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

Abstract

BackgroundDiagnostic 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.MethodsA 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).ResultsThe 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.ConclusionsOur 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.

Virtual Interactive Case-Based Education (VICE): A Conference for Deliberate Practice of Diagnostic Reasoning

“…VICE added to our residents’ education as a stand-alone conference, but it may function best when situated in a longitudinal curriculum that includes training on reasoning theory and cognitive bias recognition. 5 , 7 Although we implemented VICE with a relatively limited population of learners (internal medicine residents), we have also piloted it with medical students and believe it would be generalizable to most medical learners, as long as cases are selected and adapted appropriately.…”

“…2 Prior work at the graduate medical education level includes longitudinal curricula on cognitive biases, clinical reasoning concepts, and diagnostic skills. [5][6][7] There are a number of resources available in MedEdPORTAL addressing diagnostic reasoning. These include introductory didactic materials on cognitive errors and decision-making, 8,9 case-based curricula to teach medical students to recognize cognitive errors, 10,11 and a simulation-based curriculum for emergency medicine residents on cognitive error avoidance.…”

Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review

“…Two studies addressed explicit diagnostic reasoning curriculum in their medical residency programs. Harris et al (2019) used a 1-week bolus of intensive diagnostic reasoning seminars followed by booster sessions given throughout the residency year. This program was repeated the following year.…”

Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education

“…In this issue of Diagnosis, Harris and colleagues present their efforts to implement and study a longitudinal diagnostic reasoning curriculum within an internal medicine residency [7]. Their approach provides an explicit, foundational curriculum (the bolus) that is followed by reinforcement of key concepts of diagnostic reasoning within the pre-existing educational structure of their residency program (the booster).…”