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Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach

  • Katherine I. Harris EMAIL logo , Jane S. Rowat and Manish Suneja
Published/Copyright: July 27, 2019
Diagnosis
From the journal Diagnosis Volume 7 Issue 1

Abstract

Background

Diagnostic reasoning skills are essential to the practice of medicine, yet longitudinal curricula to teach residents and evaluate performance in this area is lacking. We describe a longitudinal diagnostic reasoning curriculum implemented in a university-based internal medicine residency program and self-evaluation assessment of the curriculum’s effectiveness.

Methods

A longitudinal diagnostic reasoning curriculum (bolus/booster) was developed and implemented in the fall of 2015 at the University of Iowa. R1, R2, and R3 cohorts were taught the “bolus” curriculum at the beginning of each academic year followed by a “booster” component to maintain and build upon diagnostic reasoning skills taught during the “bolus” phase. Self-administered diagnostic thinking inventory (DTI) scores were collected in the spring of pre-curriculum (baseline, 2014–2015) and post-curriculum (2016–2017).

Results

The overall DTI scores improved in the R1 cohort, although statistically significant differences were not seen with R2s and R3s. In the original DTI categories, R1s improved in both flexibility of thinking and structure of thinking, the R2s improved in structure of thinking and the R3s did not improve in either category. R1s showed improvement in three of the four subcategories – data acquisition, problem representation, and hypothesis generation. The R2s improved in the subcategory of problem representation. R3s showed no improvement in any of the subcategories. The R3 cohort had higher mean scores in all categories but this did not reach statistical significance.

Conclusions

Our program created and successfully implemented a longitudinal diagnostic reasoning curriculum. DTI scores improved after implementation of a new diagnostic reasoning curriculum, particularly in R1 cohort.

Keywords: diagnostic reasoning; education; internal medicine; internship and residency; problem-based learning
Corresponding author: Katherine I. Harris, MD, University of Iowa, Department of Internal Medicine, 200 Hawkins Drive, E327-1 GH, Iowa City, IA 52242, USA, Phone: 319-384-8512

Acknowledgments

We would like to thank Teresa Ruggle and Kris Greiner for their assistance in preparing and editing this manuscript. We would also like to thank Dr. Kristi Ferguson for her help in the statistics and Dr. Bharat Kumar for his help in developing the sub-categories of the DTI.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2019-0023).

Received: 2019-03-20
Accepted: 2019-07-17
Published Online: 2019-07-27
Published in Print: 2020-01-28

©2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2019-0023
Keywords for this article
diagnostic reasoning; education; internal medicine; internship and residency; problem-based learning

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education
  4. Mini Review
  5. Controversies in diagnosis: contemporary debates in the diagnostic safety literature
  6. Opinion Paper
  7. Balancing confidence and humility in the diagnostic process
  8. Point/Counterpoints
  9. Roots of the total testing process
  10. Total testing process: roots and state-of-the-art
  11. Original Articles
  12. Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach
  13. Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers
  14. Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database
  15. Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors
  16. Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume
  17. Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules
  18. Letter to the Editor
  19. The day God created man
  20. Case Reports
  21. Entamoeba histolytica liver abscess case: could stool PCR avoid it?
  22. A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
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