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PulmoHouse: A DECODE-based Case-Integrated Teaching–Learning Strategy for Postgraduates in Respiratory Medicine
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Received: ,
Accepted: ,
How to cite this article: Sivagnaname Y, Durga K, Radhakrishnan P. PulmoHouse: A DECODE-based Case-Integrated Teaching–Learning Strategy for Postgraduates in Respiratory Medicine. Glob J Med Pharm Biomed Update. 2026;21:14. doi: 10.25259/GJMPBU_126_2025
Abstract
Postgraduate medical education increasingly demands teaching strategies that go beyond factual knowledge to cultivate diagnostic reasoning, clinical adaptability, and reflective thinking. Conventional teaching–learning formats often fall short in reproducing the uncertainty and evolving complexity of real-world clinical decision making, particularly in respiratory medicine where overlapping radiological, immunological, and pathological presentations are common. We propose PulmoHouse, a novel case-integrated teaching–learning strategy grounded in the DECODE framework, designed specifically for postgraduate training in respiratory medicine. PulmoHouse employs a structured, stepwise diagnostic simulation in which real-world pulmonary cases are revealed progressively, encouraging learners to evolve hypotheses, integrate multimodal data, prioritize differentials, and engage in guided debate and reflection. By closely mirroring authentic diagnostic workflows, PulmoHouse promotes active learning, metacognition, and iterative clinical reasoning. The model integrates high-resolution imaging interpretation, laboratory correlation, and peer-facilitated discussion within a specialty-focused educational environment. Conceptually distinct from traditional case-based or problem-based learning, PulmoHouse emphasizes diagnostic ambiguity, hypothesis revision, and reflective closure as core components. Although currently conceptual, the model is designed to be scalable, adaptable, and amenable to future prospective evaluation using validated tools such as script concordance testing. PulmoHouse offers a theory-informed, specialty-specific approach that has the potential to enhance cognitive authenticity and learner engagement in postgraduate respiratory medicine education.
Keywords
Case-based learning
Clinical reasoning
DECODE-based learning
Postgraduate medical education
PulmoHouse
Respiratory medicine
INTRODUCTION
Postgraduate medical education is increasingly expected to develop not only factual knowledge but also diagnostic reasoning, clinical agility, and metacognitive awareness. Traditional teaching– learning (TL) formats, such as lectures, seminars, and conventional case presentations, often fail to simulate the uncertainty, complexity, and iterative integration required in real-world diagnostic practice.[1,2] This limitation is particularly evident in respiratory medicine, where overlapping clinical, radiological, and pathological patterns are common.
We propose PulmoHouse, a novel TL strategy adapted for postgraduate respiratory medicine. Rooted in the DECODE framework, PulmoHouse provides a structured, immersive, case-based educational experience designed to replicate authentic diagnostic reasoning in complex pulmonary cases.
THE DECODE FRAMEWORK: PEDAGOGICAL BASIS
DECODE is a structured teaching framework that emphasizes diagnostic reasoning through a stepwise, interactive, and reflective process.
Unlike traditional problem-based learning (PBL) [Table 1], DECODE functions as a diagnostic simulation model, grounded in cognitive psychology and clinical decision-making theories.[3-5] The acronym represents six sequential steps in diagnostic reasoning:
| Attribute | Lecture | Case-based learning | Problem-based learning | PulmoHouse (DECODE) |
|---|---|---|---|---|
| Interactivity | Low | Moderate | High | High |
| Diagnostic complexity | Low | Moderate | Low–Moderate | High |
| Integration of imaging and labs | Minimal | Moderate | Limited | High |
| Reflective reasoning | Absent | Limited | Present | Core component |
| Specialty adaptability | Low | Moderate | Moderate | High |
D – Dissect the case: Progressive disclosure of clinical data, beginning with history and examination, followed by imaging, laboratory findings, and pathology
E – Evolve hypotheses: Learners dynamically generate and revise differential diagnoses as new information emerges
C – Correlate information: Integration of clinical features with radiological, laboratory, and functional data
O– Organize priorities: Ranking of probable diagnoses with justification
D – Debate dilemmas: Peer-to-peer and faculty-guided critique of competing hypotheses
E – Educate by reflection: Reflective consolidation incorporating evidence-based explanations.
The DECODE framework aligns with illness script theory, dual-process models of reasoning, and script concordance principles, all of which emphasize learning through ambiguity, hypothesis revision, and reflective discourse.[3,5,6]
PULMOHOUSE: DECODE ADAPTED TO RESPIRATORY MEDICINE
PulmoHouse adapts the DECODE framework specifically for respiratory medicine, a specialty characterized by complex radiologic patterns, immunologic overlap, and evolving diagnostic pathways. It is designed for Respiratory Medicine postgraduate trainees and incorporates the following features:
Case selection
Real-world diagnostically challenging cases are selected, including:
Diffuse cystic lung diseases (e.g., Birt–Hogg–Dubé syndrome, lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis).
Overlapping interstitial lung diseases (ILD) (e.g., fibrotic hypersensitivity pneumonitis (HP), idiopathic pulmonary fibrosis (IPF), connective tissue disease [CTD]-ILD).
Granulomatous disorders with atypical manifestations.
Opportunistic and unusual infections in immunocompromised patients.
Decode flow
Each case is revealed in time-sequenced manner, simulating real clinical decision pressure.
Visual decoding
High-resolution computed tomography (HRCT) thorax interpretation forms a central component of the learning process.
Differential mapping
Learners actively chart and revise evolving differential diagnoses.
PULMOBOARD
A concluding structured peer discussion facilitated by faculty focuses on reasoning pathways rather than factual recall.
