Clinical Reasoning Certificate Program

Clinical reasoning is a key skill that all physicians must master to safely care for their patients. We are lucky at UPMC to have a culture devoted to teaching trainees sound clinical reasoning skills, but this type of culture does not exist everywhere. The overarching goal of this certificate program is to prepare residents to be an ambassador of clinical reasoning wherever they work, no matter what career path they choose.

As a part of this certificate, residents learn how to leverage clinical cases to teach clinical reasoning in a variety of settings: clinical reasoning conference, morning report, the bedside, and written case reports. They also learn evidence-based clinical reasoning strategies and how to integrate them into their clinical and educational practices.

While some of this material is delivered through a set of engaging workshops held throughout the year, the most important learning in this program occurs through experience. All residents in the certificate program work closely with a faculty mentor to craft and present at our monthly Clinical Reasoning Conference, where an expert faculty discussant walks us through their approach to an unknown clinical case. Residents also write and publish an installment of our recurring online case tutorial, Pitt Puzzles. Other mentored opportunities for teaching and scholarship are made available throughout the year as well. Notably, this program is compatible (and dovetails nicely) with both the Certificate in Medical Education and the Certificate in Hospital Medicine.

For additional information about this track, please contact Dr. Casey McQuade. For more information, please click here.


Casey McQuade, MD (Certificate Program Director)

Eliana Bonifacino, MD MS

Debbie Dinardo, MD MS

Tom Painter, MD

Sarah Tilstra, MD MS

Bill Follansbee, MD

Clinical Reasoning Conference:

A series of Clinical Reasoning Conferences held monthly at Montefiore Hospital and broadcast to our other local teaching hospitals. An unknown case is presented to an expert discussant in a stepwise fashion. The discussant “thinks out loud” and explains their clinical reasoning as the case unfolds. A moderator helps to frame the discussion with special attention to the Diagnostic process. Cases are developed and written by residents in the Certificate Program, under the mentorship of one of our clinical reasoning faculty. This conference is consistently rated one of the favorites by our residents each year.

Pitt Puzzles

A series of online, interactive, case-based exercises with an emphasis on teaching core clinical reasoning concepts. Each Puzzle takes approximately 10-15 minutes to complete. Pitt Puzzles were originally developed in 2018 by two senior residents (Dr. Ben Smith and Dr. Michelle Fleshner) to help enrich the education of their colleagues. The Pitt Puzzle tradition continues strong today, with monthly Puzzles published by the Reasoning Certificate Residents for the rest of the residency

Clinical Reasoning Seminar Series:

Every year, we hold 4-6 seminars / workshops to help our Certificate residents develop their clinical reasoning and educational skills. These hour-long sessions are held remotely to allow for easier attendance of our residents, who rotate through several teaching hospitals. A sample list of topics, including past and future talks, is posted below:

  • From Case to Conference: Developing a Case to Teach Clinical Reasoning
  • Clinical Reasoning 201 – Beyond Bias and Dual Process Theory
  • Tom W, Wordle, and Clinical Reasoning
  • Deliberate Practice For Residents
  • Novice to Expert – Continuing Your Clinical Reasoning Education
  • Diagnosing the Misdiagnosis, a Medical Educator’s Guide to Identification and Real-Time Remediation of Clinical Reasoning Mis-Steps
  • Teaching Clinical Reasoning to New Trainees