Factors associated with clinical reasoning ability

Mark Graber mark.graber at IMPROVEDIAGNOSIS.ORG
Wed Aug 31 13:37:58 UTC 2016

Thanks for sharing Dr Manesh’ survey, Shantanu.  

If the goal is to assess their clinical reasoning, I’d like to see other questions, like these:
	When confronted with a new diagnostic challenge, I regularly construct (and document) a differential diagnosis
	When I’m not sure of a diagnosis or ’the next step', I get a second opinion from a peer
	When I’ve reached a tentative diagnosis, I consider whether my conclusion might have been influenced by a cognitive bias

If the goal is broader, looking at success in the diagnostic process, there are other key behaviors that are relevant:
	Have I succeeded in making the patient a partner in the diagnostic process?
	Does my patient know when, why, and how to get back to me if the symptoms persist, change or don’t respond to treatment?
	How often do I personally interact with the radiologists or pathologists interpreting diagnostic tests on my patients?
	According to independent surveys, how effectively am I communicating with my patients?
	Do I keep a record of tests and consults ordered and make sure I close the loop on all of these?
	Do I designate a surrogate to review returning test results if I’m going on vacation?

It would be great to hear from others on the listserv about this.  What observable behaviors characterize clinicians who excel at diagnosis?


Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook
President, Society to Improve Diagnosis in Medicine

On Aug 30, 2016, at 4:57 PM, Shantanu Nundy <shantanu at HUMANDX.ORG> wrote:

Our collaborators at Johns Hopkins will soon be leading a national study to validate the Human Diagnosis Project (Human Dx) open case collaboration platform as a tool for measuring clinical reasoning ability.

Part of this initial study includes surveying physicians and trainees to collect data on factors known or strongly suspected to be associated with clinical reasoning ability, including structural factors (e.g., years of practice, practice setting) and physician attitudes, beliefs, and behaviors.

Dr. Reza Manesh, one of the PIs for the study, copied here, is interested in getting feedback from this group on a late draft of the survey. See attached.

Thank you in advance for your insights,
Shantanu Nundy, MD

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