PulmoHouse is intended as a weekly or biweekly academic activity, ideally conducted in 60–90 min interactive sessions.
DISTINCTIVE NOVELTY OF PULMOHOUSE
While PulmoHouse shares surface similarities with existing case-based learning (CBL) and PBL approaches, it represents a fundamentally different pedagogical model rather than an incremental adaptation. Conventional CBL typically involves retrospective discussion of completed cases, and PBL emphasizes open-ended problem exploration with variable structure. In contrast, PulmoHouse operationalizes a diagnostic simulation paradigm, wherein clinical information is disclosed in a time-sequenced manner that mirrors real-world diagnostic uncertainty.
A key distinguishing feature is the structured DECODE framework, which enforces iterative hypothesis generation, active revision, and prioritization under evolving data conditions. Unlike traditional models that may emphasize knowledge acquisition, PulmoHouse prioritizes dynamic clinical reasoning, cognitive debiasing, and metacognitive reflection as core learning objectives.
Furthermore, PulmoHouse uniquely integrates high-resolution imaging interpretation, multimodal data synthesis, and specialty-specific diagnostic pathways within a single structured session. The inclusion of peer-driven diagnostic debate (PulmoBoard) and reflective closure ensures that reasoning processes, not merely final diagnoses, are critically examined.
Thus, PulmoHouse is best conceptualized as a simulation-based, cognition-driven educational model, specifically designed to replicate the complexity and uncertainty inherent in real-world respiratory medicine practice, distinguishing it fundamentally from traditional CBL and PBL frameworks.
ILLUSTRATIVE PULMOHOUSE SESSION: A DECODE-BASED CASE INTEGRATION EXAMPLE
To demonstrate the practical conduct of PulmoHouse, an illustrative real-world scenario is presented.
Case scenario
A 42-year-old non-smoking woman presents with progressive exertional dyspnea and dry cough for 8 months. There is no significant occupational exposure. She has a history of hypothyroidism on treatment.
D – Dissect the case
The session begins with limited information, history and examination findings only. Oxygen saturation is mildly reduced on exertion, with bilateral basal fine crackles on auscultation.
E – Evolve hypotheses
Participants independently generate differentials, including fibrotic HP, IPF CTD–associated ILD, and sarcoidosis.
C – Correlate information
HRCT thorax images are subsequently revealed, showing mid-to-lower zonal fibrosis with traction bronchiectasis and subtle ground-glass opacities. Pulmonary function tests demonstrate a restrictive defect with reduced diffusion lung capacity of carbon monooxide. Autoimmune serology reveals antinuclear antibody positivity with Anti -Sjogren’s syndrome-related antigen A antibody antibodies.
O – Organize priorities
Learners prioritize CTD-associated ILD over IPF and fibrotic HP, justifying the hierarchy based on radiologic distribution, extrapulmonary clues, and serological findings.
D – Debate dilemmas
A faculty-guided discussion explores diagnostic dilemmas such as usual interstitial pneumonia-pattern CTD-ILD versus IPF, emphasizing radiologic subtleties, clinical weighting, and common cognitive biases.
E – Educate by reflection
The session concludes with a reflective discussion on diagnostic evolution, reinforcement of illness scripts, and evidence-based clarification of the final diagnosis and management approach.
This vignette illustrates how PulmoHouse operationalizes the DECODE framework while preserving diagnostic uncertainty and authentic clinical reasoning.
Educational merits
PulmoHouse addresses key gaps in postgraduate respiratory training:
Simulation of diagnostic reality: Replicates evolving uncertainty and progressive data integration
Multimodal evidence integration: Combines clinical findings with imaging, physiology, and laboratory data
Promotion of hypothesis revision: Encourages adaptive reasoning and correction of cognitive bias
Metacognitive development: Reflective closure strengthens awareness of diagnostic reasoning processes
Applicability across training levels: Suitable for both junior and senior residents.
OPERATIONAL FEASIBILITY AND IMPLEMENTATION
PulmoHouse is designed to be a practical and reproducible TL model adaptable across academic institutions. A typical session can be conducted with a faculty-to-learner ratio of approximately 1:6–1:10, allowing effective facilitation of discussion while maintaining active learner participation.
Preparation involves case curation and structuring of sequential data disclosure, which typically requires 1–2 h of faculty preparation time per session, depending on case complexity. Once developed, cases can be archived and reused, enhancing long-term feasibility.
Each PulmoHouse session is ideally conducted over 60–90 min, structured according to the DECODE sequence. Assessment can be incorporated using formative approaches, including evaluation of differential diagnosis generation, reasoning pathways, and participation in structured discussion. Tools such as script concordance testing or structured reflective feedback may be used to objectively assess clinical reasoning skills.
The model is inherently scalable and reproducible, as it does not require advanced infrastructure beyond standard clinical data (case records, imaging, and laboratory results). It can be implemented in both resource-rich and resource-limited settings and adapted to varying batch sizes with minor modifications in facilitation style.
These features support the integration of PulmoHouse into routine postgraduate teaching schedules while maintaining consistency and educational impact across institutions.
Future Prospects
PulmoHouse can be:
Institutionalized within postgraduate respiratory medicine curricula
Adapted to other specialties using the DECODE framework
Enhanced through digital archives, flipped classrooms, or structured feedback
Studied prospectively using validated assessment tools such as script concordance testing.[6]
CONCLUSION
PulmoHouse represents a novel, theory-driven TL strategy that immerses postgraduate learners in the diagnostic complexity of respiratory medicine. Built on the DECODE framework, it offers a scalable, specialty-specific alternative to conventional teaching formats and has the potential to enhance authentic clinical reasoning in postgraduate education.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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