UCSF

Clinical problem solving (CPS) conferences provide a real-time view into diagnostic reasoning, yet faculty who serve as discussants often do so without formal guidance. This article offers a practical framework for clinicians preparing to take on the CPS discussant role, emphasizing that success depends less on reaching the correct diagnosis and more on structured reasoning. Preparatory steps include strengthening clinical analytical skills, observing experienced discussants, and practicing in low-stakes settings that foster comfort with speaking and thinking aloud. During the CPS session, discussants must balance concise reasoning with attention to pacing, audience engagement, and evolving information. Key skills include framing the problem, articulating diagnostic schemas, refining hypotheses, managing uncertainty, and conducting a cognitive autopsy. Reflection and feedback after the conference and planning for future sessions reinforce growth. Although large language models can generate fluent analyses of clinical cases, they cannot form causal models of disease or illness, cannot integrate real world constraints or patient values, and lack any sense of consequence or responsibility. When faculty step into the role of discussant, they model a quintessential physician skill: the ability to think and communicate clearly, flexibly, and humanely in the face of uncertainty.