Diagnostic Reasoning in the Multiproblem Patient An Interactive, Microcomputer-Based Audit

This article describes an interactive computerprogram that allows students to enter a completely free-form problem list at the keyboard and receive immediate analysis of the accuracy and thoroughness of their diagnostic impressions. This type of exercise is a departure from traditional instruments because it focuses on patients with multiple interacting issues offering greater realism in approximating the elderly or primary care interaction. The program is briefly described and correlations with traditional audit techniques are shown. More important, development of the program had a profound effect in evolving our understanding of the teaching of diagnostic reasoning in multiproblem patients. This process is described.