You Too Can Teach Clinical Reasoning!

Abstract

* Abbreviations: HSP — : Henoch-Schonlein Purpura RLQ — : right lower quadrant As part of the ongoing Council on Medical Student Education in Pediatrics series on skills and strategies used by great clinical teachers,1–6 this article focuses on practical knowledge and skills for teaching clinical reasoning. Building on SNAPPS and One Minute Preceptor models,6 we will address the clinical assessment portion of oral and written presentations that represents the culmination of the clinical reasoning process. Using the concepts of problem representation,7 semantic qualifiers,8 and illness scripts7,9,10 defined below, we will outline how you can guide your students’ clinical reasoning development. A problem representation is “the one-liner” at the end of a presentation that synthesizes the entire patient story (history details, physical findings, and investigations) into 1 “big picture” statement.7 To create a problem representation, physicians restructure pertinent patient details into abstract terms called semantic qualifiers. Semantic qualifiers are abstractions in medical rather than lay terminology and generally exist in divergent pairs, such as acute versus chronic and severe versus mild (Table 1, step 2).8 Here is an example of a problem representation, with the semantic qualifiers in italics: A previously well, 2-year-old unimmunized girl presents with an acute history of respiratory distress. She is febrile , looks unwell , and is drooling. View this table: TABLE 1 Teaching Steps for Clinical Reasoning Novice clinicians can be taught to generate problem representations by using semantic qualifiers. First, have your students write out a 1- to 2-sentence problem representation (summary of patient information) based on either a written … Address correspondence to Joseph Gigante, MD, Department of Pediatrics, Vanderbilt University School of Medicine, 8232 Doctor’s Office Tower, Nashville, TN 37232-9225. E-mail: joseph.gigante{at}vanderbilt.edu