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NEJM Healer offers a systematic way to develop clinical reasoning skills through deliberate practice.

NEJM Healer packages the most current and reliable clinical information in an expansive library of patient cases with a granular, data-driven approach to building skills.

Using NEJM Healer, students engage in simple, yet immersive virtual patient encounters. They learn how to thoroughly gather and evaluate data, iteratively create problem representations, activate illness scripts, build broad differential diagnoses, and apply knowledge to home in on a lead diagnosis and outline a sound management plan.

Educators can monitor a student’s path to sound clinical reasoning through a digital fingerprint of each student’s data-gathering and decision-making history, helping them to identify students in need of remediation, and informing their evaluations.

Preclinical

NEJM Healer helps medical schools introduce clinical reasoning curriculum into pre-clinical years, in a structured and explicit fashion.

By practicing with NEJM Healer cases, M1 and M2 students gain confidence and increased skills in the iterative process of making well-reasoned, evidence-based, and patient-centered diagnostic decisions. These learners absorb what questions to ask in practice, and get a sense for how knowledge and reasoning come together. In addition, educators get an early look at which students need more attention and coaching in specific areas.

Clinical

When students transition to clerkship, they are often limited to the patients and disease processes they see in the wards. Moreover, because clinical reasoning assessment can be subjective, time-intensive, and difficult to do in a group setting, assessing student performance typically primarily focuses on objective assessments of clinical knowledge.

NEJM Healer removes these constraints and gives educators a tool to objectively evaluate clinical reasoning progress as students onboard and offboard their clinical rotations and advance toward independent clinical practice.

As they begin the transition to residency, students must hone their skills and develop a deeper, more intuitive understanding of the clinical reasoning process while applying deeper levels of clinical knowledge.

NEJM Healer allows educators to identify clinical reasoning deficits in students by providing a systematic assessment of their diagnostic competency before they graduate.

Transition to Residency

With fewer formal assessments for MD candidates, educators are looking for a new way to make sure students are prepared for residency. They want to know that students understand the practice of medicine and not just its knowledge base when recommending a candidate for residency. They also want to ensure that candidates have been exposed to a wide variety of bread- and- butter clinical scenarios.

NEJM Healer offers the objective assessment of a student’s clinical reasoning skills that educators need to ensure learners’ preparedness for residency and help guide recommendations.

Experience NEJM Healer Yourself

Deliberate Practice for Developing Sound Clinical Reasoning and Achieving Diagnostic Excellence

One Tool Fits a Variety of Medical School Needs

There are a variety of ways you can use NEJM Healer, whether you teach at a large academic institution and want to provide structured and objective assessment in your clinical reasoning or case-based education program, or you’re responsible for a small program at a rural or community hospital and lack adequate resources to teach clinical reasoning.

Enhance Didactic Curriculum

Supplement a focused course syllabus in clinical reasoning or clinical skills. Use in traditional lecture, flipped classroom, bedside teaching, educator-moderated, and asynchronous learning environments.

Clinical Skills Course

Help students transition from didactic to clinical learning in early internship through safe, deliberate practice. Identify struggling students for remediation and support.

Clinical Reasoning Multi-Year Curriculum

Gain deep and longitudinal assessment of students’ clinical reasoning development and their skills in summarizing, presenting, and documenting clinical cases effectively.

Assessment for Residency

Recommend students for residency through meaningful assessment – measuring what matters for improved patient outcomes.

Experience NEJM Healer Yourself

Schedule a NEJM Healer demonstration and see how easy it is to integrate sound clinical reasoning curriculum and assessment into your program.

The NEJM Healer Educator Portal: Helping Educators Teach, Coach, and Assess

Our robust Educator Portal makes it easy to create and track assignments and assess performance. With an intuitive interface and extensive reporting, the NEJM Healer Educator Portal:

  • Provides extensive, consistent, and objective feedback over a wide range of cases,
  • Helps educators identify those who need remediation,
  • Jumpstarts coaching conversations with any learner.

Assignments

Assigning cases in NEJM Healer is easy!

