While medical students usually know a lot about sophisticated imaging studies and exotic lab tests, they often don't know how to approach a patient, make a clinical diagnosis, and come to a sensible differential diagnostic hypothesis. With the help of CNDLS, Dr. Wolfgang Rennert designed a website on which students could work through case scenarios in order to practice their clinical thinking and decision making skills.

In a move to take medical training back to the bedside and emphasize the clinical teaching of concepts rather than the theoretical teaching of facts, Dr. Rennert was looking for a learning tool that would allow students to reflect on the material and to practice clinical thinking in a self-directed manner. In order to improve students' ability to diagnose and management a patient's case, Dr. Rennert attended a CNDLS workshop on web design in the previous year which inspired him to design a virtual version of a hands-on clinical training program. The website takes students through different clinical case scenarios, see patient photos, and read the relevant disease history. The 'physical examination' page guides the student through a problem-based discussion of physical examination features, all supported by clinical images leading to a clinical differential diagnosis. Pertinent clinical findings, differential diagnoses, relevant laboratory and imaging studies and patient management strategies are discussed in further detail. The emphasis on the physical examination features that the patient presents with and the diagnostic relevance of clinical findings means laboratory tests and imaging studies are offered only as supportive tools.

Since Dr. Rennert has introduced the site to residents in the pediatric residency training program, students have commented that they value the emphasis on clinical teaching during their clerkship in pediatrics. The project also instigated interaction between Dr. Rennert and his colleagues across campus, who are facing similar problems in teaching clinical diagnostic skills. The website remains a work in progress as cases are added. Second, the challenge remains, how to evaluate the educational impact that the site has on student learning. While students are evaluated on 'clinical management' skills during their clerkship, these evaluations are based on rather vague criteria for performance. On the other side, exam scores may correlate with knowledge, but they may not correlate with clinical performance. Dr. Rennert is planning with CNDLS ways to evaluate the site and implement an evaluation system.