Generation and Refinement of Diagnostic Hypotheses


**Please note that readings should be done in order by session.  Cases are specific to the faculty members leading the session**

Learning Objectives

  • Describe the process of hypothesis generation                       
  • Practice concepts of hypothesis generation, refinement, and verification
  • Compare the pros and cons of using analytical (ex. Bayesian) and non-analytical (intuitive) reasoning strategies in clinical diagnosis
  • Describe availability and representativeness heuristics
  • Identify errors in diagnostic hypothesis generation
  • Discuss the concept of parsimony and times when this tool of diagnostic validity may fail
  • Understand which test characteristics are important to utilize when interpreting a test
  • Discuss importance of measuring diagnostic errors in terms of patient safety
  • Identify types of diagnostic errors made in primary care practice
  • Develop strategies to improve communication about diagnostic uncertainties with clinic preceptors

Cases for Erin:

Case 3 Diagnostic Refinement Homework

Case 4 Diagnostic Refinement Homework 

Cases for Shwetha

Case 2 Hypothesis Generation


 Readings for Session One:

1) Learning Clinical Reasoning Kassirer Chapter 2 and 3 

What are hypotheses? How are hypotheses generated?

How are diagnoses initiated? What factors are known to be important in the generation of diagnostic hypotheses? What are some examples of a diagnostic hypothesis?

What are some strategies to arrive at a diagnosis from an unstructured experience?

Define the process and goals of hypothesis refinement 

Does the sequence of data collection matter?  Why or why not?  If not, why do we teach medical students to sequence data collection?

How is experience (from book knowledge or clinical encounters) stored and accessed?

 

2) Bringing Diagnosis Intro the Quality and Safety Equations

Why are diagnostic errors frequently overlooked when we discuss improvement of quality and safety practices?

What are some consequences of the absence of diagnosis-related quality measures?

What solutions does the author suggest for placing emphasis on diagnosis in defining quality and safety in health care?


3) Types and Origins of Diagnostic Errors in Primary Care Settings

Why was this study done and what was the objective of the study?

Describe the setting and how the evaluation for diagnostic errors was conducted.

How did they categorize diagnostic errors?

Describe the results. What were the some of the most common errors found?


4) Introduction Forms to Focus 


Readings for Session Two:   


5)  What Every Teacher Needs to Know About Clinical Reasoning.

                List benefits and drawbacks of a Bayesian/probabilistic/analytical clinical reasoning strategy.

                List benefits and drawbacks of pattern recognition or non-analytical clinical reasoning strategies

                How do novices and experts differ in their use of these two reasoning strategies?  What is the optimal reasoning strategy? 

                Describe the implications of this on medical education


6)  Using SNAPPS to facilitate expression of clinical reasoning and uncertainties - a randomized comparison group

                In creating the SNAPPS model, what problem do the authors intend to address?

                Outline the steps of the SNAPPS model           

                How many of the steps in the SNAPPS model do you routinely use while precepting in clinic?  Which do you do the least?

                Describe the findings of the study

                What is the value of encouraging learners to discuss their uncertainties? 


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