Teaching Diagnostic Clinical Reasoning

Most medical students in the United States are not systematically taught clinical reasoning with the same rigor as they are taught the medical interview and physical examination. Despite the exponential growth of interest in evidence-based medicine, the integration of such inquiries into clinical reasoning with individual patients remains a relatively weak link.

Diagnostic strategies of inexperienced medical students frequently begin with an exhaustive collection of data, whereas expert clinicians use multiple complex “scripts” gained through reflection on clinical experience. Experts test a limited number of hypotheses starting early in the interview and move quickly to closure, sometimes with inappropriately heavy reliance on the clinical laboratory. Yet if the laboratory is routinely used to rule out improbable diagnoses without estimating pretest probability, the odds of missing serious ...