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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Apr 9, 2018

Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here

Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD

Full show notes available at

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Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine.

Learning objectives:

After listening to this episode listeners will…

  1. Develop an appreciation for clinical reasoning.
  2. Recall the importance that the educator plays in role modeling.
  3. Learn how to improve diagnostic accuracy by keeping a patient log.
  4. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy
  5. Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice.
  6. Explain the difference between experience and expertise.

Time Stamps

  • 00:00 Disclaimer, Intro
  • 02:30 Guest Bio
  • 04:50 Dr. Dhaliwal
  • 06:45 Book recommendation
  • 09:14 App recommendation
  • 11:34 Advice for learners and teachers (Pearl #1)
  • 12:40 Can a computer out-think a human?
  • 15:49 Defining Clinical Reasoning
  • 18:38 “Train the Brain” introduced
  • 20:30 Knowledge is a precondition
  • 21:46 A learner who lacks synthesis
  • 24:23 How to provide learner feedback
  • 27:04 Defining problem representation, illness scripts, etc.
  • 29:20 How to start teaching clinical reasoning
  • 31:00 Focus on the “why” and not the “what”
  • 32:11 Teaching the nomenclature of clinical reasoning
  • 36:07 “You can’t get the right answer if the brain is solving the wrong problem”
  • 36:34 Osler and his “Incessant Watch”
  • 40:40 Being wrong feels exactly the same as being right
  • 42:00 Patient tracking (Dr. Dhaliwal’s recommendation)
  • 45:30 Why keeping a patient log is so important
  • 47:00 Are heuristics beneficial?
  • 48:55 Can you debias yourself?
  • 50:00 “Going slow just makes you slow.”
  • 52:00 All evidence has flaws, but knowledge is still king.
  • 55:13 Clinical reasoning on multi-disciplinary teams
  • 59:27 Take-home points

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