Expert reasoning
For every decision point: what to think, why, and what the common wrong turn looks like. Not an answer key — a demonstration of how the reasoning runs.
← Home
How it works
From the handoff call to the teaching pearls.
Every case runs the same seven acts. You work the encounter forward, committing to decisions at each stage, then compare your reasoning against a practising hospitalist's.
The seven acts
1
The handoff
The ED calls with what they have: vitals, a one-line history, and a question. You build a differential before the picture is complete — because that is when it matters.
2
History & focused exam
Past history, medications, social context, examination findings — disclosed progressively. The picture gets clearer, or considerably more complicated.
3
Investigations, first pass
Bloodwork, ECG, imaging, point-of-care ultrasound. Real values with reference ranges. Interpret them before you read on.
4
Initial management & evolution
Treatment starts and the picture moves over the next six to twenty-four hours. Some of what you did helped. Some of it didn't.
5
The pivot
The crux of every case: a complication, an ethical bind, or a resource limitation. The messy middle that no guideline flowchart covers.
6
Resolution & disposition
Discharge, transfer, or death. The plan, the follow-up, and what you actually say to the patient and the family.
7
Debrief & teaching pearls
Six to eight evidence-based pearls, the cognitive biases that were operating named explicitly, guidelines cited with their publication year, and the full case summary.
What members get, per case
Teaching pearls
Six to eight per case, each with the cognitive bias named — anchoring, premature closure, search satisficing — and the guideline cited by year.
Reference card
One page. Doses, thresholds, decision rules, and the transfer criteria from that case. Sized to live in a lab coat pocket.
Self-assessment
Three scored multiple-choice questions and a short reflection on what you would do differently. Print the whole case with your answers for your CPD records.
The rhythm
Your pace. One new case a month.
Join free and the library is yours to work — every case that has cleared clinical review, in any order, as fast or as slowly as you like. Your answers save in your browser as you go, so you can stop halfway through a shift and pick it up later.
When a new case opens, one email tells you it's there. That's the only email we send.
Competency mapping
Cases are mapped against three frameworks, so your CPD record has structure rather than a list of talks you attended:
CSHM 2015 — Canadian Society of Hospital Medicine core competencies, 40 chapters.
CanMEDS-FM 2017 — the seven physician roles, exercised across the case set.
SHM 2023 — Society of Hospital Medicine, 53 chapters including the 2023 additions.
This is competency-mapped, CME-style learning. It is not currently accredited, and does not carry Mainpro+ credits.
See it working.
The first act of a real case, reasoning unlocked, so you can judge the format before you join.
Read the sample case