Table 1.

Examples of teaching strategies

Have the resident explain his or her thought processes
• When the resident presents a case, have him or her explain the reasoning for each step in the process (gathering data, coming up with hypotheses, making a diagnosis, etc.)How are these data important? What led you to make this diagnosis? What supports your first hypothesis? Your second?This is an interesting strategy for getting a sense of the “quality” of the resident’s clinical reasoning. This strategy can also be used simply in support of the reasoning process.
• Have the resident sum up the clinical situation in 2 or 3 sentences.In a few sentences, summarize the key elements of the situation so that I can understand your thought process.This is an interesting way to “force” the resident to synthesize the key elements, bit by bit, and to develop his or her ability to articulate the patient’s problem.
• Have the resident rank the diagnoses in order of priority and justify his or her choice.In your estimation, which is the most probable diagnosis? Why? What diagnoses did you rule out during the interview? Why?This strategy provides access to the hypotheses generated, then excluded, by the resident. This strategy helps the residents to make connections and develop networks of knowledge about various diseases.
• Explain your own clinical reasoning process in the case being discussed and how it was developed.When the patient tells me that … and when I observe that …, this makes me think of … and so then I …Experts’ clinical reasoning tends to be condensed. They do not necessarily remember the steps in the clinical reasoning process and often have difficulty expressing them.
• If necessary, go back to the patient (to role play) and explain the reasoning behind the steps that were followed.I chose to ask these questions because I was thinking of …. When I saw that … it made me think of … and that is why I took the interview in this direction.All too often, the model loses its teaching effect when the clinician teacher wrongly assumes that the resident was able to follow the teacher’s clinical reasoning process simply by observing him or her.
Read or diagram
• Encourage the resident to do some reading comparing various diseases and disease courses, based on cases encountered.Read about gout and septic arthritis, listing the elements of the anamnesis and the physical examination that distinguish these two diseases.This process will encourage the resident to conceptualize various pathologies instead of merely learning a list of signs and symptoms by heart. This process is even more effective when the supervisor reviews with the resident what he or she understands from the reading.
• Create a diagram of differential diagnoses using the elements obtained during the consultation.Take a moment to do a diagram of the differential diagnoses that you thought of, based on these symptoms; or draw a diagram that illustrates your overall understanding of this clinical situation.This will enable the resident to make connections between the various elements gathered from the patient, and will enable the supervisor to have access to these connections, in order to support them, correct them, or suggest other connections.