Guest Author: Eliana Bonifacino, MD MS, Academic Hospitalist, MWHC
What is a diagnostic framework?
A diagnostic framework, sometimes referred to as a schema, is a cognitive tool that aids clinicians in a systematic approach to the diagnostic process by both assisting in recall of common causes of a problem and triggering subsequent hypothesis-driven inquiry. Given that human working memory is of limited capacity, a diagnostic framework allows a clinician to organize related diagnoses into meaningful categories, facilitating retrieval from long-term memory. For example, a commonly used framework for acute kidney injury includes pre-renal, intrinsic renal, and post-renal causes. For learners, teaching using frameworks can help them reorganize their knowledge from pre-clinical years to a format that is more easily accessible for diagnosis in their clinical years. These frameworks are then iteratively developed, revised, and refined for learners through repeated exposure to a topic, information retrieval, and targeted study.
How to use frameworks for teaching:
For educators, frameworks can be easily adapted for teaching. Some examples include:
In case-based teaching (e.g., morning report, PBL, chairman’s conference), instead of simply brainstorming a differential for a patient’s medical presentation, facilitators can introduce a diagnostic framework and have learners list differential diagnoses that would fit into each category.
In real-time bedside or ward teaching, educators can either draw out their own diagnostic frameworks or pull up an easily accessible online/text version while a learner presents, and discuss each category.
In prepared teaching sessions, educators could print out a copy of an online version with intentional blanks, and the team can fill it in together verbally.
Next steps after illustrating the frameworks would be deliberate reflection on each likely diagnosis: discussing which features of that patient’s case fit with that diagnosis, which do not fit, and what is missing from the case that you would expect if this were the diagnosis.
Where to find frameworks?
Some examples include:
Penn Frameworks: A free educational resource that provides frameworks for Neurology, Dermatology, and Internal Medicine/specialties.
Clinical Problem Solvers: A free educational resource that provides frameworks for Neurology and many Internal Medicine subspecialties.
Mansoor AM. Frameworks for Internal Medicine. 2nd edition. ed. Lippincott Williams & Wilkins, Wolters Kluwer; 2024. Available online through Dahlgren Memorial Library
Stern SDC, Cifu AS, Altkorn D. Symptom to Diagnosis: An Evidence-Based Guide. 4th ed. McGraw-Hill Education; 2020. Available online through Dahlgren Memorial Library
To learn more, please review the following resources:
Diagnostic Schema. Exercises in Clinical Reasoning. Accessed July 09, 2026.
Bonifacino E, Olson APJ, McQuade CN. Teaching clinical reasoning. In: Aronowitz PB, Keenan C, editors. Teaching and coaching in the hospital. Philadelphia, Pennsylvania: American College of Physicians; 2025.
Dreicer JJ, Parsons AS, Joudi T, Stern S, Olson APJ, Rencic JJ. Framework and Schema are False Synonyms: Defining Terms to Improve Learning. Perspect Med Educ. 2023 Jul 28;12(1):294-303. doi: 10.5334/pme.947. PMID: 37520506; PMCID: PMC10377745.