NEJM Healer Demystifies, Teaches, and Assesses Diagnostic Skills
September 21, 2021
Clinical reasoning is notoriously tough to teach, let alone assess. It involves complicated cognitive processes, demands lots of in-person instructional time, and is context-specific.
NEJM Healer, a new online learning application from NEJM Group, was designed to change that. NEJM Healer teaches and assesses clinical reasoning by breaking down the patient diagnosis process into discrete steps, providing learners with detailed feedback on how their thinking brings them closer to or further from the correct diagnosis. The cases are appropriate for medical, physician assistant, and nurse practitioner programs and for residents who want to hone their clinical reasoning skills.
“There has been a broad change in medical education, from a focus on knowledge to one on skills and application,” said Raja-Elie E. Abdulnour, MD, lead editor and director of educational innovation at NEJM Group and the creator of NEJM Healer. Yet, educators struggle to teach the physician’s thought process.
Most students enter their clerkship without a mastery of clinical reasoning, according to a 2017 Journal of General Internal Medicine study in which 70% of clerkship directors surveyed rated students’ knowledge of clinical reasoning concepts prior to clerkship as poor to fair. “Clinical reasoning is something that people have only begun to dissect in the past 20 years,” explained Dr. Abdulnour. “That’s in large part thanks to our understanding of the cognitive models at the foundation of clinical reasoning.” Many schools have added clinical reasoning modules or lectures to their curriculum, but most are didactic and lack interaction with patients—real or virtual.
Dr. Abdulnour and the NEJM Healer team began designing and developing the app in late 2019, with advice from national leaders in clinical reasoning education. The team piloted the application in 2020 with over a dozen medical schools and physician assistant programs to optimize the user experience and look closely at assessment. With the help of a world-class network of medical experts and authors from more than a dozen institutions, the team built a library of cases and the medical content needed to drive these encounters.
NEJM Healer provides students with a variety of adult medicine patient cases akin to what a clinician might encounter in real practice. Student users triage the patient, take a history, perform a thorough virtual physical examination, and consider lab and imaging results as they narrow their differential diagnosis. NEJM Healer graphically displays how each finding affects the probability of the presence or absence of the diseases in their differential, giving students insight into how an experienced diagnostician would work their way through the clinical reasoning process. NEJM Healer offers a library of detailed illness scripts and diagnostic schemas to support the learning process, bringing together knowledge and reasoning.
What makes NEJM Healer unique, said Dr. Abdulnour, is its ability not only to teach clinical reasoning but also to assess students’ mastery down to a very granular level. Its proprietary, algorithmic assessment provides summary performance scoring and detailed feedback on students’ clinical reasoning, comparing student decision-making to that of experienced physicians. It also has the clinical rigor of NEJM experts behind it. “We convened a wide array of experts in clinical reasoning as well as academic clinicians to consult with us to create our content,” said Dr. Abdulnour. The tool’s developers also beta-tested it at multiple institutions, and early users helped shape the current version. One medical school has allowed more than 400 students to use NEJM Healer instead of its Objective Structured Clinical Exam.
Instructors can integrate cases into their curriculum or use them as a point-in-time assessment or across the broader curriculum spanning pre-clinical and clinical learning. “When you get to the end of the case, it’s almost like you just spent an entire day with an expert,” said Dr. Abdulnour. “No instructor would ever have that kind of time to sit with students and give that level of feedback.” A typical student completes a case in about 20 minutes before spending time on the performance feedback the application provides.
Institutions can buy the complete NEJM Healer library or select case bundles. Educational Management Solutions is the distributor of NEJM Healer. For more information, visit www.simulationiq.com/nejm-healer.