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Clinical Reasoning Education through Gamification

Errors in diagnostic reasoning are a leading cause of medical error. Diagnostic reasoning as described by information processing theory starts with data acquisition, formation of a problem representation, followed by illness script activation and a hypothesis for the patient’s presentation. Additional data is then acquired in a hypothesis-driven fashion to determine illness script concordance and ultimately identification of the most likely diagnosis. Exposing learners to this cognitive process in an explicit manner can enhance clinical reasoning skills and improve patient care. Working closely with leading experts in case-based clinical reasoning education, NEJM Group has applied gamification principles and diagnostic reasoning theory to a computer-based clinical reasoning simulator aimed at teaching and assessing students and trainees.  This application is being piloted in several medical schools, internal medicine residency programs, and physician assistant training programs, thus allowing an iterative development process with rapid response to learner and educator feedback. By profiling clinical reasoning at various levels of expertise, this program may help define mastery in clinical reasoning.

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