17: Teaching Clinical Reasoning – Bob Trowbridge

In this episode we get tips on how to teach clinical reasoning from Bob Trowbridge, an expert clinical educator at Maine Medical Centre.

Visit us at https://www.facebook.com/IMreasoning to comment on the episode and to give us your thoughts on this topic.

LINKS: To check out/order Teaching Clinical Reasoning, co-edited by Bob Trowbridge and other books in the American College of Physicians (ACP) Teaching Medicine series, click HERE. 

Here are a couple of brief videos of Bob precepting a junior doctor without and then with the One-Minute Preceptor approach to teaching and feedback.

Here’s a copy of the structured reflection form that Bob talks about in the podcast: Structured Reflection


Episode 16 – feedback 2 – “end-of-run eval”

We decided to call this episode an “in-between-isode”, borrowing the term from the Tim Ferris show.  Its a short follow up continuing with our theme of feedback.  How do we provide an evaluation for a strong performer?  Does it help them to hear how great they are? Will it be a useful session? Will it help them improve even further?

Leave us your thoughts on our new Facebook page.


Episode 15: Feedback

In this episode we begin our foray into the topic of feedback.  You will hear us “worry out loud”,  together with our guest Dr. Chris Watling from the University of Western Ontario, about the difficulties in giving effective feedback to our trainees.

Several themes arise from our conversation.  Feedback needs to be specific, credible, and not soul-destroying (although ironically, we each shared some of our most traumatic feedback experiences as the most memorable, and influential, course-correcting moments).  How we give and receive feedback is not only dependent on the individuals involved, but also importantly on the culture of the discipline; medical training culture is different from musical training, different from athletic training.

Also, keep an “ear” out for our new segment, the BOM (Bias of the Month). Enjoy!


A few relevant and interesting articles by Dr. Chris Watling:

Learning culture and feedback: an international study of medical athletes and musicians.

Unfilled promise, untapped potential: Feedback at the crossroads.

Beyond individualism: professional culture and its influence on feedback.

Toward meaningful evaluation of medical trainees: the influence of participants’ perceptions of the process.

To participate in the Human Diagnosis Project and Morning Report click HERE.

Click HERE for a Goodreads review of The Laws of Medicine: Field Notes from an Uncertain Science by Siddhartha Mekherjee.


Episode 13: Stump the Chumps – take 3

Finally, our much awaited third try with Stump the Chumps.  This time one of our registrars Dr. Brian Grainger challenges us with a case of a young patient.  This is a longer episode, which I guess reflects the fact that sometimes, when the diagnosis is not obvious, you just have to take your time.  Enjoy!


Episode 12: Compassion

What is compassion fatigue? Can you learn how to be more compassionate with your patients? We talk to Dr. Tony Fernando, psychiatrist, sleep specialist, educator and researcher, about compassion in healthcare, happiness, mindfulness, enlightenment, buddhist monks, and a bunch of other stuff. Enjoy!


Check out the University of Auckland CALM website- Computer Assisted Learning for the Mind, a resource founded by Dr. Tony Fernando and colleagues for medical students (and everyone else) to learn about mindfulness, mental resiliency, and managing stress, anxiety, and depression.

Here’s a very interesting, informative YouTube video by Tony on the science of happiness.

And here’s a great article from Stuff.co.nz about Tony and his work in the area of compassion and compassion fatigue.

If you’re interested in training your compassion muscles here’s a link to the Stanford University Compassion Cultivation Training and the Cognitively-Based Compassion Training at Emory University.

If you’d like to leave a comment about this episode, give us feedback or suggest topics for future episodes, please click the comments link on the upper left of this page.

Episode 11: Stump the Chumps – take 2

We bring you our second attempt at “stump the chumps”.  Our friend and colleague Oliver Menzies brought an interesting case.  We think this case was not quite as enigmatic as our first one (episode 5) but we hope it illustrates sound clinical reasoning as we work our way through the clinical information.  Enjoy.

Episode 10: The Second Victim

When we talk about medical errors, we need to remember that there are two victims; the patient who suffers harm as a result of the error, and the clinician who makes the error.  As long as the practice of medicine remains a human endeavour, medical errors are inevitable.  As a medical community we need to accept that errors will occur.  We need to talk about them openly and honestly, share our own stories, and support our colleagues when they share their stories with us. As members of society, we should better understand the fallibility of medical practitioners, and we need to understand the limits of their craft.

We had the opportunity to interview Brian Goldman, an ED doctor from Toronto, Canada, who is also a journalist, host of the CBC radio show “White Coat, Black Art”, author of two books unveiling the secrets of medical culture, and a “TED-talker” with his presentation entitled “Doctors make mistakes – can we talk about that”.

We also interviewed our friend and colleague, Dr. David Spriggs, a Brit who has lived in NZ for many years, an excellent general internist and geriatrician, who regularly teaches our trainees on the reality of making mistakes.


We highly recommend Dr. Brian Goldman’s TED talk and his excellent books, The Night Shift, Real Life in the Heart of the ER and his latest, The Secret Language of Doctors, Cracking the Code of Hospital Slang. Follow this link to his radio show White Coat, Black Art. You can also check out Brian’s website.


If you’d like to leave a comment about this episode, give us feedback or suggest topics for future episodes, please click the comments link on the upper left of this page.