Tutor notes for Clinical Reasoning

Relevant section of Primary Care Curriculum

Objective Knowledge Skills Attitudes GMC Outcomes

for Graduates

Be able to Knowledge of diagnostic Be able to generate appropriate Clinical curiosity, 13b,13e,13

demonstrate clinical reasoning.
problem solving skills Understanding that clinical
to a satisfactory decisions are made in the wider
standard context of the NHS and have
resource implications
working diagnoses and be able flexibility of thinking f
to consider whether any sieves Be able to recognise the limits
could help in generating of personal competence and act
appropriate hypotheses. appropriately
Be able to seek relevant and
specific information from the
patient to help distinguish
between working diagnoses.
Be able to seek relevant and
discriminating signs to help
confirm or refute working
diagnoses.
Be able to identify and apply
information to the management
of the patient’s problem.
Be able to show a well organised
approach to data gathering and
information giving.
Aims:
The student should be able to:

• Show a well organised approach to data gathering.

• To seek relevant and specific information from the patient

to help distinguish between working diagnoses, and
generate an appropriate working diagnosis.
Objectives:
By the end of the primary care block students will:

• Have consulted with patients and received feedback on

their clinical reasoning skills with strategies for
improvement.
• Have demonstrated clinical reasoning skills to an
acceptable level.
• Have demonstrated a well organised approach to
information gathering.
Resources:
The video on the next slide gives an overview of how we
approach clinical reasoning at Leicester Medical School, and
suggests two frameworks for teaching it:
• The hypothetico-deductive model
• The Bowen framework
Giving feedback on clinical reasoning

The two tools below are being used to give feedback to

students on their clinical reasoning:

• The LAP (Leicester assessment package) is based

around the hypothetico-deductive model
• The Bowen feedback framework is based around the
Bowen model.
Hypothetico-deductive reasoning schema
The Bowen Model schema
Suggestions for using the models
Hypothetico-deductive model
Can be used in a group setting with simulated patient.
• Students can rotate taking the history from the patient simulator
• Information obtained is captured on a whiteboard (suggested format on
next slide)
• The simulation is paused at relevant points to ask the students how
they are interpreting the information they have obtained in order to 1)
formulate their PDI, and 2) after elaborating the presenting complaint
to generate their list of differential diagnoses – from most likely to least
likely – justifying their answers from the information gathered.
Suggested format for capturing data acquired in consultation
Suggestions for using the models
Bowen model
• Ask the student to identify and verbalise their illness scripts for each
chosen differentials.
• Challenge the student to compare and contrast the data acquired
against their illness script for each of differential.
• Encourage the student to practice accurate problem representation –
accurately translating and presenting the key features of the patients
presentation in medical language.
Tools for feedback - LAP competency areas
 Tools for
feedback

LAP

Strategies for
improvement
Tools for feedback
LAP – strategies for improvement cont.
Tools for feedback
Bowen model - framework for feedback