2. Develops and prioritizes hypotheses related to clinical diagnosis (MK).
Pre-Emergent	Emerging (1 point)	Acquiring (2 points)	Mastering (3 points)
Has not achieved the Emerging level. Hypotheses are not grounded in reasonable rationales. Perseverates on hypotheses despite contradictory evidence.	Lists at least 3 hypotheses with relevant rationales, even if rationales are basic.	Develops multiple working hypotheses, articulates reasoning using relevant basic science/explanations. Reconsiders differential diagnoses after receiving new case information, integrates new key features into reasoning.	Prioritizes multiple working hypotheses and articulates clear rationale for the rank ordering of the hypotheses. Includes an explicit statement about how well each hypothesis fits this patient and discusses reasoning of low likelihood hypotheses. Identifies case information that doesn’t fit a given hypothesis. Develops diagnostic strategy to rule in or rule out hypotheses.

CLERKSHIP LEVEL (for reference; not expected of pre-clerkship students): Uses key features and problem list to develop prioritized, realistically plausible differential diagnoses using a systematic approach. Uses new information and data to reprioritize, reconsider, and develop new hypotheses. Considers ‘must not miss’ diagnoses as well as most common or likely diagnoses. Uses basic science principles, knowledge of likelihood of diagnoses, and test characteristics to develop organized diagnostic strategy to confirm or dismiss differential diagnoses.