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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

Guest Author: Eliana Bonifacino, MD MS, Academic Hospitalist, MWHC Problem representation is the mental model or understanding of a patient’s clinical condition that forms in a clinician’s mind as they encounter a patient and is iteratively refined over the course of the encounter. It is expressed verbally, either in written or oral form, through a summary statement or a one-liner. Although only one part of a complex process, the development and articulation of a precise, concise, and accurate problem representation is a key skill in diagnostic reasoning and can provide educators with insight into a learner’s thinking that is otherwise difficult to observe. By convention, teaching problem representation should first involve clearly delineating its foundational components, including: Demographic characteristics of the patient, which include age, gender, and pertinent comorbidities or risk factors for disease Temporal course of the presenting illness Description of the salient components of the clinical syndrome For learners to improve their problem representations, feedback is essential. Educators can consider committing to asking learners to present a summary statement during rounds or in case presentations (e.g., morning report, problem-based learning sessions), role-modeling their own summary statements when discussing a case, giving timely feedback on the summary statements, and