term retention of material. The correct answers will become available immediately after the completion of the quiz on Canvas. As the course stretches over ten months, the quizzes provide a useful means of reviewing content that was covered earlier in the course.
Near the end of the course, flashcards will be available on the ANKI platform. These are meant as a study aid and are not mandatory.
ICR bayesian reasoning Assignment
Students are required to complete an assignment in which they apply the principles learned in ICR to a real patient seen in the CAP clinical experience. This counts for 5% of the ICR grade. Assignment details are available on Canvas, including a sample of what the completed assignment should look like.
Self-Directed Learning Assignments
Each student will be required to complete two self-directed learning assignments during the course. The assignment schedule will be distributed early in the course. Following the schedule, the first one of these will be submitted to the small group faculty leader via email while the second one will be presented to the group in a 5-min oral presentation at the start of a small group session in addition to being submitted via email to the small group faculty leader. Completion and performance of the self-directed learning assignment will factor into the class performance grade for the course.