Process and Development

A CCC committee was formed, consisting of physicians, nurse educators, and medical education experts. A list of 12 critical chief complaints was developed out of the work of this group.  From there, a blueprint of chief complaints and corresponding diagnoses was developed for Year 1 through Year 3 of medical school, resulting in a grid of 144 diagnoses.  Students work through the same chief complaints each year in a spiral manner, with different diagnoses each year. With a generous grant through the Josiah Macy Foundation, the committee’s vision for deliberate clinical reasoning practice using interactive, online video-based CCCs was made a reality.

In the CCC curriculum, students watch a physician and standardized patient enact a history and physical examination sequence. The video stops at intervals and asks the student his/her current differential diagnosis. After the student has typed in his or her reasoning, a video-recorded panel discussion among physicians from different specialties considers the same data as just seen by the student, and generates an expert list of differential diagnoses, role modeling expert reasoning. The student then is asked to compare his/her differential with that of the panel before moving on to the next section of the history and/or physical examination. This engages students by allowing them to compare their clinical reasoning to the thinking of practicing physicians evaluating the same cases. The videos allow students to ‘see’ the thinking of physicians--a goal that is frequently espoused in medical education theory but rarely systematically accomplished for all students in practice.  It also freed the clerkship year to be unapologetically idiosyncratic and opportunistic, since all students encounter all 144 diagnoses during the CCCs.

This website demonstration provides you the opportunity to review the videos and other media comprising the CCC curriculum and to experience the general sequence of interactive events that promote deliberate practice of clinical reasoning. This demonstration is freely available to use as often as you like. To implement the full curriculum, complete with interactivity (i.e., students entering data, which is then captured and tracked by a learning management system), this content may be purchased for you to integrate into the software of your design or choosing.