Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

HM Epstein hmepstein at GMAIL.COM
Tue Sep 12 04:36:44 UTC 2017


This may be a terrific article...if only I could read it. I don't have
access to the Annals of Internal Medicine. I've requested Media credentials
but in the meantime, for those of you who do have access, here's an
abstract. And the link:
http://annals.org/aim/article/2653703/diagnostic-reasoning-endangered-competency-internal-medicine-training

Best,
Helene

Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

Arabella L. Simpkin, MD, MMSc; Jatin M. Vyas, MD, PhD; Katrina A.
Armstrong, MD, MSCE
Article, Author, and Disclosure Information
<http://annals.org/aim/article/2653703/diagnostic-reasoning-endangered-competency-internal-medicine-training#>

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   <http://annals.org/aim/article/2653703/diagnostic-reasoning-endangered-competency-internal-medicine-training#>
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   <http://annals.org/aim/article/2653703/diagnostic-reasoning-endangered-competency-internal-medicine-training#>
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   <http://annals.org/aim/article/2653703/diagnostic-reasoning-endangered-competency-internal-medicine-training#>


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Diagnosis is one of the most important tasks performed by internal medicine
physicians, and diagnostic reasoning is perhaps the most critical of an
internist's skills. The foundation of the diagnostic process is the
patient's medical history and the physical examination, which lead to an
initial differential diagnosis that is adjudicated through an
ever-increasing array of diagnostic tests and data points as well as the
patient's course over time. Historically, diagnostic reasoning and
expertise have been highly valued in residency training, figuring
prominently in curricula, conferences, and teaching rounds. However,
despite growing recognition of the importance of diagnostic error with
regard to patient safety and the need to “enhance healthcare professional
education and training in the diagnostic process” (1), several signs
indicate that the focus on diagnostic reasoning in internal medicine
training may be threatened (2). Indeed, only 2 of the 22 Internal Medicine
Milestones of the Accreditation Council for Graduate Medical Education and
American Board of Internal Medicine—milestones 1 and 7—explicitly include
diagnostic skills (3). Although this disconnect between the importance of
diagnostic reasoning skills and the current approach to medical education
has not gone unnoticed, responses largely have focused on adding clinical
reasoning courses to medical school curricula and incorporating clinical
reasoning into certification assessments (1, 4).






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