Improving Reasoning Once Michael decided to work to improve his clinical reasoning, he realized that he did not have a strategy to do so. Determined to improve his grades, be better prepared for...

Improving Reasoning

Once Michael decided to work to improve his clinical reasoning, he realized that he did not have a strategy to do so. Determined to improve his grades, be better prepared for residency and be the best possible physician, Michael decided to try out the step-by-step approach for improving clinical reasoning. He found a mentor, Dr. Jones, who was willing to review the approach and provide feedback and opportunities for reflection. He then set up meetings with Dr. Jones twice a week for 2 months to create a time and space to review his progress and to get feedback. Methodically, Michael worked through the steps one by one. During the first meeting, he and Dr. Jones reviewed the strategies for creating a differential diagnosis, and he asked Dr. Jones to help him identify the most common chief complaints and presentations for his upcoming rotation – Neurology. There were six common presentations, and Michael worked to build grids for each. He also collected cases from his rotation for steps 6, 7, 9 and 11. The process of going through all of the steps was timeconsuming, but Michael noticed an improvement in his performance on rounds. He emphasized his clinical reasoning on rounds using the SNAPPS method of presentation and listened to the feedback that he was given. He became more interested in the work he was doing and more engaged with patient care. Michael then noticed a change in his evaluations, and his course grades and performance on OSCEs began to improve.