Directions
How to use TLAC — and what you'll get out of it
TLAC works the way deliberate practice works: short, repeated, graded reps that force you to commit before you see the answer. The harder you commit, the more the feedback teaches you. Speeding through stages will produce a score — but not a skill.
The five stages of a case
- History. Read the presentation. Note what's pertinent and what's pertinently absent
- Exam. Select the findings that change your thinking. Don't pick everything — discrimination is the skill
- Hypothesis. Write 3–5 differentials, each with your reasoning: what fits, what argues against it, and what's missing. Be specific (e.g. "Hodgkin lymphoma," not "lymphoma")
- Workup. Pick the next test that would meaningfully change management — not the most exhaustive panel
- Synthesis. Commit to a final diagnosis, your confidence, and the next action. Then read the expert reasoning and rubric feedback
How grading works
- Rubric points are awarded for matching expert-weighted differentials. Tier-1 (top diagnoses) carry the most weight
- Partial credit (◐) is given for the right category at the wrong specificity, with a nudge to refine — e.g. "Specify Hodgkin or non-Hodgkin"
- Confidence and accuracy are tracked as two separate meters. Strong calibration — knowing what you don't know — is the long-game skill TLAC trains
What you get
- Faster, cleaner differentials at the bedside — without skipping framing
- Better test selection: fewer shotgun panels, more decisive workups
- Calibrated confidence: you'll stop being surprised by your misses
- A written record of your reasoning you can share with an attending or mentor
Ready to think like a clinician?
Pick up where the directions left off — your first case is waiting.
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