Using “The Clinical Sieve” to Express Diagnostic Thinking

Dr. Carlos A. Cuello-Garcia, School of Medicine, Instituto Tecnologico, Monterey, Mexico.

Dr. Cuello-García uses an interactive pedagogy to teach clinical reasoning using on-line postings of clinical cases. Here he describes a technique for thinking about clinical cases which he terms the “clinical sieve.” This session incorporates teaching students about several key diagnostic reasoning concepts: ‘sensitivity,’ ‘specificity,’ and ‘likelihood ratios.’ The exercise is particularly valuable because it uses authentic problem scenarios and can easily adaptable to clinicians in all areas of the health sciences. This type of reasoning context discussed by Dr. Cuello-Garcia (the need for high stakes judgments under conditions of uncertainty) is an example of what has been termed ‘naturalistic decision-making.’ You can find out more about thinking and decision-making in this type of judgment process in “Naturalistic Decision Making” by Caroline Zsambok and Gary Klein (1997). Thank you, Dr. Cuello-García, for this most interesting clinical session.