Presented By: Gillian Michaelson, Case Western Reserve University School of Medicine
Co-Authors: Calen Frolkis, The MetroHealth System, The Department of Medicine

Purpose 
The Institute of Medicine reported that diagnostic error may contribute to 80,000 deaths in the US. The American College of Graduate Medical Education (ACGME) includes clinical reasoning as a core competency. Trainees cannot master this if faculty cannot effectively evaluate their skills using language they will understand. Therefore, our goal was to develop and trial a workshop for faculty and students to improve understanding of clinical reasoning and provide a framework for step-wise teaching. 

Methods 
A review of clinical reasoning tools was conducted and the Assessment of Reasoning Tool (ART) was selected as the workshop foundation due to its specific definitions of clinical reasoning components and metrics of success at different levels. The workshop included: an introduction with essential definitions, small group sessions practicing the ART in simulated learner scenarios, and a large group reflective exercise. Participants were immediately surveyed for feedback and will be sent another survey about a year afterwards. Attempts were also made to systematically assess the application of the workshop content on the wards, but this was ultimately unsuccessful. 

Results 
The workshop was presented twice to internal medicine faculty members and once to the majority of the 82 internal medicine residents at a large academic medical center. It was also presented nationally as an Alliance for Academic Internal Medicine webinar. Immediate feedback was overwhelmingly positive and longer-term feedback on applicability is being collected. 

Conclusion 
Education on clinical reasoning and its assessment is a critical and often neglected aspect of faculty and student training. A workshop to propagate a common fluency in the language of diagnostic thinking and develop a comfort evaluating it is a valuable step towards more competent clinicians and educators. An important lesson learned was the difficulty of creating a systematic approach for evaluating student clinical reasoning and faculty feedback across the hospital.