The case library in the educator portal provides all the info educators need about each case, including the lead diagnosis and key teaching points and they can search and filter cases according to:

  • Presentation (e.g., headache)
  • Acuity (acute vs. chronic)
  • Patient age
  • Organ system
  • Learning objectives
  • Final diagnosis
  • Case difficulty
  • Setting

Learner Performance and Progress Reporting

NEJM Healer provides reporting on both learners’ performance and progress to help educators track individual learners and cohorts at each stage of a case and for the case as a whole.

These reporting data present educators with powerful insights into learners’ clinical reasoning profile according to both objective and self-assessed measures.

Objective Measurements:
  • Data acquisition thoroughness
  • Data acquisition efficiency
  • Lead diagnostic accuracy
  • Differential diagnostic accuracy
  • Illness script concordance
Learner Self-Assessments:
  • Problem representation concordance
  • Management plan concordance
  • Degree of concern for the patient’s status
  • Degree of certainty with the diagnosis

Educators can get quick snapshots of the key assessments above and interact with graphs showing how learners compare with each other across an assignment, making it easy to identify outliers. Want to delve deeper? Download .csv files that show how every learner did on each measure, including their problem representations and differentials at each stage. Want to work in depth with a single learner? Access and print their detailed end-of-case reports.

RESEARCH

Experts Call for Improved Clinical Reasoning Training in All Phases of Medical Education

“Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve diagnostic accuracy and reduce diagnostic error"1
1Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors. J Gen Intern Med.
[pubmed.ncbi.nlm.nih.gov/28840454/]
“Learners should be encouraged to read about their patients’ problems in a way that promotes diagnostic reasoning, rather than to read about topics in a rote-memorization fashion, without context. The organization of knowledge stored in memory facilitates the recall of key concepts for application to the next relevant clinical case.”2
2Educational Strategies to Promote Clinical Diagnostic Reasoning. N Engl J Med.
[pubmed.ncbi.nlm.nih.gov/17124019/]
“Diagnostic errors cause substantial preventable harm. In a 2019 study published in the journal Diagnosis, “Causes were disproportionately clinical judgment factors (85.7%) across categories (range 82.0–88.8%).”3
3Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers. Diagnosis.
[degruyter.com/document/doi/10.1515/dx-2019-0019/html]
“From a National Survey of Internal Medicine Clerkship Directors Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic.” “Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers.”4
4Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors. J Gen Intern Med.
“A case vignette-based clinical reasoning curriculum can effectively increase residents’ knowledge of clinical reasoning concepts and their self-assessed ability to recognize and apply clinical reasoning concepts.”5
5Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis.
[pubmed.ncbi.nlm.nih.gov/30901312/]
“Background Errors in medicine are common and often tied to diagnosis. Educating physicians about the science of cognitive decision-making, especially during medical school and residency when trainees are still forming clinical habits, may enhance awareness of individual cognitive biases and has the potential to reduce diagnostic errors and improve patient safety.”6
6Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis.
[pubmed.ncbi.nlm.nih.gov/30901312/
“Diagnostic reasoning deficits are frequently identified in students and residents referred for remediation. Effective remediation of diagnostic reasoning deficits includes both granular assessment of the learner’s diagnostic reasoning pathway—from hypothesis generation to working diagnosis—and targeted coaching exercises for the learner (along with their pedagogical purpose).”7
7Targeted Strategies to Remediate Diagnostic Reasoning Deficits. Academic Medicine.
[PMID: 34261865 DOI: 10.1097/ACM.0000000000004244]
Dozens of virtual patient encounters
Expert problem representations, management plans, differential diagnoses, and rationales to help guide learners
Hundreds of diseases to consider
An overview of clinical reasoning and a glossary of key terms
100+ expert illness scripts to provide and support students’ clinical knowledge
Detailed assessment of clinical reasoning skills

Experience NEJM Healer Yourself

Schedule a NEJM Healer demonstration and see how easy it is to integrate sound clinical reasoning curriculum and assessment into your program.