DiagnosisAnyone who teaches medicine asks students to list their differential diagnosis when discussing a new clinical case. It’s also part of several models for education including the One-Minute Preceptor and SNAPPS.

For the most part, students are good at coming up with answers to the differential, but what do you do when they strike out? Or what if the answer is always the same, i.e. chest pain = myocardial infarction?

Educator’s Trick of the Trade:

Enter the game SPIT.This is an acronym for:

  • S erious
  • P robable
  • I nteresting
  • T reatable

I keep a handy supply of 3×5 cards in my pocket and will hand them to the learner when they stall or just to make things interesting. The rules are simple. One answer to each category and each category must have a different answer. I’ll then go through the categories with the students and probe for their reasoning. Its amazing how something so simple creates so many teachable moments.

Robert Cooney, MD MSMedEd

Robert Cooney, MD MSMedEd

Chief Strategy Officer, 2018-20 ALiEM Chief Resident Incubator
Director of Faculty Development
Department of Emergency Medicine
Geisinger Medical Center
Robert Cooney, MD MSMedEd


Dad of 3, Part time adventurer, Emergency Medicine Doc and Director of Faculty Development for @GeisingerHealth