Introduction - Week 1

Question 1

History of differential Diagnosis

Movement away from _____-_____ medical theory or bodily humors theory to a more modern _____ approach.

Early theory that disease was an outcome of _____ in one of the four bodily fluids: _____, _____ bile, _____ bile, and _____.

Answer 1

Movement away from Hippocratic-Galenic medical theory or bodily humors theory to a more modern scientific approach.

Early theory that disease was an outcome of imbalances in one of the four bodily fluids: blood, yellow bile, black bile, and phlegm.

Question 2

History of differential diagnosis

New and emerging ______ tools to assist medical _____.

William _____ a Canadian physician (18__-19__) founded North American Clinical Medicine.

Answer 2

New and emerging diagnostic tools to assist medical examination.

William Osler a Canadian physician (1849-1919) founded North American Clinical Medicine.

Question 3

Clinical reasoning

1) _____ knowledge
2) _____ knowledge
3) _____ knowledge
4) _____ expertise

Answer 3

1) Conceptual knowledge
2) Procedural knowledge
3) Scientific knowledge
4) Individual expertise

Question 4

Case based clinical reasoning method

1) _____ representation
2) Building _____ scripts
3) Systematic, analytic reasoning - _____

Answer 4

1) Problem representation
2) Building illness scripts
3) Systematic, analytic reasoning - ISBAR

Question 5

ISBAR

1) _____ or _____
2) S_____
3) B_____
4) A______
5) R______

Answer 5

1) Introduction or Identify
2) Situation
3) Background
4) Assessment
5) Reccomendation

Question 6

Introduction or Identify

Who you are, your _____, where you are and why you are _____.

Who you are and what is your role?

Patient ______

Answer 6

Who you are, your role, where you are and why you are communicating.

Who you are and what is your role?

Patient identifiers

Question 7

Situation

What is _____ at the moment?

What is the key _____ that the patient presented with, and what made them come to you.

What is going on with the _____?

Answer 7

What is happening at the moment?

What is the key symptom that the patient presented with, and what made them come to you.

What is going on with the patient?

Question 8

Background

What are the _____ that led up to this situation?

What is the clinical _____/_____?

Answer 8

What are the issues that led up to this situation?

What is the clinical background/context?

Question 9

Assessment

What do you believe is the _____?

Answer 9

What do you believe is the problem?

Question 10

Recommendation

What should be done to _____ the situation?

What would you _____?

Risks - patient/_____ health and safety?

Assign and accept _____/_____.

Answer 10

What should be done to correct the situation?

What would you recommend?

Risks - patient/occupational health and safety?

Assign and accept responsibility/accountability.

Question 11

Barriers to communication in healthcare

1) S_____/_____
2) _____ constraints
3) I_____
4) _____ state
5) _____ effects
6) R_____/_____
7) G_____

Answer 11

1) Speech/language
2) Time constraints
3) Illness
4) Mental state
5) Medication effects
6) Race/culture
7) Gender

Question 12

Attributes of clinical reasoning

Holistic & contextual perspectives - _____ of whole person, their entire _____, relationships, background and _____.

Creativity - ability to generate, discover or _____ ideas,; ability to imagine _____.

Answer 12

Holistic & contextual perspectives - consideration of whole person, their entire situation, relationships, background and environment.

Creativity - ability to generate, discover or restructure ideas; ability to imagine alternatives.

Question 13

Attributes of clinical reasoning

Inquisitiveness - thoughtful, _____ and curious approach; explore _____ and alternatives.

Perseverance - _____ to pursuit knowledge despite and _____ that are encountered.

Answer 13

Inquisitiveness - thoughtful, questioning and curious approach; explore possibilities and alternatives.

Perseverance - dedication to pursuit knowledge despite any obstacles that are encountered.

Question 14

Attributes of clinical reasoning

Intuition - insightful patterns of knowing from previous _____ and _____ recognition.

Flexibility - capacity to adapt, modify or change thoughts, ideas and _____.

Answer 14

Intuition - insightful patterns of knowing from previous experience and pattern recognition.

