Putting Schemas to the Test: An Exercise in Clinical Reasoning

Abstract

A 70-year-old previously healthy man presented to the emergency department with 6 weeks of fatigue, fevers, and chills. He had abdominal fullness, early satiety, and 20-pound weight loss over the preceding 8 months. He did not have headache, night sweats, cough, dyspnea, diarrhea, dysuria, or rash. His family noticed yellowing of his skin and eyes over the previous week. He had immigrated from Vietnam to the USA 30 years prior. He lived in Northern California and had traveled to Minnesota 1 month earlier. He previously worked as a landscaper and had been retired for 10 years. He denied tobacco, alcohol, or recreational drug use.

Framework and Schema are False Synonyms: Defining Terms to Improve Learning

“…Though the terms scheme, schema, and conceptual framework [22][23][24][25][26] are often used as a synonym for framework in medical education we suggest distinguishing external representations of knowledge organization (i.e., frameworks [27]) from idiosyncratic conscious and unconscious cognitive mental representations of knowledge (i.e., schema). In the most basic sense, human beings use symbols and words to create frameworks to share conscious elements of their schemas with one another [28].…”

“…Schemas are learned through sociocultural experiences and are activated unconsciously in a particular context (e.g., when a learner speaks to patients it is best to avoid medical jargon but when presenting to an attending physician a learner should use medical terminology). Since everyone has a unique collection of prior physical and sociocultural experiences, schemas are idiosyncratic [22]. Parts of schema are unconscious and reflexive; therefore, it is impossible to fully determine which schemas are activated during a series of decisions or behaviors, even by the individual themselves.…”

“…When teaching clinical reasoning, educators commonly use the terms "schema" and "framework", though as yet there is no clear consensus definition of these terms in the medical literature and they are often used interchangeably [22][23][24][25][26]. Lack of clarity around this terminology may lead an educator to lack specificity in the design of their teaching session or to fail to consider how their teaching will integrate into what the learner already knows about a topic.…”

Diagnostic Schemas: Form and Function

“…In cognitive psychology, both illness scripts (encapsulated knowledge about a single disease) 18 and frameworks to approach a problem are considered types of schemas (i.e., structured representations of knowledge in memory). However, in the clinical reasoning literature, schemas have come to refer to the latter, even though the two forms are closely linked in learning and problem solving.…”

Surgery Clerkship Curriculum Changes at an Academic Institution during the COVID-19 Pandemic

“…A diagnostic schema is an illustrative approach used to categorize a specific abnormality. 7 For example, if a patient presents in shock, a potential schema would outline the different types of shock, such as hypovolemic, distributive, obstructive, and cardiogenic. After the MS3s arrive at a preliminary list of differential diagnoses, they are encouraged to think about illness scripts.…”