Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: Despite a commitment to high-quality medical education, diagnostic errors continue to be pervasive. Clinical presentations with nonspecific symptoms and diagnoses with wide differentials are prone to diagnostic errors; dizziness may be the epitome of this conundrum. Dizziness is a common symptom, costly to assess, and frequently misdiagnosed. Diagnostic decisions have high stakes, given the [...]

Background: Early development of clinical reasoning and problem-solving competencies are essential in generating individualized, outcome-based, and cost-effective patient care plans (Nat Acad Press 2015). However, few medical schools and residency programs have an explicit curriculum in clinical reasoning (Graber et al., 2012). A recent survey of internal medicine clerkship directors found medical students receive limited [...]

Background: The Exercises in Clinical Reasoning (ECR) series in the Journal of General Internal Medicine (JGIM) is a unique and growing series of 30 case-based problem-solving manuscripts, designed to teach the foundations of clinical reasoning to both educators and students. For selected cases, the ECR team has produced teaching materials, including PowerPoints of ECR cases [...]

Background: Diagnostic errors (DE) – defined as incorrect, missed, or delayed diagnoses not made within a timeframe consistent with standard clinical practice – are common and can lead to harm, especially in acute care settings. One cause of DEs is suboptimal clinical reasoning in the diagnostic process. Electronic clinical documentation has been suggested to potentially [...]

Background: Diagnostic and clinical reasoning errors are common and a source of harm to our patients. Improving clinical reasoning skills is challenging due to the absence of feedback. Care transitions have been recognized as an area of vulnerability for hospitalized patients, however, they also represent opportunities for error recognition and improvement as the oncoming clinician [...]

Background: Hospital discharges represent an important transition of care between the inpatient and outpatient setting. Discharge summary documentation enables providers to convey clinical reasoning and important updates in patient care; however, reviews of these documents suggest error rates as high as 36.4% (1.42 errors per document) (McMillen, et. al. 2006). Formalized resident discharge summary curricula [...]

Background: High quality clinical documentation is essential for patient safety. Thoughtful clinical documentation transmits one’s clinical reasoning and is considered to be a professional responsibility. There are no accepted standards for assessing documentation with respect to clinical reasoning. We therefore undertook this study to establish a metric to evaluate hospitalists’ documentation of clinical reasoning in [...]

Background: The Association of American Medical Colleges identifies consideration of social determinants of health (SDoH) and patient-specific factors as key components of entrustable professional activities (Englander 2016). Prior studies of medical students and Internal Medicine (IM) residents demonstrated baseline gaps in integrating SDoH into clinical reasoning (CR) in the outpatient setting (Schwartz 2010, Wilhite 2020), [...]