Teaching Clinical Decision Making: The Keystone Experience

Gregory W. Good, OD, PhD
Michael J. Earley, OD, PhD
Kelly K. Nichols, OD, MPH, PhD


Preceptors facilitate clinical education by teaching knowledge organization skills to allow meaningful information retrieval during patient examination. The intensive patient-based Keystone Course series designed at The Ohio State University College of Optometry uses case scenarios to help students develop these skills. Students analyze individual patient data and develop a patient illness script composed of three elements: epidemiology, temporal pattern and key features. Students next compose a ranked differential diagnosis list by comparing the patient’s illness script to classic disease presentations. The goal is to teach meaningful diagnostic integration and the importance of basic science principles to eye and systemic interactions.

Key Words: clinical teaching, diagnostic reasoning, differential diagnoses, illness script

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