The current form of the clinicopathological conference (CPC) began in the early 20th century when Dr. Walter Cannon of Harvard Medical School attempted to enliven medical education by substituting the case based system of education, popular in their law school, in lieu of lectures. Further expansion and development by Dr. Richard Cabot led to the current format of the CPC.
At one time the CPC was the mainstay of clinical education as an expert clinician would review a summary of a patients history and physical findings, followed by laboratory and radiological studies, developing their own diagnosis and its’ rationale, but “the” confirmatory diagnosis, often in the form of pathologic (usually autopsy) findings, was presented at the end of the discussion. Currently the CPC has been criticized by its focus only on diagnosis, minimal inclusion of the socioeconomic impact of disease and rehearsed nature so, it has gradually disappeared as a formative educational tool.
Recently there has been an increased interest in understanding how clinicians think or the process they use to arrive at a differential diagnosis that has culminated in several popular books. Those efforts have led to the realization that to a great extent clinical diagnosis relies on recognizing patterns which also highlights what a CPC requires of the participant; recognition of clinical presentations that facilitates their arriving at a tentative diagnosis. However, cognitive biases can interfere with this process, but the necessary generation and rationale for a differential diagnosis within the CPC helps to overcome some of these barriers.
This problem based approach to a clinical case is one unique characteristic of a CPC that fosters critical thinking. Another important aspect of a CPC is providing all learners the same information and opportunity to arrive at a diagnosis. It places proper emphasis and importance on the history and physical exam so they do not become overshadowed by laboratory and radiological findings.
The structure of the CPC should follow some general guidelines:
1. Cases should not be too generic or unusual, but they should emphasize the type of cases a practicing physician will encounter.
2. The CPC has to incorporate enough historical and physical exam findings that the most likley diagnosis will be included within their own differential diagnosis. In other words, information is not hidden, but what is known is made available. There will be times when based on clinical features or laboratory/radiological features this process, while logical and thoughtful may not result in the correct diagnosis. In the practice of medicine this possibility is always present so, such a "humbling" experience is a reasonable outcome.
3. The diagnosis needs to be based on the information presented and supported by the rationale for the decisions made, tests requested or their interpretation.
4. When appropriate the historical aspects of various clinical diagnoses as well as their socioeconomic impact for the patient or the population can be included. When occurring in a “live-setting” the CPC is dynamic, stressful, at times humorous, but always remains a thoughful conversation that captures a human experience, some of which can be included in the written case as well.
5. The CPC can include relevant radiological or pathological pictures (no more than ten combined) and the text should be less than 2,500 words with less than 25 references.
6. The CPC is meant to demonstrate a problem based approach to a case, so, the differential diagnosis should not be exhaustive. The 3-5 most probable diagnoses should be presented, but the focus of the discussion spent on the most likely.
The current form of the clinicopathological conference (CPC) began in the early 20th century when Dr. Walter Cannon of Harvard Medical School attempted to enliven medical education by substituting the case based system of education, popular in their law school, in lieu of lectures. Further expansion and development by Dr. Richard Cabot led to the current format of the CPC.
At one time the CPC was the mainstay of clinical education as an expert clinician would review a summary of a patients history and physical findings, followed by laboratory and radiological studies, developing their own diagnosis and its’ rationale, but “the” confirmatory diagnosis, often in the form of pathologic (usually autopsy) findings, was presented at the end of the discussion. Currently the CPC has been criticized by its focus only on diagnosis, minimal inclusion of the socioeconomic impact of disease and rehearsed nature so, it has gradually disappeared as a formative educational tool.
Recently there has been an increased interest in understanding how clinicians think or the process they use to arrive at a differential diagnosis that has culminated in several popular books. Those efforts have led to the realization that to a great extent clinical diagnosis relies on recognizing patterns which also highlights what a CPC requires of the participant; recognition of clinical presentations that facilitates their arriving at a tentative diagnosis. However, cognitive biases can interfere with this process, but the necessary generation and rationale for a differential diagnosis within the CPC helps to overcome some of these barriers.
This problem based approach to a clinical case is one unique characteristic of a CPC that fosters critical thinking. Another important aspect of a CPC is providing all learners the same information and opportunity to arrive at a diagnosis. It places proper emphasis and importance on the history and physical exam so they do not become overshadowed by laboratory and radiological findings.
The structure of the CPC should follow some general guidelines:
1. Cases should not be too generic or unusual, but they should emphasize the type of cases a practicing physician will encounter.
2. The CPC has to incorporate enough historical and physical exam findings that the most likley diagnosis will be included within their own differential diagnosis. In other words, information is not hidden, but what is known is made available. There will be times when based on clinical features or laboratory/radiological features this process, while logical and thoughtful may not result in the correct diagnosis. In the practice of medicine this possibility is always present so, such a "humbling" experience is a reasonable outcome.
3. The diagnosis needs to be based on the information presented and supported by the rationale for the decisions made, tests requested or their interpretation.
4. When appropriate the historical aspects of various clinical diagnoses as well as their socioeconomic impact for the patient or the population can be included. When occurring in a “live-setting” the CPC is dynamic, stressful, at times humorous, but always remains a thoughful conversation that captures a human experience, some of which can be included in the written case as well.
5. The CPC can include relevant radiological or pathological pictures (no more than ten combined) and the text should be less than 2,500 words with less than 25 references.
6. The CPC is meant to demonstrate a problem based approach to a case, so, the differential diagnosis should not be exhaustive. The 3-5 most probable diagnoses should be presented, but the focus of the discussion spent on the most likely.