Flexibility - capacity to adapt, modify or change thoughts, ideas and behaviours.

Question 15

Attributes of clinical reasoning

Academic integrity - seeking truth through _____ process.

Reflexivity - contemplation of assumptions, thinking and behaviours for purpose of deeper ______ and self-_____.

Answer 15

Academic integrity - seeking truth through honest process.

Reflexivity - contemplation of assumptions, thinking and behaviours for purpose of deeper understanding and self-evaluation.

Question 16

Attributes of clinical reasoning

Confidence - firm belief in one’s _____ ability.

Open-mindedness - receptiveness to different views and sensitivity to one’s bias, prejudice, preconception and assumptions.

Answer 16

Confidence - firm belief in one’s reasoning ability.

Open-mindedness - receptiveness to different views and sensitivity to one’s bias, prejudice, preconception and assumptions.

Question 17

Cognitive errors in diagnosis

Anchoring - tendency to lock onto _____ features in patient’s presentation too early in the clinical reasoning process, and _____ to adjust to this initial impression in the light of later _____.

Ascertainment bias - clinician’s thinking is shaped by prior assumptions and preconceptions, for example, _____, _____, and _____

Answer 17

Anchoring - tendency to lock onto salient features in patient’s presentation too early in the clinical reasoning process, and failing to adjust this initial impression in the light of later information.

Ascertainment bias - clinician’s thinking is shaped by prior assumptions and preconceptions, for example, ageism, stigmatism, and stereotyping.

Question 18

Cognitive errors in diagnosis

Confirmation bias - tendency to look for confirming _____ to support a clinical diagnosis rather than look for _____ evidence to refute it, despite the latter often being more _____ and definitive.

Diagnostic momentum - once labels are attached to patients, they tend to _____. What started as a possibility gathers increasing _____ until it becomes definite and other _____ are excluded.

Answer 18

Confirmation bias - tendency to look for confirming evidence to support a clinical diagnosis rather than look for disconfirming evidence to refute it, despite the latter often being more persuasive and definitive.

Diagnostic momentum - once labels are attached to patients, they tend to stick. What started as a possibility gathers increasing momentum until it becomes definite and other possibilities are excluded.

Question 19

Cognitive errors in diagnosis

Fundamental attribution error - tendency to be judgmental and blame patients for their illness rather than examine the _____ that may have been responsible. Patients with a mental illness and from _____ or marginalised groups are at particular risk of this error.

Overconfidence bias - tendency to believe we know more than we do. It reflects a tendency to act on incomplete _____, _____ or hunches. Too much faith is placed on opinion instead of carefully collected cues. This error may be augmented by _____.

Answer 19

Fundamental attribution error - tendency to be judgmental and blame patients for their illness rather than examine the circumstances that may have been responsible. Patients with a mental illness and from minority or marginalised groups are at particular risk of this error.

Overconfidence bias - tendency to believe we know more than we do. It reflects a tendency to act on incomplete information, intuition or hunches. Too much faith is placed on opinion instead of carefully collected cues. this error may be augmented by anchoring.

Question 20

Cognitive errors in diagnosis

Premature closure - tendency to accept a _____ without sufficient evidence and before it has been fully verified. This error accounts for a high proportion of _____ or _____ diagnoses.

Psych-out error - people with a _____ illness are particularly vulnerable to clinical reasoning errors, and co-morbid conditions may be overlooked or minimalised. A variant of this error occurs when medical condition are misdiagnosed as _____ conditions.

Unpacking principle - failure to collect and unpack all of the relevant _____ and consider differential diagnoses may result in significant _____ being missed.

Answer 20

Premature closure - tendency to accept a diagnosis without sufficient evidence and before it has been fully verified. This error accounts for a high proportion of inaccurate or incomplete diagnoses.

Psych-out error - people with a mental illness are particularly vulnerable to clinical reasoning errors, and co-morbid conditions may be overlooked or minimalised. A variant of this error occurs when medical condition are misdiagnosed as psychiatric conditions.

Unpacking principle - failure to collect and unpack all of the relevant cues and consider differential diagnoses may result in significant possibilities being missed.