Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine. Learning objectives: After listening to this episode listeners will… Develop an appreciation for clinical reasoning. Recall the importance that the educator plays in role modeling. Learn how to improve diagnostic accuracy by keeping a patient log. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice. Explain the difference between experience and expertise. Time Stamps 00:00 Disclaimer, Intro 02:30 Guest Bio 04:50 Dr. Dhaliwal 06:45 Book recommendation 09:14 App recommendation 11:34 Advice for learners and teachers (Pearl #1) 12:40 Can a computer out-think a human? 15:49 Defining Clinical Reasoning 18:38 “Train the Brain” introduced 20:30 Knowledge is a precondition 21:46 A learner who lacks synthesis 24:23 How to provide learner feedback 27:04 Defining problem representation, illness scripts, etc. 29:20 How to start teaching clinical reasoning 31:00 Focus on the “why” and not the “what” 32:11 Teaching the nomenclature of clinical reasoning 36:07 “You can’t get the right answer if the brain is solving the wrong problem” 36:34 Osler and his “Incessant Watch” 40:40 Being wrong feels exactly the same as being right 42:00 Patient tracking (Dr. Dhaliwal’s recommendation) 45:30 Why keeping a patient log is so important 47:00 Are heuristics beneficial? 48:55 Can you debias yourself? 50:00 “Going slow just makes you slow.” 52:00 All evidence has flaws, but knowledge is still king. 55:13 Clinical reasoning on multi-disciplinary teams 59:27 Take-home points Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student