Attempt review · why, not just what
Med-2 Clerkship · Student
Liam reached a diagnosis but missed safety-critical signal — the errors below trace back to unpinned red flags and context.
Each error traced back to the pin decisions that caused it
BecauseReached a plausible diagnosis but crossed a safety boundary in management — a knowledge-vs-action gap rather than a knowledge gap.
Rehearse the safety boundary for this presentation and the safe alternative before committing a plan.
BecausePinned the distractor “Hemoglobin” as if it were diagnostic, and never pinned “Tachycardic, regular, no murmur” and “Swollen, tender right calf” — so the pre-test probability for Pulmonary embolism stayed low and a mimic outranked it.
Pin the discriminating findings before committing the differential — they raise the pre-test probability that puts Pulmonary embolism on top.
The evidence behind the causal read
Diagnostic clue
Safety red flag
Context factor
Management modifier
Distractor
Submitted vs. expected ranking
| Diagnosis | Expected | Learner | Outcome |
|---|---|---|---|
| Pulmonary embolismWorking diagnosis | #1 | #2 | Misranked |
| Acute coronary syndromeCan't-miss | #2 | #2 | Correct |
| Aortic dissectionCan't-miss | #4 | #4 | Correct |
| Community-acquired pneumoniaReasonable alternative | #3 | #1 | Misranked |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent