Practice any time
anywhere

Join Teaching Medicine to get personalized help with what you're practicing or to learn something completely new. We'll save all of your progress.

Help students
succeed with
personalized
practice

Assign our practice cases
Our Software does all the marking
Our algorithms generate feedback
You download the scores

Join Teaching Medicine For Free as

a learner

an instructor
or assistant

Continue

Have an Account?

Learner

Instructor or Assistant

Account Details

Practice anyone
anywhere

Join Teaching Medicine to get personalized help with what you're practicing or to learn something completely new. We'll save all of your progress.

Help students
succeed with
personalized
practice

>Find standards-aligned conten
Assign practice exercises
Track student progress
Join millions of teachers and students

Join Teaching Medicine For Free as

a learner

an instructor
or assistant

Continue

Learner

Instructor or Assistant

Account Details

Introduction

Please Create the Introduction

Case Title:*

Introduction:*

Chief Complaint:*

Diagnoses:*

Selected Diagnoses:

No diagnosis selected

Location:*

Age:*

Gender:*

/ Race:

Version:

Notes:

Status:

History

Please Create the History

Chief Complaint:

Diagnoses:

No diagnosis selected

Case Title:

Step 1: Type or Copy-Paste your history first.

Step 2: Click on Highlight button and then highlight phrases that will become interactive.

Version 1

Physical Exam

Please Create the Physical Exam

Step 1: Type or Copy-Paste your physical exam first.

Step 2: Click on Highlight button and then highlight phrases that will become interactive.

Version 1

Investigations

Age Category:

Gender:

Modify result for:

Modified Investigations

Count: 0

Review

Case Title:

Introduction:

History:

Physical:

Investigations:

Modified Investigations

Investigation

Active cases count: 1

Case #	Case Title	Chief Complaint	Deadline	Started	Status	Completed	My Stats
19	24 female with chest pain	Pain, chest

Institute:

Class:

Assign case to class

Class	Assign Date	Assigned by

Introduction

Location:

Ethnicity:

Chief Complaint:

Can't find a diagnosis?

Diagnoses	Increases Probability	Decreases Probability
No diagnoses selected yet.

History

History:

Physical Exam

Physical Exam:

Investigation

Can't find an investigation?

Investigations to be submitted for results:

No investigation selected yet

This is round of ordering investigations

Ranking

Classify your Final Diagnoses

Select the most probable diagnosis:

Select your 2nd most probable diagnosis:

(optional)

Ranking

Classify your Final Diagnoses

Awareness and communication of uncertainty/confidence in your diagnosis is very important to help you become aware of diagnostic error. Please rate your uncertainty/confidence for your most probable diagnosis.

Very Uncertain

Very Confident

History Key Feature

History:

Click on any data to add Key Features.

History Key Feature:

Physical Key Feature

Physical:

Click on any data to add Key Features.

Physical Key Feature:

Problem Representation

History Key Features:

Physical Exam Key Features:

Problem representation:

	Increases	Decreases

Narrative for Diagnostic Justification:

Case Title :

Filter by university :

Completed users:

Filter by online class :

Investigations Equals :

Most probable diagnosis :

Investigations Not :

Ddx :

Total Users : 0

Misdiagnoses
Failure Of Ddx
Failure Of Dx Justification
Ddx
Dx Ranking
Cognitive Errors
Investigations
Individual Score
Dx Justification
Uncertainty
Flow
Key Features

0 different diagnoses added to the Ddx.

0% students added the correct diagnosis to their Ddx.

0% students added the correct Dx in the introduction.

0% students added the correct Dx in the history.

0% students added the correct Dx in the physical exam.

0% students added the correct Dx in the investigations.

Differential Diagnoses	Increases Probability	Decreases Probability

Penalties for over-ordering	Average	Max allowed	# of penalties	Penalty-2

	Users Selected	Data not used in Ddx?	Cost	Patient time	Patient risks

Investigation Rounds	Users Selected

These Stats show which diagnoses were ranked "Most Probable" at different stages of the case.

End of Case:

Cognitive Errors

Total errors demonstrated in this case:
Number of learners who demonstrated at least 1 error:

Premature Closure:

This error occurs if you accept a diagnosis as the "final most probable diagnosis" without collecting or assigning the confirmatory (gold standard) data. If the following diagnoses were ranked as "most probable" for the case AND the required data was not assigned as "INCREASES" probability, then this behavior is consistent with premature closure error.

Most probable Diagnosis	Required INCREASES data	# of Learners

Failure to Rule Out:

This error occurs if you reject a diagnosis as probable without collecting or assigning the confirmatory (gold standard) data. If the following diagnoses were either NOT included in the Ddx, or if they were included but did not have the following data assigned as "DECREASES" probability, then this behavior is consistent with a failure to rule out error.

