Patrick DonnellyNo reasoning errors on this attempt — the learner pinned the signal that mattered and the differential followed. Use it as an exemplar in the cohort debrief.
Attempt review · why, not just what
Patrick Donnelly · Acute Dyspnea After Arthroplasty
PGY-1 Internal Medicine · Resident
Patrick pinned the findings that matter and reasoned cleanly through this case.
Pin decisions vs. what mattered
The evidence behind the causal read
Pinned signalMissed signalFixated on distractor
Diagnostic clue
- Pleuritic chest painPinned
- Acute dyspneaPinned
- Unilateral calf swellingPinned
- Tachycardic, regular, no murmurPinned
- Clear chest on auscultationPinned
- Swollen, tender right calfMissed
- D-dimerPinned
- CT pulmonary angiography (CTPA)Pinned
Safety red flag
- Heart RatePinned
- Respiratory RatePinned
- Oxygen SaturationMissed
- Tachypnoeic and anxiousPinned
- 12-lead ECG and continuous telemetry with repeat saturationsPinned
Context factor
- Systolic Blood PressurePinned
Management modifier
- Baseline CBC, creatinine and coagulation panelMissed
- Platelet CountPinned
- CreatininePinned
Distractor
- TemperatureCorrectly ignored
- HemoglobinCorrectly ignored
Differential outcome
Submitted vs. expected ranking
| Diagnosis | Expected | Learner | Outcome |
|---|---|---|---|
| Pulmonary embolismWorking diagnosis | #1 | #1 | Correct |
| Acute coronary syndromeCan't-miss | #2 | #2 | Correct |
| Aortic dissectionCan't-miss | #4 | #4 | Correct |
| Community-acquired pneumoniaReasonable alternative | #3 | #3 | Correct |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent
- Diagnostic clue7/8
- Safety red flag4/5
- Context factor1/1
- Management modifier2/3
- Distractor0/2pinned