Vertical Reading Is Not Just For Clinical Reasoning

Recently I got interesting in more formalized teaching of clinical reasoning. I am currently enrolled in a Coursera ( course on clinical reasoning. My reason for taking this MOOC is that I wanted to see how others teach this material so that I could improve my teaching. A great revelation I had while reading Judith Bowen’s now classic NEJM article () and which was reenforced in the Coursera course was vertical reading. The way I summarize this is that we recognize diseases best, not by their similarities, but by their differences. With vertical reading you compare 2 or more diseases by filing out a table with epidemiology, pathophysiology, signs, symptoms, testing, etc. Instead of reading about 1 disease at a time and filling in the table horizontally you fill in the table vertically and read about each component of the table for both diseases at the same time.

The reason I bring this topic up is that I am doing journal club next week and I have asked the residents to read 2 articles on seemingly the same topic. There are nuances that make the articles different but if you read them individually and separately you likely wouldn’t pick up on these nuances. Thus, the vertical reading. I gave the residents a table to fill out comparing the 2 articles. They will read them both at the same time comparing the articles on each of the elements of the table;moving vertically down the table. They should be able to detect the nuances of each article. We will see.