Medical reasoning: Not sustained activation of neuronal circuits

Azevedo, T.; Oliveira, M.; Iegoroff, R.; Godoy, A.

Background and aims: For a physician, it is essential to extract relevant information from a patient's history and identify abnormal findings of the physical examination to select exams for an accurate diagnosis. We checked the performances of medical students in different steps of the clinical reasoning. Methods: Twenty-five medical students that finished the first two years of basic training, gave us written approval and were tested. We presented 3 different clinical cases: colon cancer (CC), pneumonia (Pn) and stroke (St). For each case, 4 findings of the history and 2 of the examination were informed. They had to choose 2 supplementary exams. Then, we asked which other 2 exams they would require. Finally, diagnosis was required. Results: For CC, 52% chose the blood count and 44% a scopy as the first exams. The other exams: scopy (32%) and blood count (28%). Diagnosis: CC (36%) and lower gastrointestinal hemorrhage (12%). For Pn, 92% chose Chest X-ray or tomography and 38% blood count. Further exams were: gasometry (54%) and blood count (29%). Diagnosis: Pn (54%) and COVID-19 (33%). For St, 79% chose Head tomography and 54% blood count. The other exams: blood glucose (37.5%) and electrolytes (29%). Diagnosis: St (88%) and brain tumor (4%). Conclusions: Our data show that, no matter the clinical case, the students strongly disagree the second set of exams they would ask to make a diagnosis. Data from the medical consultation can activate neuronal circuits on a standardized way at an initial step of the clinical reasoning, but that activation cannot be sustained.