Debra Williams Portfolio Page
Navigation links: ETAP 623 Spring 2023 (Zhang) | Differential Diagnosis
About Me
I am currently in Emergency Medical Services education, teaching potential EMTs as well as current providers. This is my third career after starting in research science and moving to finance. My goal is to teach providers to be compassionate, critical thinkers and always do the best for their patient.
Personally I love anything outdoors. I live in Colorado because of the environment, so my husband and I are in the mountains with our dog as much as we can. My husband is a wilderness paramedic and I am a wilderness EMT, so we often end up in interesting situations. But we always have fun.
My Topic and Purpose
Differential diagnosis is an important piece of the practice of medicine. It involves considering multiple causes for the patient complaint and ruling it in or out based on patient presentation. The challenge in teaching and learning this process is in moving from rote memorization to critical thinking, consideration of multiple options at one time and the ability to ignore irrelevant complaints and presentations.
The goal of this mini-course is to introduce the idea of differential diagnosis and provide opportunities for students to build their own framework for assessing the potential causes of patient complaints.
Scope of Learning Outcomes and Content
This course seeks to introduce the process of differential diagnosis, which is the process of producing and prioritizing a list of potential diagnoses for a particular patient presentation. This will not involve learning the facts about the presentations, but rather the critical thinking involved in organizing and prioritizing the causes.
Needs Assessment
Educational opportunity
Differential diagnosis is the process of identifying the etiology of a disease through systematic assessment of patient history and physical examination (Cook, 2020). It is one of the most challenging process for medical professionals to learn, teach or practice, but done correctly, it improves patient outcome, communication with all stakeholders and assures continuity of care.
Learners
EMT students early in the educational program, after anatomy/physiology and at the beginning of pathophysiology. EMT students are the initial audience but because of the focus on process rather than medicine, this class is scalable to any level of medical provider.
Analysis of gaps
The ideal thought process for differential diagnosis is the use of deductive and inductive reasoning to formulate a list of potential diagnoses and work through a dynamic process to determine the correct diagnosis (Reinoso, 2018). However, the students’ educational background is traditionally the scientific method, which is developing a theory, then a hypothesis, gather data, analyze, draw conclusions and then repeat with a different theory or hypothesis (O’Leary, 2007).
Existing efforts
There are limited formal efforts to teach differential diagnosis. Emergency medicine education at the EMT or paramedic level has very strict topic and time requirements. Differential diagnosis education involves teaching physiology and pathophysiology, metacognition, conceptual change, concept mapping and critical thinking. Those are topics not tested for national registration certification and often seen as not as important as testable topics. Each of the thought processes in differential diagnosis may be taught, but not as one cohesive process.
One group attempting to teach differential diagnosis to nurse practitioner students developed a differential concept map to help students learn differential diagnosis and develop a plan of care (Reinoso, 2018). Another group suggests teaching critical thinking through the introduction of scenarios into the lecture which encourages differential diagnosis and the development of a treatment plan (Montoya, 2021).
Intent Statement
This course will help students understand differential diagnosis by introducing the concept and encouraging them to build their own differential diagnosis concept maps.
Analysis of the Learner and Context
- EMTs with an introductory level knowledge of physiology and pathophysiology
- EMT instructors with various levels of knowledge of physiology and pathophysiology
- Focus of the course is on process, so it is scalable to any level of medical knowledge/background
Performance-Based Objectives
At the conclusion of the course learners will be able to:
- Build concept maps
- Define differential diagnosis
- Generate list of differentials for an example patient presentation
- Understand systematic approach to differential diagnosis and integrate patient assessment
Task and Content Analysis
Course Purpose:
This mini-course will introduce both EMT students as well as EMT instructors to the concept of differential diagnosis and using the concept map as an organizational/teaching tool
Learning Outcomes
At the end of the course, learners will be able to:
- Build concept maps
- Define differentials and differential diagnosis
- Generate list of differentials
- Understand systematic approach to differential diagnosis
Prerequisite Knowledge/Skills
In order to reach outcomes, learners must know/learn
- Basic anatomy/physiology and associated medical vocabulary
- Introductory patient assessment, including history taking, physical examination and vitals
- Introductory pathophysiology for the example patient presentations
Curriculum Map
| Unit 1: Concept mapping | Unit 2: Differentials | Unit 3: Differential diagnosis |
|---|---|---|
| Objectives | Objectives | Objectives |
| Understand purpose of concept map
Build the concept map used in differential diagnosis |
Define differentials
Brainstorm differentials for patient presentation Complete concept map |
Use of patient assessment and diagnostic tools
Begin differential diagnosis (rule in and rule out) |
| Lessons: | Lessons: | Lessons: |
| What is differential diagnosis?
What is concept mapping? How is concept mapping used in differential diagnosis? |
What are differentials? | Patient assessment
How to integrate patient assessment into concept map |
| Activity: | Activities: | Activity |
| Build blank concept map
(whiteboard or https://cmap.ihmc.us/) |
1) Brainstorm differentials for example patient complaint
2) Complete concept map |
Begin differential diagnosis given patient presentation |
References and Resources
Cook, C. E., & Décary, S. (2020). Higher order thinking about differential diagnosis. Brazilian journal of physical therapy, 24(1), 1–7. https://doi.org/10.1016/j.bjpt.2019.01.010
Montoya, L. (2021, September 7). Critical thinking scenarios in lecture. Limmer Education. https://limmereducation.com/article/critical-thinking-scenarios-in-lecture/
O'Leary, Z. (2007). The social science jargon buster. SAGE Publications Ltd, https://dx.doi.org/10.4135/9780857020147
Reinoso, Bartlett, J. L., & Bennett, S. L. (2018). Teaching Differential Diagnosis to Nurse Practitioner Students. Journal for Nurse Practitioners, 14(10), e207–e212. https://doi.org/10.1016/j.nurpra.2018.08.028