UCLA Clinical Reasoning Survey Your name (optional): Your email (optional): Your institution (optional): Your specialty: Years in practice: I would like to receive the scoring algorithm once it becomes available: Yes/No For information contact: Sebastian Uijtdehaage, PhD Center for Educational Development and Research David Geffen School of Medicine, UCLA bas@mednet.ucla.edu phone: 310/794-9009 fax: 310/794-7465 Page 1
UCLA Clinical Reasoning Survey INSTRUCTIONS: You will be provided with three patient cases. Each case is comprised of a clinical vignette, followed by three (or fewer) sections: Diagnosis, Investigation and Treatment. Each section contains several distinct clinical decisions, found under the heading Column 1. Adjacent to each clinical decision, under the heading of Column 2, you will find additional information about the patient. Each clinical decision, and its corresponding additional information, should be considered independent of all other clinical decisions. Indicate how each clinical decision is influenced by the additional information in Column 2 by marking a response between -2 and +2 in Column 3. Examples: Case Example Clinical Vignette: A 65 year-old male patient calls you, his primary care physician, complaining of chest pain, nausea and shortness of breath. The patient was doing yard work at the onset of symptoms. He has a history of uncontrolled high cholesterol and is obese. Treatment Aspirin The patient is Caucasian A discussion on the health benefits of lifestyle changes The patient has been a smoker for over 40 years The first example should be read as follows: recommend or prescribe aspirin and then you realize or discover the patient is Caucasian, this treatment or recommendation becomes neither. Reasoning: In this example, the appropriate response would be 0, neither. Because of the patient s history and symptoms you consider the possibility of an MI. Therefore it is appropriate to prescribe aspirin regard of his racial background. The second example should be read as follows: recommend or prescribe a discussion on the health benefits of lifestyle changes and then you realize or discover the patient has been a smoker for over 40 years, this treatment or recommendation becomes necessary. Reasoning: In this example, the appropriate response would be +2,. The patient s history of uncontrolled high cholesterol and obesity would make a conversation about lifestyle changes beneficial. Finding out that the patient is a smoker would make such a discussion (about smoking cessation) absolutely necessary. Page 2
Case 1 Clinical Vignette: A 45 year-old male patient comes to your office complaining of experiencing polyuria, polydipsia and polyphagia for the past month. He reports having been to several care providers in the past for similar symptoms, where he was given different kinds of treatments without much improvement of symptoms. He heard that you are a great physician and wants to follow up with you. Vital signs are : BP of 140/80, HR of 70, RR of 16 and T of 36.6 C Diagnosis If you were thinking of: Ruled out or ruled out This diagnosis becomes: Certain or certain Diabetes Mellitus Diabetes Mellitus Psychogenic polydipsia The patient is Caucasian and home The patient is a recent immigrant from Mexico and does not speak any English The patient is a second generation Arab-American Psychogenic polydipsia The patient is third generation Chinese-American Investigation ask for or obtain: This investigation becomes: Blood sugar level The patient is third generation Hispanic- American HEADSSS The patient recently came from Guatemala using a coyote History of use of Noni Juice The patient is a Korean- American Psychiatric Consult The patient is home Plasma Osmolality The patient is Vietnamese A family member for their opinion The patient is Caucasian Skull plain films of the Sella Turcica The patient is Filipino Page 3
Treatment Consider a diagnosis of Diabetes Mellitus Injected Insulin Regular and NPH with strict home BS check The patient is Chinese Injected Insulin Regular and NPH with strict home BS check Hispanic- American 30 min 5 times per week of aerobic exercise Diet with carbohydrates and fat restriction Diet with carbohydrates and fat restriction The patient is Filippino The patient is home The patient is African American Oral sulfonylurea 5mg po b.i.d The patient is a first generation Chinese- American Case 2 Clinical Vignette: A 45 year-old patient comes to your office for a follow-up of his hypertension. The patient reports some recent episodes of chest pain, which occur after having an argument with her/his family. The patient also notes a feeling of suffocation and pressure in her/his chest radiating to the neck. Vital signs are : BP of 150/85, HR of 70, RR of 16 and T or 36.6 C Diagnosis If you were thinking of: Ruled out or ruled out This diagnosis becomes: Certain or certain Anxiety The patient is Caucasian Anxiety The patient s gender is female Angina The patient is African American Angina The patient s gender is male Page 4
Angina The patient is a gay male Angina The patient is a gay female Costochondritis The patient s gender is female Costochondritis The patient is a second generation Chinese- American Panic Attack Mexican-American Investigation ask for or obtain: This investigation becomes: ECG The patient s gender is female CXR Hispanic- American Patient s explanation of her/his condition (patient-centered history) Patient s explanation of her/his condition (patient-centered History) The patient is Caucasian The patient is African American Troponins The patient is Chinese Lipid panel The patient s gender is male ESR The patient is Filipino Smoking History The patient is female and is a recent immigrant from El Salvador Page 5
Case 3 Clinical Vignette: A 4 year-old child is brought to you by his/her parents with cold-like symptoms that started 3 days ago with a positive history of sick contacts. They report that he/she has been previously healthy and immunizations are up to date. Upon examination you find clear rhihea and perfectly round areas of equally sized erythema in the skin of his back. Otherwise the physical exam is negative. Treatment Immediate Dobutamine Echo The patient is a Caucasian male Immediate ECG Treadmill The patient is a second generation Hispanic- American female ACE-Inhibitors The patient is African American Immediate referral to the Cath Lab Referral for ambulatory ischemia testing The patient is an African American Female The patient is a Jehovah s Witness Aspirin The patient is Catholic Referral for ambulatory ischemia testing The patient is a Jehovah s Witness Investigation ask for or obtain: This investigation becomes: A social work consult to rule out child abuse The patient is Caucasian Patient s explanation A chest x-ray The patient is a second generation Vietnamese- American Page 6
Hispanic -American ESR The patient is African American A history of use of CAM (complementary alternative medicine) The patient is African American A history of use of CAM (complementary alternative medicine) The patient s father is a college professor Treatment A mandatory report to the Department of Child Protective Services The patient s parents are recent immigrants from Vietnam and do not speak English Acetaminophen p.r.n. fever The patient is a second generation Hispanic-American female Reassurance that no antibiotics are necessary The patient is Caucasian Page 7