Council on Medical Student Education in Pediatrics


Search This Site

COMSEP Meeting in Ottawa, ON

Poster Presentation:

Developing and Assessing an e-Learning Module Using Illness Scripts to Improve Students Diagnostic Reasoning Skills

Nicole Akar-Ghabril,Childrens National,Washington,DC,Christina Tuluca,Childrens National,Washington,DC,Jeff Sestokas,Childrens National,Washington,DC,Gabrina Dixon,Childrens National,Washington,DC,Wilhelmina C. Bradford,Childrens National,Washington,DC,Mary C. Ottolini,Childrens National,Washington,DC


There is debate regarding how to effectively teach diagnostic reasoning to medical trainees. Our goal is to teach key elements of diagnostic reasoning during oral case presentations. Following data acquisition, the expert creates a “problem representation” to define the case, which then triggers recollection of “illness scripts.” An illness script is medical knowledge stored with a predictable structure: predisposing conditions, pathophysiological insult, and clinical consequences. This allows related knowledge to become accessible for creating a reasonable differential and course of action. Third year medical students at Children’s National are introduced to a framework "PBEAR" (Problem representation, Background Evidence, Analysis, Recommendation) for presenting oral case presentations (OCP) based on this theory. 



Create an elearning module for medical trainees that

1) Provides an organized framework for clinical diagnostic reasoning

2) Models PBEAR format for OCP

3) Provides practice opportunities to assess case presentations using the OCP tool


INNOVATION: A 30-minute interactive elearning module was developed focusing on illness scripts and problem representation statements. The module demonstrates effective strategies to study and store medical knowledge and opportunities to apply knowledge by analyzing cases and practicing creating problem representations statements. The module describes the OCP Tool, developed to provide feedback to students during bedside rounds. The module concludes with 3 videos, the 1st depicts a poor, the 2nd an average, and the 3rd an excellent presentation. The student is asked to rate each presentation using the OCP tool. We analyzed ratings assigned by 31 students to the cases, to determine if the students correctly rated the cases as poor, average, or excellent.

RESULTS: 68%, 78% and 95% of students correctly assigned each of the 3 cases an overall rating of poor, average and excellent respectively. 75% of students agreed with the statement "The module enhanced my diagnostic reasoning skills."

CONCLUSION: After completing the module, the majority of students correctly scored the cases using the OCP tool, suggesting that the module conveyed the concepts of illness scripts and problem representation statements. Most medical students perceived the module enhanced their diagnostic reasoning skills.