he EMEC always has a stellar line up of workshops and this year was no exception. It was a difficult choice to decide which workshops to go to – you get to choose to attend 2 out of 4 possible options, resulting in major FOMO for the workshops you miss. However, even after just a quick skim of what was on the cards, one choice was very easy for me – I’d had my eye on Simon McCormick’s Random Patient Generator since I first saw it on Twitter in September of 2017 and here was Simon doing a session on “Clinical Decision Making – How to Teach Expertise” during which the Random Patent Generator promised to make an appearance.
The workshop did not disappoint. To begin with Simon talked about how we make decisions and the relationship between system 1 and system 2 thinking*.
Simon role played the discussion system 1 and system 2 might have when an expert clinician is making a diagnosis, especially when the patient doesn’t quite fit into the pattern that system 1 wants it to [This was an exceptional demonstration, and really does testament to how great an educator Simon very clearly is.] and demonstrated how system 2 can be used to “interrogate” system 1. He discussed the point that knowledge doesn’t always readily translate into clinical reasoning and that understanding how our learners think and come to their diagnosis is more important simply teaching them base facts. Saying this he also acknowledged that teaching clinicians about bias in their decision-making doesn’t actually make those biases have less effect, but what it does do is make us more aware of other people biases when they make clinical decisions. So perhaps, we will become better safety nets for our colleagues.
Then we moved on to using the Random Patient Generator, and with dramatic thunderbird music (provided by Simon himself) the projector scroll up to reveal the first part of a clinical stem.
All we knew at this point was the age, gender and presenting complaint. From this we generated a list of differential diagnoses. Cue some more thunderbird theme tune and we had a range of patient observations. In our groups we reviewed our differential diagnosis. With the new information we changed the order of what we thought would be A-listing differentials and even generated some new differentials that we hadn’t previously thought of. Simon swapped some of the observations – did this change our most likely diagnosis? How much did we need the observations to change before we would shake off out preconceived diagnosis? There was clear disparity in the room between how much change was required to unanchor our top diagnosis. Clearly the way in which we were making our diagnosis was affected by our clinical backgrounds and previous experience. Simon then revealed the final pieces of information in the clinical vignette and we had the opportunity to review our differentials again.
Following this we got to make our own mini version of the RPG and have a play within our groups. There is no correct diagnosis with the random patient generator, so despite the anx felt by some you can’t expect to be told if you were “right” in this educational game – perhaps it is not one for the easily frustrated! I, however, found it thoroughly fascinating, and can barely wait to have an opportunity to use it.
Simon did give a warning with using the RPG as an educational game though – learners can get both bored with it [never!] and too familiar with the game of it. So it’s not something that you could use with the same group of learners over and over again. You can, however, use the principles of the game in clinical practice:
What would you think of this patient you’ve just assessed (seen/triaged) with [inserting presenting complaint] if he/she wasn’t a regular attender, but it were their first presentation?
If those oxygen saturations were normal for this patient how would that change your differential diagnosis?
For more info on Simon’s workshop take a look at this fabulous sketch by @WhistlingDixie4
*N.B. System 1 is not the bad guy – pattern recognition is vitally important, it enables us to make decisions extremely quickly which can be life saving. We need to be able to switch rapidly between system 1 and system 2 and use them in harmony.
- Blink: the power of thinking without thinking. Malcolm Gladwell (available from https://www.amazon.co.uk/Blink-Power-Thinking-Without/dp/0141014598)
- Thinking fast and slow. Daniel Kahneman. (available from https://www.amazon.co.uk/Thinking-Fast-Slow-Daniel-Kahneman/dp/0141033576/ref=sr_1_1?ie=UTF8&qid=1529702427&sr=8-1&keywords=thinking+fast+and+slow)