Reasoning Models

For use with the Clinical Reasoning (online) Game

Anatomic Model

Consider the body anatomically, starting with the head, and think about any pathology of that particular structure which could explain the information shown on the cards.

Systems Model

Similar to the Anatomic Model, but in this case work through the major body systems (cardiovascular, respiratory etc), considering whether there is a condition affecting each system which would explain the clinical features.


Also known as Murtagh’s Model, PROMPT follows a series of logical steps in considering a differential:
A. What is the probability diagnosis (what is most likely)?
B. What serious conditions must be ruled out?
C. What conditions are often missed?
D. Consider the seven masquerades (conditions which can be difficult to diagnose because of their many possible presentations):

1. Depression

2. Diabetes

3. Drugs

4. Anaemia

5. Thyroid dysfunction

6. Spinal dysfunction

7. Urinary tract infection
E. Is this patient trying to tell me something?

Pivot & Cluster

The most complex of the reasoning models, ‘pivot and cluster’ relies on identifying the patterns within the data, and then considering if there are any other possible diagnoses which have the same pattern. For example, if the patient presents with fever and right iliac fossa pain, a possible diagnosis is appendicitis. This is your pivot.
Now, consider other things which follow the same pattern: for example, pelvic inflammatory disease, or diverticulitis. This is the cluster.
Consider whether any of the possible diagnoses in the cluster is more or less likely. If one is considered more likely, it becomes the new pivot.

Spot Diagnosis

This model relies heavily on pattern recognition, or ‘illness scripts’. The clinician spots patterns in the information available which resemble the known patterns of particular conditions.

Surgical Sieve

This reasoning model uses a mnemonic to prompt the clinician through a list of possible causes or types of conditions in an effort to aid recall of known diagnoses:
V – Vascular
I – Infectious or Inflammatory
N – Neoplastic
D – Drugs or Degenerative
I – Intoxication or Idiopathic
C – Congenital
A – Autoimmune or Allergic
T – Trauma
E – Endocrine
M – Metabolic or Mental

Date reviewed: 16 August 2023

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