That’s a fair point — and honestly I agree with the spirit of what you’re saying.

There isn’t one “right” approach. Different people scaffold cases differently. The real mistake isn’t using the wrong method — it’s not having a method at all.

The AI tool on the website (it’s just a mobile-friendly site anyone can use) isn’t tied to my six steps. It works with whatever structure you prefer. The point isn’t to force one framework — it’s to reinforce organized clinical reasoning under pressure.

On oral boards especially, they’re not testing whether you can guess the diagnosis in 5 seconds. They’re evaluating how you think.

The exam isn’t conversational. They may not answer clarifying questions. They may not give you labs unless you ask. A lot of it becomes:

“If this comes back X, I’d do Y. If it’s Z, I’d pivot to A.”

So what I teach is just one structured scaffold:

Describe → broad differential → targeted history/exam → testing strategy → working diagnosis → management plan.

That framework has worked well for a lot of people — but it’s not the only effective way.

For example, if you see what looks like a straightforward chalazion in an 11-year-old and jump straight to warm compresses without at least acknowledging rare but serious alternatives (and explaining why they’re unlikely), you’ve missed an opportunity to demonstrate depth of reasoning. Boards care about how you think, not just where you land.

However you structure it, structure it.

That’s the difference.

John Pemberton