For our newly combined courses, R472 and R473 Multiplanar Anatomy and Pathology I and II, we needed a way to incorporate critical reasoning that utilized concepts learned in the course. These concepts included knowledge of anatomy, pathology and methods of imaging. We wanted to make critical reasoning as seamless as possible in the online learning environment and wanted to encourage student-to-student collaboration as well. Clinical reasoning is a structured decision-making process that includes information gathering, hypothesis generation, problem representation, collecting differential diagnoses, selecting the most likely diagnosis and providing justification for the chosen diagnosis. While it is not within our scope of practice to diagnose in the clinical setting, it is a fun activity for students to try to determine the correct diagnosis using the resources provided in the module. The strategy we chose was problem-based learning in the form of a cartoon family suffering from a multitude of ailments that required medical imaging to aid in diagnosis.

Step-by-Step Implementation

  1. In week 1, introduce the family and scenario for the course.  
  2. During the two-semester course, introduce a family member with an unknown pathology every other week. Students are encouraged to work together and discuss the problem to find a solution. This mimics the process that occurs in the clinical setting. 
  3. Students respond to the scenario with a diagnosis and an explanation of their process that led to their decision. Students must include a reference source for their conclusion.  
  4. The responses are due a day before the weekly modules closes and the diagnosis revealed. Students cannot view other student answers until they have posted their responses. 
  5. Students have the opportunity to respond to their classmates’ submissions. 
  6. Students’ grades are based on a rubric. Within medicine, it is sometimes difficult to reach the correct answer. Often there is a list of differential diagnoses. As long as the student finds a pathology that fits the signs and symptoms of the problem and supports their answer with their reference points are not reduced. A correct answer is given a bonus point as an incentive to look for the best-fit diagnosis based on signs and symptoms.  
  7. At the end of both semesters, students are given a wrap-up of the Poor Pete story.


Based off student evaluations and comments, the Poor Pete scenarios are a great success. Students enjoy evaluating the scenarios looking for clues about the pathology. The encouragement to collaborate with others to reach an answer is seen as a positive with this assignment. One outcome we did not expect was students discussing the case with technologists and radiologists in the clinical setting. This turned into a collaboration with professional staff that brought a camaraderie in the work environment. Technologist and doctors were eager to hear the correct diagnosis and this in turn brought further staff-student interaction. In response to student requests, we developed an entire storyline explaining Poor Pete’s many ailments. The students loved the completion of the storyline.