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Section 2 The Framework System

SECTION 2: The Framework System

🧠 Why Frameworks Matter

Suppose you’re asked to name all U.S. states at random. You’d probably stall after a few entries. But if you approached it methodically—alphabetically (A, B, C…) or geographically (northeast, southwest…)—you’d recall more states, more quickly.

🧩 This is the power of structured recall—and it’s the foundational idea behind frameworks.

📚 Applying Frameworks to Medicine

In internal medicine, clinicians face a similar challenge:

“How do I recall a long list of differential diagnoses?” A structured framework breaks these vast lists into smaller, organized sublists, making information easier to remember and use. Example: Consider Systemic Vasculitis — a condition with a dauntingly broad differential. We break it down by vessel size: - Large vessel vasculitis - Medium vessel vasculitis - Small vessel vasculitis Then, further subdivide small vessel vasculitis based on serologic markers: - ANCA-associated - Non–ANCA-associated This creates a mental scaffold, making recall easier and more robust.

🧭 Flexible Structure by Topic

The optimal framework depends on the topic: Example: Abdominal Pain Can be structured in two ways: 1. Anatomically – liver, stomach, gallbladder, small intestine, etc. 2. By quadrant – RUQ, LUQ, epigastric, etc. Either method compresses a long differential into smaller, manageable chunks.

🔬 Frameworks and Diagnostic Workup

Frameworks don’t just enhance memory—they guide investigation.

Example: 03 Spaces/Medical Hub/📝 Exam Prep/Medicine Notebook/Pleural Effusion

The framework begins with a diagnostic step: - Apply Light’s criteria (based on lab data) - Determine whether the fluid is transudate or exudate Thus, the diagnostic process is built into the framework. You’re not just memorizing—you’re being trained in how to think and act like a clinician.

🔄 Summary

  • Frameworks organize memory by category, prevalence, or diagnostic sequence
  • They reduce cognitive overload
  • They integrate investigation and management steps
  • They can be adapted to match clinical reasoning styles

    Frameworks transform passive memorization into active clinical reasoning.

📖 References

  1. Bower GH. Memory for scripts with organized vs. randomized presentations. Br J Psychol. 1980;71(3):369–377.
  2. Bower GHC, Michal C, Lesgold AM, Winzenz D. Hierarchical retrieval schemes in recall of categorized word lists. J Verbal Learn Verbal Behav. 1969;8:323–343.
  3. Cohen BH. Recall of categorized word lists. J Exp Psychol. 1963;66:227–234.
  4. Tulving E, Pearlstone Z. Availability vs accessibility of information in memory for words. J Verbal Learn Verbal Behav. 1966;5:381–391.

Let me know if you’d like visual diagramming (e.g., quadrant charts or flow arrows) for any framework example.