Clinical reasoning — dyspnea case in an older patient
A complete example of a 45-minute clinical reasoning session. Students work through a patient case from presentation to diagnosis. Live via QR: word clouds for first impressions, multiple choice for the differential diagnosis, open questions for deeper exploration, and layered slides for lab results. For MBO level 4 and HBO nursing.
Build your own clinical reasoning casePhase-by-phase structure
Case presentation (5 min)
Mrs. De Wit, 78 years old, presents at the ER with dyspnea that has been increasing over the past two days and mild confusion. Photo of the patient (Image Studio persona), vital signs, and history in SBAR format.
First impression (5 min)
Word cloud: what thoughts come to mind with this presentation? Students type 1-3 words on their device. The class sees the collective first impression — often surprisingly diverse.
Differential diagnosis (10 min)
Multiple choice: what are the three most likely diagnoses? Students choose, the teacher sees the distribution in real time. Discuss: why do students choose what they choose, and which lines of reasoning lead to which diagnosis.
In-depth questions (10 min)
What information would you want now? Open question, students type freely. Discuss the top answers: which questions are clinically relevant, and which miss the point.
Lab result reveal (5 min)
Layered slide: the teacher reveals the lab result. NT-proBNP elevated, troponin normal, CRP slightly elevated. How does this fit with which diagnosis?
Diagnosis and treatment (8 min)
Multiple choice: what is the most likely diagnosis? (cardiac decompensation). What is your first treatment action? Discuss: prioritizing, ABCDE, escalation.
Reflection (2 min)
Open question: what did you learn from this case? For each learning goal, the cockpit shows who has mastered it and who hasn't yet. Input for your next lesson.
Why this structure works
The case follows the clinical reasoning path: presentation → first impression → hypothesis → testing → diagnosis → treatment. Unlike a PowerPoint where the teacher does the talking, students take each step themselves — and the teacher sees in the cockpit where the reasoning falters. A student who gets the first impression right but misses the differential diagnosis thinks differently from a student who misses both.
For differentiation: layered slides contain extra context for MBO level 4 (in-depth lab interpretation) that is skipped for level 3.