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Clinical Reasoning Exercises

Introduction to Exercises in Clinical Reasoning

Copy of The Doctor

The Doctor by Sir Luke Fildes © Tate (2015)
Available under a CC-BY-NC-ND 3.0 (Unported) license


The Exercises in Clinical Reasoning (ECR) section of JGIM Web provides tools for faculty and trainees interested in both learning and explicitly teaching core concepts in clinical reasoning. Ultimately, we aim to have a positive impact on students and trainees as they develop expertise in the diagnostic process, with the core aim of improving patient care. The ECR series utilizes a clinical problem-solving format and then includes a meta-cognitive commentary to decipher the clinical reasoning process used by expert diagnosticians. This parallel process allows the reader to understand the framework by which the clinician solves (or doesn’t solve) the case.  

On this page, you will find a downloadable curriculum built on the ECR series designed to help clinician educators learn and teach critical reasoning concepts. Each case on the website will include an introduction to the clinical reasoning concept highlighted in the case, downloadable teaching slides, which include an embedded instructor’s guide, and links to other clinical reasoning resources.  We hope that the ECR website will inspire others to use clinical reasoning concepts to enhance their teaching, and potentially, and will even motivate some educators to submit their work to the JGIM ECR series.

Content for each clinical reasoning concept:

  • Introductory document: Defines the reasoning concept and links it to the related ECR case(s)
  • ECR case: Provides free access to the ECR manuscript(s)
  • PowerPoint: Offers a teaching slide-set that can be used to walk learners through the ECR case while focusing on a key reasoning concept

Current Reasoning Concepts:

Problem representation

Illness scripts

Dual process theory

Diagnostic Schema

The JGIM Exercises in Clinical Reasoning Editorial Board:

Gabrielle Berger, MD is an Assistant Professor of General Internal Medicine at the University of Washington Medical Center. She is an assistant program director for the UW Internal Medicine Residency and directs the residency's Clinician-Educator Pathway. Dr. Berger earned her M.D. from Emory University in Atlanta, Georgia. She was a chief resident at San Francisco General Hospital prior to joining UW Medicine.
Juan N. Lessing MD, FACP is an Assistant Professor of Medicine in the Division of Hospital Medicine, Department of Medicine, at the University of Colorado. He serves as the University of Colorado Hospital Internal Medicine Clerkship Site Director. He graduated with a degree in Art and Archaeology from Princeton University; medical school at the University of California, San Francisco; and completed residency and chief residency at the University of Washington, Seattle.
Denise-M-Connor.png Denise M. Connor, MD is an Associate Professor of Clinical Medicine at the University of California, San Francisco (UCSF) based at the VA Medical Center. She is Associate Director of PRIME Residency program and Director of the Diagnostic Reasoning Block for second-year medical students. She earned her MD from the University of Pennsylvania, School of Medicine.

Jeffrey Kohlwes MD, MPH is a Professor of Clinical Medicine in General Internal Medicine and Director of the PRIME Residency program at the University of California, San Francisco based at the Veterans Affairs Medical Center.  He earned his MD from Dartmouth College and public health degree from the University of Washington.  He is also the Associate Editor for Clinical Content for the Journal of General Internal Medicine.

Carlos-Estrada.png Carlos Estrada, MD, MS, FACP is Director of the Division of General Internal Medicine at the University of Alabama at Birmingham, Birmingham and Senior Scholar for the BVAMC Quality Scholars Fellowship Program. Dr. Estrada earned his MD from Cayetano Heredia University (Lima, Peru). His research interests are in medical education, faculty development, and clinical prediction rules.

Rabih Geha, MD is Chief Resident at the University of California, San Francisco. He earned his MD from Brown University. His clinical interests are in medical education with a focus on clinical reasoning and diagnostic expertise.  


Mark C. Henderson, MD is UC Davis School of Medicine Associate Dean for Admissions and Outreach and vice chair and residency program director for the Department of Internal Medicine. He earned his MD from UCSF school of Medicine. His research has focused on medical education, including student career choices and the use of systematic reviews in clinical education.

Untitled.png Neil Mehta, MBBS, MS is Assistant Dean for Education Informatics and Technology and Professor of Medicine Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He earned his MBBS from N.H.L Municipal Medical College.

Contact the ECR Team