Table 2.

Weighing Data in the Clinical Reasoning Process*

Differential diagnosis	Female	Left-sided	Pleuritic pain	Shortness of breath	Pregnancy	Hypotension	Elevated JVP
Gastroesoph-ageal reflux disease	=	↓	↓↓	↓↓	↑↑	↓↓	↓↓↓
Muscular strain	=	↑	↑	↑	=	↓↓	↓↓↓
Costochond-ritis	↑	↑	↑	↑	=	↓↓	↓↓↓
Angina	↓	↑	↓	↑↑	=	=	=
Myocardial infarction	↓	↑	↓	↑↑	=	↑↑	↑↑
Pulmonary Embolism	↑	↑	↑↑	↑	↑↑↑	↑↑	↑↑

*After reading a case history and physical examination, a learner is asked to populate the columns with the problem list and then rate supporting and refuting data with arrows: up for supporting, down for refuting. The number of arrows indicates the degree of influence on the diagnostic decision. An equal sign indicates that the data neither increases nor decreases the probability of the disease