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Licensed Unlicensed Requires Authentication Published by De Gruyter July 6, 2020

Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students

  • Yvonne Covin ORCID logo EMAIL logo , Palma Longo , Neda Wick , Katherine Gavinski , Blake Barker and Jim Wagner ORCID logo
From the journal Diagnosis



Explicit education on diagnostic reasoning is underrepresented relative to the burden of diagnostic errors. Medical educators report curricular time is a major barrier to implementing new curricula. The authors propose using concise student-identified educational opportunities -- differential diagnosis and summary statement writing -- to justify curriculum development in diagnostic reasoning.


Eighteen clerkship and 235 preclinical medical students participated in a 1 h computerized case presentation and facilitated discussion. Students were surveyed on their attitudes toward the case.


All 18 (100% response) clerkship students and 121 of the 235 preclinical students completed the survey. Students felt the module was effective and relevant. They proposed medical schools consider longitudinal computerized case presentations as an educational strategy.


A computerized case presentation is a concise instructional strategy to teach critical points in diagnosis to clerkship and preclinical medical students.

Corresponding author: Dr. Yvonne N. Covin, Department of Internal Medicine, Division of General and Hospital Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7982 San Antonio, San Antonio, 78229, TX, USA, E-mail:

Funding source: University of Texas System United States


The authors acknowledge the Internal Medicine clerkship and Foundations of Clinical Reasoning course committees for case peer review.

  1. Research funding: This study was supported by a grant from the University of Texas System Kenneth Shine Academy Health Science Education Small Grants Program.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: This study received institutional review board approval from the UT Southwestern Medical Center (protocol number STU 092016-077).


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Received: 2020-03-02
Accepted: 2020-05-03
Published Online: 2020-07-06
Published in Print: 2021-05-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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