Problem-based learning (PBL) has been used in the medical education model since the 1950s. An extension of PBL is case-based learning (CBL), in which students are provided a specific set of clinical symptoms and work towards a diagnosis. CBL has become a central component of medical education during the last decade. Throughout the process of CBL, a student or group of students develop a list of possible diagnoses, the whole which is referred to as the differential diagnosis. Students attempt to work through a clinical case by asking a series of questions that they would normally ask during an encounter with a patient. As the questions are answered and additional information becomes available, diagnoses are added or removed from the differential diagnosis. We have created a web-based software tool in Allaire Cold-Fusion", designed to teach students how to work with differential diagnosis. The tool has two components: one component allows for easy clinical case entry and editing (authoring), and the other component allows the student to interact with a clinical case.

The case-editing component provides the necessary framework to develop a case by providing prompts in the form of clinical questions. These questions currently fall into the general categories of history, physical examination, laboratory evaluation, radiology and consults. A case consists of the answers to some or all of the questions in each category. In addition to text answers, multi-media can be easily linked to a question. The Microsoft Access" database is scalable to accommodate additional cases, categories, media and/or questions. A case can be encountered by an individual student or, when projected onto a large screen, encountered by a group of students. The encounter component provides a one-sentence description of a clinical problem, as well as all of the questions from a given category. In this manner the concept of recognition rather than recall is used for the encounter component. During an encounter the screen is divided into three sections. The left section contains the questions in a given category, the middle section is a placeholder for the answers to questions that have been asked, and the right section holds differential diagnoses that are both currently active and those that have been previously considered. Differential diagnoses are manually entered. As the student works through the case, the active diagnosis can be manually re-ordered and diagnosis can be added or removed.

This software tool is best utilized with a facilitator who is knowledgeable regarding clinical medicine. The goal of each encounter is for students to think of a clinical problem in terms of diagnoses. The facilitator can question the students on how they would ask a given history question, how they would perform a given component of the physical examination or what explicit question they would ask a consultant. Through iterative questioning, the students arrive at a small number of possible diagnoses. Each week during the last eight months, we have been using this tool with a facilitator to teach a group of 12-14 students how to develop differential diagnoses around a given clinical problem. The students have been very excited about the program, especially the multimedia component, as this assists with simulating a patient encounter. Visit our web site and encounter our existing cases at http://umed.med.utah.edu/pediatrics.

This demonstration will introduce the participant to an exciting web-based software tool to simulate clinical patient encounters. The participant will see how easy a clinical case can be developed in a very short period of time. The participant will also be able to work with clinical cases to develop a differential diagnosis, adding and/or removing diagnoses as the answers to questions are provided. The use of growth charts, electrocardiograms, pictures and radiographs adds depth to the program further simulating a real patient encounter.

Christopher G. Maloney, MD
4822 South Bron Breck Street
Salt Lake City, UT 84117
Phone: 801 588-3280
Fax: 801 588-3297
Email: chris.maloney@hsc.utah.edu

CO-AUTHORS:

Jeffrey A. Nielson
University of Utah
50 North Medical Drive
Salt Lake City, UT 84113
Email: jeffrey.a.nielson@hsc.utah.edu