Indiana Ascension St. Vincent Internal Medicine Residency Program Case Study
See how DDx gave PGY-1 residents a safe, structured environment to strengthen clinical decision-making from day one.
Overview
Using DDx as an assessment and learning tool at the start of residency
At Indiana Ascension St. Vincent Internal Medicine Residency, early opportunities to practice structured diagnostic reasoning can help residents build confidence and surface areas for growth before stepping into real patient encounters. Faculty piloted DDx during orientation — designed to function both as a primer for clinical encounters and a mechanism for surfacing broad areas of knowledge gaps. 16 PGY-1 internal medicine residents completed five residency-level DDx cases over the course of one week during orientation.
Overview
The challenge
New residents need more than lectures to feel prepared on day one
The residency program sought a scalable case-based learning solution that would allow incoming internal medicine residents to practice clinical reasoning and diagnostic decision-making through realistic patient encounters while identifying knowledge gaps before their first clinical rotations.
Before the pilot, survey results revealed that while residents felt moderately confident in structuring patient encounters and communication, confidence was significantly lower in key areas — including ordering medications, applying reasoning in simulations, and formulating accurate assessments. Faculty needed a tool that could surface these gaps early, establish performance baselines, and give residents a safe, scalable environment to begin closing them before their first independent patient encounters.
The solution
Why DDx by Sketchy?
Deployed five residency-level GME DDx cases during the first week of orientation; Residents completed cases in person during structured academic sessions; Cases simulated real-world clinical encounters including patient interviews, differential diagnosis, test ordering, and management planning; Faculty used DDx as both a teaching platform and an assessment tool to identify early knowledge gaps across the cohort
Faculty member — Indiana Ascension St. Vincent Internal Medicine Residency Program
How did DDx by Sketchy fit?
DDx was piloted both as a primer for clinical encounters and as a mechanism for surfacing broad knowledge gaps at the very start of residency. Faculty and residents alike praised DDx for its ability to engage learners and support development from day one. Adoption was seamless — with nearly every intern already familiar with Sketchy from medical school, which accelerated onboarding and kept sessions focused on learning.
Five residency-level emergency medicine DDx cases were available for residents to workthrough.
The results
Strong self-efficacy gains across all measured competencies
After just one week using DDx, residents reported substantial improvements across all measured domains. Most notable gains included a 78.13% improvement in confidence ordering medications, a 43.19% improvement in identifying the correct setting for admission, a 33.33% increase in developing a differential diagnosis, and a 36.36% improvement in overall readiness for real or simulated patient encounters. More than 90% of residents expressed that they would continue to use DDx independently.
Testimonials
What did residents and faculty say?
An engaging, and impactful start to residency
The Indiana Ascension St. Vincent pilot demonstrated that DDx provides residents with a safe, engaging, and impactful primer for clinical decision-making at the very start of their training. With measurable gains across key competencies, high levels of engagement, and strong faculty endorsement, the pilot validated DDx as a valuable complement to bedside teaching and simulation — one that expands assessment and remediation capabilities from day one of residency.
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