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Your registrar’s clinical reasoning and diagnostic thinking skills

Home / Your registrar’s clinical reasoning and diagnostic thinking skills

Clinical reasoning is one of the most important aspects of a doctor’s skill set in practising safe and effective medicine. During GP training is a key period in starting to refine this skill.

GPT1 registrars will be provided with the opportunity to complete the Diagnostic Thinking Inventory (DTI) during 2019 to gain insight into their clinical reasoning skills.

What is the DTI?

This well-established and validated instrument was developed by Dr Georges Bordage and colleagues in the UK and is used for measuring clinical reasoning and diagnostic approaches. Each of the 42 DTI items contains a rating scale with two statements at each end, representing a continuum along which respondents indicate how they would diagnose in most cases.

The DTI results in two scores that indicate important features of clinical reasoning/diagnostic thinking:

  1. Flexibility in thinking – how responsive a clinician can be in following up new information provided by the patient, particularly how able they are to use multiple methods of investigation, to allow for alternative diagnostic possibilities and to manage conflicting information.
  2. Structure of memory – how well knowledge is stored and structured in memory to maximise availability during the diagnostic process, with an emphasis on considering each case as a whole rather than on a symptom-by-symptom basis.

What can registrars gain from this?

Participating registrars will receive a DTI Feedback Report containing results on the two scores plus a list of online clinical reasoning resources. The report will also recommend that registrars discuss their DTI results with their supervisors and medical educators, particularly in preparation for exams.

It is important to remember that:

  • The DTI is not an assessment, it is a reflective exercise for registrars, designed to encourage self-reflection on current clinical practice, with a view to improving and refining clinical reasoning skills.
  • Assessment of clinical reasoning is one of the main objectives of the RACGP Key Feature Problems (KFP) exam and ACRRM’s StAMPS exam, which many past registrars have found challenging.

For more information contact Dr Linda Klein, Deputy Director of Research and Evaluations.