Table 2.

CoT and diagnostic reasoning prompts.

Traditional CoT reasoning prompt
Traditional chain-of-thought (CoT)	Prompt: Provide a step-by-step deduction that identifies the correct response {Example Question 1} Example Rationale 1: The patient had a surgical repair of a displaced femoral neck fracture. The patient has petechiae. The patient has a new oxygen requirement, meaning they are having difficulty with their breathing. This patient most likely has a fat embolism. {Example Question 2} Example Rationale 2: This patient is having chest pain. They recently had a heart attack and has new chest pain, suggesting he may have a problem with his heart. The EKG has diffuse ST elevations and he has a scratching murmur. This patient likely has Dressler Syndrome.
Clinical reasoning prompts
Differential diagnosis CoT	Prompt: Use step by step deduction to create a differential diagnosis and then use step by step deduction to determine the correct response. {Example Question 1} Example Rationale 1: This patient has shortness of breath after a long bone surgery. The differential for this patient is pulmonary embolism, fat embolism, myocardial infarction, blood loss, anaphylaxis, or a drug reaction. The patient has petechiae which makes fat embolism more likely. This patient most likely has a fat embolism. {Example Question 2} Example Rationale 2: This patient has chest pain with diffuse ST elevations after a recent myocardial infarction. The differential for this patient includes: myocardial infarction, pulmonary embolism, pericarditis, Dressler syndrome, aortic dissection, and costochondritis. This patient likely has a high-pitched scratching sound on auscultation associated with pericarditis and Dressler Syndrome. This patient has diffuse ST elevations associated with Dressler Syndrome. This patient most likely has Dressler Syndrome.
Intuitive reasoning CoT	Prompt: Use symptom, signs, and laboratory disease associations to step by step deduce the correct response. {Example Question 1} Example Rationale 1: This patient has findings of petechiae, altered mental status, shortness of breath, and recent surgery suggesting a diagnosis of fat emboli. The patient most likely has a fat embolism. {Example Question 2} Example Rationale 2: This patient had a recent myocardial infarction with new development of diffuse ST elevations, chest pain, and a high pitched scratching murmur which are found in Dressler’s syndrome. This patient likely has Dressler’s Syndrome.
Analytic reasoning CoT	Prompt: Use analytic reasoning to deduce the physiologic or biochemical pathophysiology of the patient and step by step identify the correct response. {Example Question 1} Example Rationale 1:The patient recently had large bone surgery making fat emboli a potential cause because the bone marrow was manipulated. Petechiae can form in response to capillary inflammation caused by fat emboli. Fat micro globules cause CNS microcirculation occlusion causing confusion and altered mental status. Fat obstruction in the pulmonary arteries can cause tachycardia and shortness of breath as seen in this patient. This patient most likely has a fat embolism. {Example Question 2} Example Rationale 2: This patient had a recent myocardial infarction which can cause myocardial inflammation that causes pericarditis and Dressler Syndrome. The diffuse ST elevations and high pitched scratching murmur can be signs of pericardial inflammation as the inflamed pericardium rubs against the pleura as seen with Dressler Syndrome. This patient likely has Dressler Syndrome.
Bayesian reasoning CoT	Prompt: Use step-by-step Bayesian Inference to create a prior probability that is updated with new information in the history to produce a posterior probability and determine the final diagnosis. {Example Question 1} Example Rationale 1: The prior probability of fat embolism is 0.05% however the patient has petechiae on exam which is seen with fat emboli, which increases the posterior probability of fat embolism to 5%. Altered mental status increases the probability further to 10%. Recent orthopedic surgery increases the probability of fat emboli syndrome to 60%. This patient most likely has a fat embolism. {Example Question 2} Example Rationale 2: The prior probability of Dressler Syndrome is 0.01%. The patient has diffuse ST elevations, increasing the probability of Dressler Syndrome to 5%. The patient has a scratching murmur which increases the probability to 10%. In the setting of a recent MI the posterior probability of myocardial infarction is 55%. This patient likely has Dressler Syndrome.

The traditional and diagnostic CoT prompts evaluated in this study. The provided rationales are in response to the example questions provided in Table 1. Note that the full text of the example questions has been omitted for readability.