Teaching heuristics and mnemonics to improve generation of differential diagnoses

Abstract

Background: Differential diagnosis (DDx) is one of the key cognitive skills that medical learners must develop. However, little is known regarding the best methods for teaching DDx skills. As metacognition plays a fundamental role in the diagnostic process, we hypothesized that the teaching of specific heuristics and mnemonics collectively termed metamemory techniques (MMTs) would enhance the capacity of medical students to generate differential diagnoses. Methods: In a 90-min DDx workshop, third-year medical students (N = 114) were asked to generate differentials before and after learning each of four MMTs. Differential sizes were compared using a linear mixed-effect model. Students also completed a post-session questionnaire which included a subjective ranking of the MMTs, as well as Likert-scale and freetext sections for course feedback. Results: One MMT (the Mental CT Scan, an anatomic visualization technique) significantly increased the size of student differentials (+13.3%, p =.0005). However, a marked cumulative increase across all four MMTs was noted (+36.5%, p <.0001). A majority of students ranked the Mental CT Scan the most useful MMT (51.5%). They found the workshop both worthwhile (4.51/5, CI 4.33-4.69) and enjoyable (4.33/5, CI 4.12-4.55), and considered the MMTs they learned useful and practical (4.49/5, CI 4.32-4.67). Conclusion:The MMT-based DDx workshop was effective in enhancing the skill of DDx generation, and was rated very favorably by students.

Effects of a Differential Diagnosis List of Artificial Intelligence on Differential Diagnoses by Physicians: An Exploratory Analysis of Data from a Randomized Controlled Study

“…Improving the quality of differential diagnosis can play a major role in the better diagnostic process. Differential diagnosis is the cognitive process of producing and prioritizing a list of potential diagnoses for a given clinical presentation [ 2 ]. By conducting efficient differential diagnosis at the early phase of the diagnostic process, physicians can reach the correct diagnosis timely.…”

“…A diagnostic decision support system (DDSS) that supports the diagnostic process by generating differential diagnoses from observations provided [ 3 ] is expected to reduce diagnostic errors by reducing cognitive biases and reinforcing physicians’ knowledge. It is said that generating potential diagnoses is a rate-limiting step of differential diagnosis for novice diagnosticians [ 2 ], and their diagnostic accuracy was reported to be associated with the number of generated diagnoses [ 4 ]. Besides, using a simple differential diagnosis checklist, which could remind users of some missed diagnoses, was reported to improve the diagnostic accuracy of medical students [ 5 ].…”

Structured work-based learning in undergraduate clinical radiology immersion experience

“…At workplaces, students were supported and challenged by resident physicians to participate and apply their competences. Applying clinical knowledge and skills with actual patients, requires students to organize and recall information and to use heuristics (“mental shortcuts”) representing a high level of academic performance [ 14 ]. Thus, we expected our students to achieve high level ILOs.…”

“The Heart is a House”: A Heuristic for Generating Cardiac Differential Diagnoses

“… 6 – 8 Although some institutions may have implemented explicit curricular elements aimed at teaching the technique of DDx proper, little of this is described in the literature. 7 Recently, we reported the successful implementation of a DDx workshop for third-year medical students built around teaching heuristics and mnemonics, collectively termed metamemory techniques (MMTs). 7 In that study, we evaluated “general-purpose” MMTs that facilitate the generation of large initial differentials across a wide variety of clinical scenarios – an example being the classic VINDICATE(S) acronym for generating differentials by pathophysiology.…”

“… 7 Recently, we reported the successful implementation of a DDx workshop for third-year medical students built around teaching heuristics and mnemonics, collectively termed metamemory techniques (MMTs). 7 In that study, we evaluated “general-purpose” MMTs that facilitate the generation of large initial differentials across a wide variety of clinical scenarios – an example being the classic VINDICATE(S) acronym for generating differentials by pathophysiology. 9 , 10 Although not assessed in that study, “use case-specific” MMTs are also widely taught and are in common use among students and experienced clinicians alike.…”