Forming a differential diagnosis is critical to ordering proper clinical testing and appropriately managing clinicaldisease. Differential diagnosis is also a challenging component of medical education for many students. Unfortunately, most differential diagnosis education comes during the third-year clerkships when the medical student is thrown into unfamiliar clinical situations and responsibilities. As such, a few attempts have been reported in the literature aimed at teaching differentialdiagnosis and clinical decision-making in the early “basic science” years of medical education (1-3). At the Mayo medical school, we have been teaching differential diagnosis in the context of the first-year Pathology course for a number of years. Students are taught how to form differential diagnoses and begin the initial steps of clinical decision-making. We also used patient interactions in the classroom to increase students’ awareness of the important aspects of clinical histories and appropriate diagnostic testing in arriving at an accurate diagnosis. Virtual and simulated patient testing has been used in other studies to some levels of success, we hypothesized that actual patients with clinical pathologies will provide even more important learning with regard to clinical decision-making for the students (1, 4, 5).

Having patient encounters in a first-year Pathology course helps medical students bridge the worlds of basic and clinical sciences. We have shown that using real patients’ experiences in the classroom significantly helps students formulate differential diagnoses and improves clinical decision-making skills, in addition to improving their understanding of disease pathology. Student scores on the patient encounter assignments significantly improved 32% during the course. Importantly, we found that 72% of students felt that the patient encounters should be incorporated in the course the following year. 74.5% of students felt that the patient encounter assignments helped them with their clinical decision-making skills. 68% of students felt that they were better able to connect patient pathology clinical presentation. 74.5% of students felt that they had a better understanding of what questions are important to ask patients. Significantly, 87% of students gained a better appreciation of the social and emotional challenges the patients go through.