Diagnosis	Required DECREASES data	# of Learners

Anchoring:

This error occurs if you choose a diagnosis early in the diagnostic process that was not the correct diagnosis, and indicated this diagnosis as the most probable diagnosis at least 2 out of 3 times during the case and again as the final diagnosis the end of the case.

Diagnosis	# of Learners

Confirmation Error:

This error typically occurs in association with the Anchoring error. If there is key data that would effectively make a diagnosis highly unlikely AND that data is not assigned as "DECREASES" probability AND this diagnosis was chosen as the most probable diagnosis, then this behavior is consistent with confirmation error.

Most probable Diagnosis	Required DECREASES data	# of Learners

Search Satisficing Error:

This error typically occurs in association with the search satisficing error.

Diagnosis	# of Learners

Please wait while we calculate scores. This could take up to 2 minutes.
If your browser shows a time out error, please use google Chrome. If your browser says it is taking a long time, please click the "Wait" option.

Minimum
Mean
Maximum
Student #	First Name	Last Name	Ddx	Dx Justification	Investigations	Final Dx	Total	Error	History (min.)	Physical (min.)	Invest. (min.)	# Invest.	# Rounds	Uncertainty Score	Status

The diagnostic process always contains some degree of uncertainty. Uncertainty is generally higher for more difficult cases, or cases in which there is conflicting data.

Communicating your level uncertainty is an important part of the diagnostic process. This graph shows how others who have completed this case have rated their level of uncertainty.

Average Times Viewed	Time
No stats found.

Misdiagnoses =

Correct Diagnosis was never added to Ddx =

Correct Dx WAS added to Ddx =

Failure to build Ddx

Reasons provided for not including the diagnosis in the Ddx:

	I had never heard of this diagnosis before
	I had heard of this diagnosis, but knew little / nothing about it
	I knew this diagnosis, but did not think about it
	I had considered this diagnosis, but other diagnoses seemed better
	I decided this diagnosis was not correct, so I left it off or deleted it
	I felt quite confident with my chosen diagnosis so no reason to add others

Failure of Dx Justification

Reasons provided for not choosing the correct Dx in the Ddx.

	I felt that I had ruled out the correct diagnosis
	There was not enough data to confirm the correct diagnosis
	There was not enough data to rule out the diagnosis that I selected
	I had confirmed my diagnosis with strong data
	The correct diagnosis just didn't seem / feel correct to me
	I was not very familiar with the correct diagnosis

These misdiagnoses occurred because the correct Dx was not added to the Ddx. In order to recognize that the correct Dx is missing from the Ddx, we would need to recognize that all diagnoses currently in the Ddx are incorrect for this patient. The DECREASES probability data RULES OUT incorrect diagnoses. On this page, if we see LOW PERCENT values for green check mark items in the DECREASES data, we have evidence of incomplete diagnostic justification and can conclude that this is a likely contributor to the misdiagnosis.

Differential Diagnoses	Decreases Probability

These misdiagnoses occurred because the correct Dx was added to the Ddx but not selected. For these errors, we want to focus 2 things. First, do we have a lot of incorrect (red X) INCREASES probability data? This will falsely make a diagnosis look correct. Second, are we missing correct (green check mark) DECREASES probability data? This would be "failure to rule out". Evidence of diagnostic justification contributing to these misdiagnoses will be the presence of RED X INCREASES data, and/or low values for GREEN CHECK DECREASES data.

Differential Diagnoses	Increases Probability	Decreases Probability

Most Common Dx Justification errors

Common errors could represet knowledge deficiencies or errors in reasoning.
Distribution of diagnostic justification errors are:

	Increases	Decreases
History:
Physical Exam:
Investigations:

An error of Omission occurs when a learner has "missed data" The most common error of omission were:

Count	Error

An error of Commission occurs when a learner has "wrong data":

Count	Error

History Key Features

Physical Key Features

Case Title :

Flow
Ddx
Dx Justification
Investigations
Bonus and Penalty
Ranking
Error
Score
Uncertainty
Key Features
My Consult

	Time
No stats found.

	Views	My Time	Average Time
No stats found.

Number of required appropriate diagnoses for this case:

Total possible appropriate diagnoses for this case:

Deleted diagnoses will not contribute to Ddx score.

		Differential Diagnoses

Other Appropriate Diagnoses for this case: (grey sub-diagnoses are considered equivalent to the black primary diagnosis and only 1 point is given if multiple equivalent diagnoses are included in the Ddx)

Diagnostic justification: this is where you show or prove that the correct diagnosis is correct and at the same time, also show the incorrect diagnosis are indeed not corrrect.

Your differential Diagnoses:	Increases Probability	Decreases Probability

Other investigations that you ordered:

Penalties for Investigations:

Not using data penalty:

Ordering too many tests or rounds penalty:

Total penalties:

Not Using Data Penalty

No data was assigned to your differential diagnosis from any of these investigations:

Ordering too many tests or using too many rounds of tests

Each test has a financial cost, a time cost to the patient, and some tests carry risks to the patient. It is important to avoid ordering too many tests. Also, each "round" of tests adds time to the diagnostic process and should be minimized as well.

	Most Probable	Less Probable	Not Probable

Your most probable Dx after the introduction was:
history was:
physical exam was:
end of case was:

Your less probable Dx after the end of case was:

Total Warnings for Cognitive errors:

This error occurs if you accept a diagnosis as the "final most probable diagnosis" without collecting the confirmatory data (in other words, the ordering the gold standard test). If the following diagnoses were ranked as "most probable" for the case AND the required confirmatory data was not assigned as "INCREASES" probability, then the learner will be notified of behavior consistent with premature closure error.

This error occurs if you reject a diagnosis as probable without collecting the confirmatory data (in other words, the ordering the gold standard test). If the following diagnoses were either NOT included in the Ddx, or if they were included but did not have the following data assigned as "DECREASES" probability, then the learner will be notified of behavior consistent with failure to rule out worst case scenario.

This error typically occurs in association with the Anchoring Error. If there is key data that would effectively make a diagnosis highly unlikely AND that data is not assigned as "DECREASES" probability, then this behavior is consistent with confirmation error.

This error typically occurs in association with the Search Satisficing Error. If there is key data that would effectively make a diagnosis highly unlikely AND that data is not assigned as "DECREASES" probability, then this behavior is consistent with confirmation error.

	Score / Total	Percent	Earned	Max

Score for history =

Score for physical exam =

Total =

History Key Features

Physical Key Features

Score =

Search Author:

Case Author

Assign Case Author

First Name	Last Name	Email

Case Title :

Building Ddx
Dx Justification
Investigations 1
Investigations 2
Final Dx
Error
History Key Feature
Physical Key Feature

Unchecked Dx:

Unchecked Data:

Dx with no data:

Show data not checked by anyone
Show data not checked by me
Show only deleted

Sort By:

Diagnoses and Supporting Data	Increases Probability	Decreases Probability

Total Required Investigations:

Number of rounds:	Min:
	Average:
	Max:

Number of orders:	Min:
	Average:
	Max:

% users chose

Classify	Diagnoses

Important and Alternate Diagnoses

How many diagnoses are required for this case?

Important:

Timing:

Required Investigations

Add required investigations

Required Investigations:

	Required Investigations:

Inappropriate Investigations

Conditional Scoring Based on Ddx

Add new Condition

If any of these diagnosis were added:

Then these Investigations will be required:

	If Dx chosen:	Then required:

Conditional Scoring Based on Timing

Add new Condition

These Investigations before:

Ordering these investigations:

		These investigations	Must preceed these investigations

Ordering too many investigations

Individual tests:		If student ordered more than:	Then they will lose
Average number of tests ordered:	ave:	tests	points
Maximum number of tests ordered:	max:
Rounds of tests:
Average number of rounds ordered:	ave:	rounds	points
Maximum number of rounds ordered:	max:

Not using Results of Investigations

For every test result where all data is NOT used in the Ddx, user will lose:

0 points
0.25 points
0.5 points
1 points

Final Diagnosis Ranking and Alternate Diagnoses

Error and Cognitive Errors

Premature Closure:

Add New

Failure to Rule Out:

Add New

Anchoring:

This error occurs if you choose a diagnosis early in the diagnostic process and despite that diagnosis not being the true most probable diagnosis, you keep that diagnosis as the most probable diagnosis throughout most, or all of the case. There is an automated algorithm to identify anchoring error. No work is required on the part of the case author to generate this feedback.

Confirmation Error:

Add New

Search Satisficing:

Add New

History:

Click on any data to add Key Features.

History Key Feature:

Physical:

Click on any data to add Key Features.

Physical Key Feature:

Investigation name:	Investigation category:
Patient age category:	Patient gender category:
ORIGINAL RESULTS:

Normal Value:
Default Value:
Make this investigation not available
Give reason why investigation is not available:
MODIFIED RESULTS FOR THE CASE

Modified value
Normal value
Select default units tobe used:

Category

Please select a category for this case:

Introduction

Please Create the Introduction

History

Please Create the History

Version 1

Physical Exam

Please Create the Physical Exam

Version 1

Investigations

Modified Investigations

Review

Modified Investigations

How to do these cases

Introduction

History

Physical Exam

Investigation

Ranking

Classify your Final Diagnoses

Ranking

Classify your Final Diagnoses

History Key Feature

Physical Key Feature

Problem Representation

My Consult

Origins of misdiagnoses

Most Common Dx Justification errors