Introduction/Review of Clinical Decision Making

This session will complement the introductory lecture given at the beginning of the Medicine clerkship. A brief review of the basic concepts will take place emphasizing the following topics:

Diagnostic Testing:

1. Characteristics of a diagnostic test
2. Evaluating screening tests
3. Bayes' theorem
4. Calculating post-test probability

Choosing a Therapy:

1. The structure of the randomized trial
2. Determining relative benefit of a therapy from a trial
3. Determining absolute benefit - the ‘number needed to treat'
4. Meta-analysis

This session will be an interactive discussion with students. Students will be expected to raise questions regarding topics which are still unclear. It is also expected that students will bring examples from their own clinical experience (at least after the first few months of the year). In particular, the practical relevance of the concepts under discussion will be clarified. Students should have a basic grasp of the concepts listed above; specific problems will be posed to the students for them to solve during the class. As before, the basic topics under discussion are:

1. How do I understand the relationship between the 'exposure' (or causal factor) and disease?
2. How do I make the diagnosis?
3. How do I choose the best treatment? The challenge at this point will be to provide the clinically relevant context.