Attempt review · why, not just what
Med-2 Clerkship · Student
Lucas 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
BecauseNever pinned “Respiratory Rate” and “12-lead ECG and continuous telemetry with repeat saturations”, so nothing prompted the dangerous-alternative sweep for this presentation.
Treat Aortic dissection as a must-exclude for this presentation — pin the context that makes it possible, then rule it in or out explicitly.
BecausePinned the distractor “Temperature” as if it were diagnostic — 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 | — | Omitted |
| Community-acquired pneumoniaReasonable alternative | #3 | #1 | Misranked |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent