A Framework for Differential Diagnosis Formulation of Clinical Lesions With Emphasis on Using an Acronym

Doctoral-level dental education requires the student-doctor to undertake a significant amount of didactic coursework and clinical training. Didactic studies directly influence clinical practice, and few disciplines illustrate this more clearly than pathology—particularly when formulating a differential diagnosis (DDX). A DDX is generated from a combination of obtained and discovered knowledge. The information obtained is first encountered in the classroom and later received from the patient. The information discovered is understood in the clinic and found on exams. Together these form the DDX, which guides actionable decisions in patient care. (Figure 1A) However, translating classroom knowledge to clinical practice can be challenging for students [1]. Any solution or pedagogical approach should incorporate multiple scholarly elements to maximize student education including active learning, utilizing didactic knowledge, providing formative assessment, and practical application [2]. An acronymic approach can address the important aspects stated above and bridge the didactic and clinical chasm. Acronyms are widely employed in healthcare and healthcare education due to their simplicity and effectiveness in enhancing learning and recall [3, 4]. The acronym “N.S.B.C.N.L.D.” (Figure 1B) stands for number, size, border, color, noun, location, and duration, with particular emphasis placed on the “noun,” as it is most important in the lesional description. Dental students are introduced to this acronym in stages: first in didactic courses, where they learn clinical entities and terminology, and later in the clinic, where they use the acronym and patient chart information to formulate clinical descriptions and DDX. An example (Figures 2 and 3) demonstrates how the acronym is used and applied in building a DDX. From a pedagogical standpoint, this simple tool incorporates the previously discussed elements: active learning—the student is dynamically engaged by providing terms for each component of the acronym; didactic knowledge—material gained from previous coursework is applied to formulate the lesional description; formative assessment—after the lesional description, and before or after the DDX is generated, allows for multiple points the instructor can provide feedback; and practical application—the acronym provides justification of the DDX which is determining patient care. Students showed success in providing more complete descriptions of clinical lesions, leading to more accurate differential diagnoses. However, they struggled to memorize the six terms in the acronym. Future use may incorporate a mnemonic, such as “never stop being curious, now learn daily,” to aid rote memorization. This method for DDX generation is advantageous for students as it does not require specialized software that may be unavailable in practice. In practice, Figure 1 can be applied succinctly as a 3 × 5 inch notecard allowing for quick utilization and availability of the variables found in Figure 1B. Additionally, the description and differential created from this framework can be used in collaboration with other healthcare professionals, especially those who treat pathology as it provides compactly and efficiently the information they use for diagnosis and treatment [5]. This acronymic tool can be applied across all levels of dental education, enhancing interprofessional collaboration, and serving as a beneficial instrument for educators and students. The author declares no conflicts of interest.