Clinical Reasoning Games and Activities

Introduction

These activities are designed to supplement the clinical reasoning you experience on placement and in teaching sessions. While completing the activities, you should try to actively consider the key principles of clinical reasoning.

Before getting started, make sure you’ve read our introduction to clinical reasoning page to familiarise yourself with the important concepts.

Remember, a key component of clinical reasoning is reflective thinking – keep this in mind as you reflect on what you take away from each activity.

Crossout!

Clinical reasoning is like a ‘whodunit?’ novel. To work out the perpetrator, the detective must ask specific questions and gather specific information to place the guilty party at the scene of the crime. In clinical reasoning, you must devise carefully considered questions that distinguish one diagnosis from another.

In Crossout! you can create bespoke boards from which you and a partner must deduce the correct diagnosis.

Gameplay

Work with a partner to create a 25-square board containing 25 diagnoses/conditions associated with an area you need to study. The diagnoses may cover one bodily system or a specific area of your curriculum, or they could just be conditions you need to learn more about.

Take turns asking questions that help you to reach the most likely final diagnosis. As each diagnosis is ‘crossed out’ or excluded, the subsequent questions need to become more specific and differentiating to discriminate the remaining options from one another.

Version 1: History-based clinical reasoning

Using two copies of the board, each person should choose one diagnosis in their head. Their partner must work out which diagnosis has been chosen using specific history questions to get to the answer.

Example questions:

• Would the patient have symptoms of abdominal pain?
• Would a family history of colorectal cancer make this diagnosis more likely?
• Would a smoking history increase the likelihood of developing this condition?

Version 2: Examination-based clinical reasoning

Using two copies of the board, each person should choose one diagnosis in their head. Their partner must work out which diagnosis has been chosen by asking about findings from clinical examination.

Example questions:

• Would the patient have tenderness on palpation of their abdomen?
• Would the patient have abnormal findings on chest auscultation?

Version 3: Investigation-based clinical reasoning

Using two copies of the board, each person should choose one diagnosis in their head. Their partner must work out which diagnosis has been chosen by asking about the imaginary patient’s investigation results.

Example questions:

• Would this patient have abnormal LFT results?
• Would this patient have abnormal findings on a chest X-ray?
• Would this patient need an upper GI endoscopy?

Connect MORE!

In this game, four key features of a condition are provided. The aim of the game is to work out the condition that connects all four. The features may be signs, symptoms, history/examination findings, investigation findings, or important negatives.

Option 1

The first worksheet provides a populated table (including an example answer in the first row) with the answers left blank to use as a worksheet. Use this to test your clinical reasoning independently. The answer key is on the next page.

Option 2

The second worksheet has a blank table which you can populate with your chosen key features to give to a partner and test their clinical reasoning.

1. Each person fills in the ‘features’ columns on their worksheet.
2. Make sure that the features along one row of the table combine to point towards one differential diagnosis.
3. Write down your ‘answers’ of expected differential diagnoses separately to use when you check your partner’s answers later.
4. Swap tables with your partner – try to work out the most likely differential diagnosis for each row of the table.
5. After an agreed time period (you may wish to extend the time depending on the difficulty of your tables), you should return your table for marking.
6. The person with the highest number of correct diagnoses wins.

Note: There may be instances where your partner thinks of a differential that is explained by all four features on your table but does not match the answer you have written down. In this case, one mark is deducted from your score unless you can suggest a further ‘feature’ that would differentiate between the two diagnoses.

This means it is really important to carefully consider the four ‘features’ you provide in the table to ensure you have ruled out other diagnoses wherever possible!

To infinity and further…

This activity is designed to stretch your clinical reasoning to the maximum. The worksheet contains flashcards which should be printed, cut out and shuffled. Take it in turns with a partner to turn over the top card and describe a differential diagnosis that would account for the sign/symptom/finding shown.

With each card you turn over, you must describe a differential diagnosis that accounts for all of the cards you have turned over in your hand. 

The first person who cannot explain all of their cards with a unifying diagnosis loses the game!

Snap!

Create illness script tables for 10 medical conditions which present in a similar way (e.g. 10 conditions that cause confusion) using your knowledge, notes from lectures and textbooks, resources from Geeky Medics, and teaching from clinical placement.

Ask a partner to create a case vignette for each condition (without telling you which is which). They can use ChatGPT to do this if they wish – see this guide for information on how to do this.

You should then go through each case and try to match it to an illness script summary.

Check with your partner once you’ve matched all the cases to see if they are correct. If there is information you didn’t already have in your illness script, add it to your table. These tables will provide helpful revision notes. This will help you to start picking out key features that help you to distinguish one diagnosis from another.

After you’ve matched 10 conditions, switch roles, and your partner should create the illness script tables, and you should write the clinical cases.

Higher or Lower?

Start with 3 similar diagnoses. Go through a series of single-line pieces of information about the case. With each new piece of information, decide whether the likelihood of each diagnosis being correct gets higher or lower.

Examples: Myocardial infarction, gastric ulcer, pancreatitis.

The patient has a history of alcohol excess: Higher; higher; much higher.

The pain radiated into the patient’s back: Unchanged, unchanged, higher.

The pain radiated into the patient’s arm: Higher, lower, lower.

The patient has a history of unstable angina: much higher, lower, lower.

Other clinical reasoning practice…

You can also practice your clinical reasoning skills using the Geeky Medics virtual patients. Use purposeful questioning (i.e. asking questions to help you discern between potential differential diagnoses) rather than just asking questions ‘because you’re supposed to’.

We also have a guide to clinical reasoning clerking to help you make the most of every patient encounter.