PedsCrit Clinical Reasoning with MJ Sacco and Andrew Parsons
May 26, 2025
In this engaging discussion, MJ Sacco, a pediatric intensivist, and Andrew Parsons, an internist and hospitalist, delve into the intricacies of clinical reasoning. They explore the importance of structured decision-making in pediatric care, highlighting cases that challenge trainees. The duo emphasizes the need for open dialogue and the Socratic method in medical training to identify knowledge gaps. They introduce the REACT tool for urgent scenarios and stress the significance of effective communication and autonomy in developing confident clinicians.
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Type One vs Type Two Thinking
- Early trainees tend to rely on fast, intuitive type one thinking but lack the intellectual fortitude to engage in slower type two thinking.
- Developing a systematic diagnostic approach helps trainees avoid premature closure and broaden their differential diagnosis.
Tease Knowledge from Process Issues
- Ask trainees what else is on their differential to assess if they have sufficient knowledge or need better scaffolding.
- Help them develop frameworks to organize knowledge rather than just telling them to "read more."
Encourage Thoughtful Verbalization
- Set expectations that you want trainees to think out loud without fear of being judged right or wrong.
- Encourage trainees to verbalize what they expect tests to show and plan next steps if results vary.