Differentials for students

[futuredvm297]

Hi all,

We are becoming a new clinical site for vet students, and to make sure I am up to speed, when a student is presenting their problem list and then differentials, how do you like them in order? DAMNIT-V/VITAMIN-D? Have them say (for vomiting in dog) "it could be metabolic disease such as Cushing's, Addison's, DM. Infectious/inflammatory such as viral, bacterial, fungal, protozoal, parasitic or gastritis, gastroenterititis".

It has been a long time since being a student! Any input is great!

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[JaynaAli]

I am just happy if they‘ll speak up and say anything, lol.

More seriously, when a student is/was giving me a differential list I actually want them to provide them in the order that are most likely to least likely based upon all the case info. I personally think the DAMNITV is useful to make sure you don’t forget a category but I feel like most people don’t formally use that often in real life. It may be difficult on a website of lists, but I feel like most common to least common diseases would be more useful to clinicians.

 

[supershorty]

I actually want them to provide them in the order that are most likely to least likely based upon all the case info.

As a current student just over halfway through 4th year, this is what seems to jive best with most people I've worked with.

I'm a little bit of a gunner and when I'm rounding the clinician on a case, I tend to go signalment and history (which has the problems worked into it), my list of differentials and why I have them ranked the way I do, and then what diagnostics I would recommend and why (and diagnostics are prioritized as well in case cost is a concern - I just came off a spectrum of care rotation so that's very much at the forefront of my mind). It's a little monologuey initially, but it generally lets us get going on care for the patient sooner.

There have been few clinicians I've worked with who want the problem list separated out - it feels clunky, rather than including it in the case history, and no one has asked me for the DAMNITV scheme. As Jayna said, that's helpful for organization, but in terms of a case presentation where you have an animal that needs care in that moment, I think having someone list out every single possible thing that goes with vomiting is more pedantic than actually contributing to the patient well-being.

 

[WhtsThFrequency]

I'm not a big fan of the long list of mnemonics to be honest (we used CINEMA HDTV + P here at the MD institution I teach at, and it's so freaking bulky).

When I'm facilitating a case session, I generally start them off by asking about general body systems. E.g. present patient, identify chief complaint, physical exam and history of present illness, and then ask them "What body systems are you the most concerned about here, and which would you like to investigate further" (gastrointestinal, renal, neuro, msk, immune, etc). THEN you think you can start getting into specifics of differentials and ranking them. That's just how I do it though....I don't think there is a hard and fast rule.

 

[battie]

We are an externship site for students not attached to any sort of teaching facility. I let the students list what they can think and then add anything I think they missed.

Don't forget part of what we're teaching then is confidence as well.