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NEJM Healer helps residents further refine their clinical reasoning skills and gives educators a formal way to assess their residents’ diagnostic accuracy.

Clinical reasoning is a core EPA for medical students entering residency, and a large portion of the competencies, milestones, and EPAs for GME programs are focused on the development of sound clinical judgment and reasoning skills. However, incoming residents have uneven exposure to both training in clinical reasoning and to a sufficient variety of clinical scenarios. Numerous pressures on GME programs make it very challenging for educators to ensure their interns meet baseline expectations in clinical reasoning or that these skills are continuously developed and assessed throughout residency.

NEJM Healer provides educators with a formal clinical reasoning assessment tool and gives residents a way to deliberately practice these skills as they continue to refine and master them throughout their residency.

Year 1

First-year residents may have been exposed to varying levels of clinical reasoning education and clinical scenarios during medical school.

NEJM Healer lets educators establish a baseline for each incoming resident’s clinical reasoning skill level and identify residents who need improvement. Residents can use NEJM Healer during their internship period to practice safely outside of patient encounters as they continue to master their skills.

Year 2

In their second year, residents begin to take on more direct patient-care responsibilities.

NEJM Healer can help these residents continue along their path to developing strong clinical judgment and practicing independently. Educators can use the application to quickly identify residents who aren’t meeting critical thresholds for remediation and coaching.

Year 3

Most third-year residents have mastered clinical reasoning skills and have started to move into the next stage of their career as mentor and educator to younger residents.

NEJM Healer gives third-years a formal tool for teaching and assessing their interns and students.

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 Application Meets a Variety of Residency Program Needs

There are a variety of ways you can use NEJM Healer in your adult medicine residency programs to help ensure that your residents meet standard-of-care and national quality metrics.

Didactic Curriculum Enhancement

Supplement a focused curriculum in clinical reasoning with case-, symptom- and organ-system-based assignments. Use in traditional lecture, flipped classroom, and asynchronous learning environments.

Rotation Onboarding / Offboarding

During transition to residency, use NEJM Healer to offer or supplement a “Bootcamp” course in clinical reasoning. Establish a baseline for incoming residents and assess their clinical reasoning skills development at the end of each rotation.

Clinical Skills Practice

Give individual residents an opportunity to deliberately practice clinical reasoning in a safe environment until their skills are entrustable. Identify residents who need remediation and additional support.

Clinical Reasoning Multi-Year Curriculum

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

Point-in-Time Assessment

Replace or supplement objective structured clinical examinations (OSCEs) in a way that is unbiased and predictive of improved patient outcomes.

Obtain detailed reporting on resident performance and concordance with experts across every stage of the clinical reasoning process, from gathering patient history through final diagnosis.

Experience NEJM Healer Yourself

Deliberate Practice for Developing Sound Clinical Reasoning and Achieving Diagnostic Excellence

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

Trusted and Used by Medical Educators from Top Institutions Across the Globe

“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]
Demystify the clinical reasoning process
Build or supplement clinical reasoning curriculum
Engage learners across cohorts
Standardize assessment
Save faculty time and resources

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.