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The Chicago College of Osteopathic Medicine (CCOM) held an interactive Grand Rounds on the Downers Grove Campus, where medical students were presented with the facts of a patient case and periodically asked to give their differential diagnosis through an interactive platform.  After the session, an interdisciplinary faculty panel discussed the basic science background of the case, in order to demonstrate to the students the integration of the knowledge acquired from their science courses into clinical medicine. The faculty panel included Perry Marshall, D.O., Associate Dean of Interprofessional Education and Clinical Assistant Professor of Emergency Medicine, (CCOM); Orhay Mirzapolos, D.O., Clinical Assistant Professor of Emergency Medicine, (CCOM); Don Martinez, BSW, M.M.S., PA-C, Assistant Professor, Physician Assistant Program, College of Health Sciences (CHS-Downers Grove), Terrence Ritzman, Ph.D., Assistant Professor, Anatomy, College of Graduate Studies (CGS-Downers Grove); Phillip Kopf, Ph.D., Chair and Professor, Pharmacology, (CGS-Downers Grove), and John Kasimos, D.O., M.S., MSHCE, FCAP, FASCP, FAOCP, Chair and Professor, Pathology, (CGS-Downers Grove).

Medical students later discussed their experience participating in the CCOM Grand Rounds. Shilpa Nair (CCOM ’28) said, “It was really interesting to see everything that we’re learning in class integrated together.” Shilpa further expressed her appreciation of the faculty going step by step through a case they might see in the future. “They put you in that mindset of being a doctor and using everything you know so far to try to figure out what could be a possible differential diagnosis, and what kind of test would you use to confirm the possible diagnosis. I think playing the role is helpful and makes you feel like you’re practicing. It was a nice cohesive look at everything we’re learning about.” 

Interactive Case Study

Dr. Marshall led the session by explaining its purpose and process. “We are going to simulate how you should be thinking as a physician. You should be getting an impression when you look at the patient’s chart, and when you walk into the room. Every question you ask, and every part of your physical exam should help you narrow your differential diagnosis. Your ability to generate a differential diagnosis is what we’re going to see here,” he said. In addition, he emphasized that the future doctors should always think about conditions that need to be caught immediately to save a patient’s life. 

As the session began, the medical students were informed that the presenting symptom was severe abdominal pain. Throughout the duration of the Grand Rounds, students received additional information in increments, including the patient’s current symptoms, medical history, medications taken, lifestyle choices, symptoms in other body systems, and physical exam details. After each increment, students entered their differential diagnosis via a QR code using their phones, which generated a word cloud in real time.

Subsequently, the medical students were asked to enter the laboratory studies they would order for this case into the word cloud. Students then had the opportunity to view and interpret the patient’s labs in order to further narrow down their differential diagnosis. They were then asked to identify one imaging study to confirm their suspected diagnosis. 

Finally, they were shown the images of the computed tomography angiography (CTA) scan of the abdomen and pelvis. The CTA scan revealed a thrombus (clot) in the Superior Mesenteric Artery, resulting in lack of blood supply to parts of the small and large intestines. The students were given one last opportunity to enter their final diagnosis before it was revealed to them that the patient’s diagnosis was acute mesenteric ischemia, a condition where blood flow to the intestines is restricted or blocked. 

Dr. Marshall emphasized, “This is one of those cannot miss life threats. The giveaways were elevated lactate and abdominal pain out of proportion to the physical exam.” The emphasis on critical thinking and symptom recognition resonated with the students. Medical student Camryn Parham (CCOM ’28) said, “It was nice to see how the medical and anatomical education that we’ve gotten so far can be applied to a medical case. This experience is building our dictionary of differential diagnoses.” 

Student Key Takeaways and Interdisciplinary Approach 

Medical student Lucia Passaglia (CCOM ’28) described, “I think it’s a really unique opportunity to have a case presented in a system-based manner and from interprofessional teams because that’s what we’ll be doing in the future as clinicians.”

Medical student Saif Quraishi (CCOM ’28) discussed, “It was nice getting the different perspectives from different departments on one case. It’s interesting to learn from different people working in different professions and about their experiences in the same case.” 

Following the case presentation, the ɫ�����Ƶ faculty panel each presented a lecture detailing information and images about acute mesenteric ischemia based on their respective specialties of physician assistant, anatomy, pathology, and pharmacology. 

CCOM Grand Rounds is an opportunity for students to experience an interdisciplinary approach to examining a patient case, preparing them to work with various healthcare professionals to provide excellent patient care.