Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

Tommaso, Laura ltommaso at NCH.ORG
Tue Sep 12 15:33:35 UTC 2017


Another side of the coin: There is a lot of curriculum that many argue should be included in medical school curriculum including practice management, billing, ethics.. Unfortunately, there is just not room, the science content is much more important, and there are only 2 years for classroom study. As a primary care physician, I find that my favorite part of the job is being a “detective”, and I see the same enthusiasm in the medical students I teach. In fact, some have even chosen to go into primary care because there is much more opportunity to use the diagnostic process. I don’t think the intellectual curiosity that a master diagnostician has is something that can be taught, either. There are many PCPs that just want to refer, refer, refer..

From: HM Epstein [mailto:hmepstein at GMAIL.COM]
Sent: Monday, September 11, 2017 11:37 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

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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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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