[EXTERNAL] [IMPROVEDX] Deep Differential Diagnoses - A new(?) kind of vignette-based assessment item

Hamm, Robert M. (HSC) Robert-Hamm at OUHSC.EDU
Wed Jan 2 21:28:55 UTC 2019


It is similar in principal to the Script Concordance Test.
  (e.g., https://www.ncbi.nlm.nih.gov/pubmed/24280838,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427021/)
in which a student is presented with a case and asked what to do, and graded according to how common his or her answer is, compared to the answer’s frequency in a sample of practicing physicians. Has the student learned the practicing physician’s script for how to handle this kind of case?

Rob Hamm

From: Martin Pusic [mailto:mpusic at GMAIL.COM]
Sent: Wednesday, January 2, 2019 12:39 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [EXTERNAL] [IMPROVEDX] Deep Differential Diagnoses - A new(?) kind of vignette-based assessment item


Hi all,

I'm  writing a proposal to develop a new kind of vignette-driven DDx case item for our residents. In it we propose to use crowd-sourcing to identify ALL the plausible diagnoses that could originate from a given case vignette. ie, by having a 100 clinicians list their possible diagnoses, we get a frequency distribution of possibilities that people considered plausible.  We would use as many clinicians as necessary to achieve "saturation" where no further plausible diagnoses are being added.

After being cleaned up for duplicates/terminology etc, the idea would be to present the weighted DDx list as the "answer" to the vignette.  The idea is that some diagnoses fall nicely into a single best answer DDx (e.g. zoster/shingles - left hand pane of attached image) while some require an inductive approach that has a "long tail" which requires more inductive effort  (e.g. lower abdominal pain - right hand pane).

My question to the group:  is this novel?  ie, are there existing systematized approaches where the answer to the case is NOT a best single answer but rather the weighted DDx?   For pedagogic reasons, would anyone ever present a case and NOT present what it turned out to be, but leave it at what it MIGHT have been?

Any literature references sincerely appreciated.

--Martin Pusic, NYU School of Medicine

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