Table 2 Educational strategies of clinical reasoning in each scenario

1. Hemoptysis

1. Understanding the symptoms including vital signs, the color of hemoptysis, timing, coagulopathy and associated conditions.

2. Practice to differ lung cancer (the most likely diagnosis), pulmonary TB and bronchiectasis; and then to recommend initial examination such as CXR, CBC, PT, PTT, Platelet and sputum smear, culture (AFB) and cytology.

2. Abdominal pain

1. Understanding the presentations including pain location, quality, provocation / palliative factors, region / radiation, timing and associated symptoms.

2. Practice to differ acute pancreatitis (the most likely diagnosis), acute cholecystitis and acute cholangitis; and then to recommend initial examination such as abdominal echo, white cell count, liver function test and amylase / lipase.

3. Fever

1. Understanding the symptoms including fever pattern, exclude upper airway, GI tract and GU tract infection and associated muscle, skin or autoimmune disease.

2. Practice to differ acute pyelonephritis (the most likely diagnosis), acute viral hepatitis and pneumonia; and then to recommend initial examination such as UA, white cell count, hepatitis work-up and CXR.

4. Anemia

1. Understanding the etiology of anemia including poor production, destruction and blood loss.

2. Practice to differ uterus myoma bleeding (the most likely diagnosis), GI tract bleeding and Vitamin B12 deficiency; and then to recommend initial examination such as CBC, MCV, serum iron and ferritin, arrange UGI endoscopy and colonoscopy and consult GYN evaluation.

5. Chest pain

1. Understanding the presentations including pain location, quality, provocation / palliative factors, region / radiation, timing and associated risk factors.

2. Practice to differ acute coronary syndrome (the most likely diagnosis), pleuritis and pneumothorax; and then to recommend initial examination such as12-lead EKG,cardiac enzyme, CXR and white cell count.