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NEJM Healer offers a systematic way to develop clinical reasoning skills through deliberate practice.

NEJM Healer packages the most current and reliable clinical information in an expansive library of patient cases with a data-driven approach to clinical encounters.

Using NEJM Healer, physician assistant (PA) students engage in realistic virtual patient encounters that range from simple to complex. They learn how to gather and evaluate data, create iterative problem representations, activate illness scripts, build broad differential diagnoses, and apply clinical knowledge to home in on a lead diagnosis. They also create a sound management plan based on the lead diagnosis.

Educators can monitor a student’s path to sound clinical reasoning and diagnosis through a virtual fingerprint of each student’s data-gathering and decision-making history, helping them to identify students in need of remediation and determine which students are ready to move along in their curriculum.

Didactic / Pre-Clinical Year

NEJM Healer helps PA programs teach a case-based curriculum infused with clinical reasoning in the pre-clinical year, in a structured and explicit fashion.

By practicing with NEJM Healer cases, pre-clinical PA students gain confidence and increased skills in the iterative process of making well-reasoned, evidence-based and patient-centered diagnostic decisions. In addition, educators get an early look at which students need more attention and coaching in specific areas.

Preceptorship

When PA students transition to their clinical years, their exposure to clinical cases is often limited to the patients and disease processes they see in the wards. Moreover, because clinical reasoning assessment can be subjective, time-intensive, and difficult to do in a group setting, assessing student performance typically focuses on clinical knowledge only and not clinical reasoning skills.

NEJM Healer removes these constraints and gives educators a tool to evaluate clinical reasoning progress as students onboard and offboard their preceptorship rotations and refine their diagnosis and management skills.

Experience a Patient Encounter

Schedule a NEJM Healer demonstration and see how easy it is to integrate sound clinical reasoning curriculum and assessment into your program.

One Tool Fits a Variety of PA Program Needs

There are a variety of ways you can use NEJM Healer throughout clinical and didactic years to help your program meet ARC-PA requirements (Standard B2.05). The application is ideal for both early and advanced learners, giving educators the flexibility to present basic skills cases geared to the mechanics of clinical reasoning as well as more challenging cases as students’ skill levels increase.

Enhance Pre-Clinical Curriculum

Supplement a focused course syllabus in clinical reasoning or clinical skills. Use in traditional lecture, flipped classroom, bedside teaching, educator-moderated groups, and asynchronous learning environments.

Clinical Skills Practice

Help students transition from pre-clinical to clinical learning through safe, deliberate practice in a screen-based, virtual apprenticeship. Identify struggling students for remediation and support.

Case-Based Multi-Year Curriculum

Gain deep and longitudinal assessment of students’ clinical reasoning development and their skills in summarizing, presenting, and documenting clinical cases effectively.

Assessment for Independent Practice

Recommend students for independent practice by going beyond multiple-choice questions to more meaningful assessment – measuring how PAs apply sound clinical reasoning to achieve improved patient outcomes.

Experience NEJM Healer Yourself

Schedule a NEJM Healer demonstration and see how easy it is to integrate sound clinical reasoning curriculum and assessment into your program.

The NEJM Healer Educator Portal: Helping Educators Teach, Coach, and Assess

Our robust Educator Portal makes it easy to create and track assignments and assess performance. With an intuitive interface and extensive reporting, the NEJM Healer Educator Portal:

  • Provides extensive, consistent, and objective feedback over a wide range of cases,
  • Helps educators identify those who need remediation,
  • Jumpstarts coaching conversations with any learner.

Assignments

Assigning cases in NEJM Healer is easy!

The case library in the educator portal provides all the info educators need about each case, including the lead diagnosis and key teaching points and they can search and filter cases according to:

  • Presentation (e.g., headache)
  • Acuity (acute vs. chronic)
  • Patient age
  • Organ system
  • Learning objectives
  • Final diagnosis
  • Case difficulty
  • Setting

Learner Performance and Progress Reporting

NEJM Healer provides reporting on both learners’ performance and progress to help educators track individual learners and cohorts at each stage of a case and for the case as a whole.

These reporting data present educators with powerful insights into learners’ clinical reasoning profile according to both objective and self-assessed measures.

Objective Measurements:
  • Data acquisition thoroughness
  • Data acquisition efficiency
  • Lead diagnostic accuracy
  • Differential diagnostic accuracy
  • Illness script concordance
Learner Self-Assessments:
  • Problem representation concordance
  • Management plan concordance
  • Degree of concern for the patient’s status
  • Degree of certainty with the diagnosis

Educators can get quick snapshots of the key assessments above and interact with graphs showing how learners compare with each other across an assignment, making it easy to identify outliers. Want to delve deeper? Download .csv files that show how every learner did on each measure, including their problem representations and differentials at each stage. Want to work in depth with a single learner? Access and print their detailed end-of-case reports.

RESEARCH

Experts Call for Improved Clinical Reasoning Training in All Phases of Medical Education

“Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve diagnostic accuracy and reduce diagnostic error"1
1Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors. J Gen Intern Med.
[pubmed.ncbi.nlm.nih.gov/28840454/]
“Learners should be encouraged to read about their patients’ problems in a way that promotes diagnostic reasoning, rather than to read about topics in a rote-memorization fashion, without context. The organization of knowledge stored in memory facilitates the recall of key concepts for application to the next relevant clinical case.”2
2Educational Strategies to Promote Clinical Diagnostic Reasoning. N Engl J Med.
[pubmed.ncbi.nlm.nih.gov/17124019/]
“Diagnostic errors cause substantial preventable harm. In a 2019 study published in the journal Diagnosis, “Causes were disproportionately clinical judgment factors (85.7%) across categories (range 82.0–88.8%).”3
3Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers. Diagnosis.
[degruyter.com/document/doi/10.1515/dx-2019-0019/html]
“From a National Survey of Internal Medicine Clerkship Directors Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic.” “Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers.”4
4Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors. J Gen Intern Med.
[pubmed.ncbi.nlm.nih.gov/28840454/]
“A case vignette-based clinical reasoning curriculum can effectively increase residents’ knowledge of clinical reasoning concepts and their self-assessed ability to recognize and apply clinical reasoning concepts.”5
5Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis.
[pubmed.ncbi.nlm.nih.gov/30901312/]
“Background Errors in medicine are common and often tied to diagnosis. Educating physicians about the science of cognitive decision-making, especially during medical school and residency when trainees are still forming clinical habits, may enhance awareness of individual cognitive biases and has the potential to reduce diagnostic errors and improve patient safety.”6
6Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis.
[pubmed.ncbi.nlm.nih.gov/30901312/
“Diagnostic reasoning deficits are frequently identified in students and residents referred for remediation. Effective remediation of diagnostic reasoning deficits includes both granular assessment of the learner’s diagnostic reasoning pathway—from hypothesis generation to working diagnosis—and targeted coaching exercises for the learner (along with their pedagogical purpose).”7
7Targeted Strategies to Remediate Diagnostic Reasoning Deficits. Academic Medicine.
[PMID: 34261865 DOI: 10.1097/ACM.0000000000004244]
Dozens of virtual patient encounters
Expert problem representations, management plans, differential diagnoses, and rationales to help guide learners
Hundreds of diseases to consider
An overview of clinical reasoning and a glossary of key terms
100+ expert illness scripts to provide and support students’ clinical knowledge
Detailed assessment of clinical reasoning skills

Experience NEJM Healer Yourself

Schedule a NEJM Healer demonstration and see how easy it is to integrate sound clinical reasoning curriculum and assessment into your program.