The material presented on this website and book is intended to assist learners in organizing their knowledge into information packets, which are more effective for the resolution of the patient problems they will encounter. There are three major factors that influence learning and the retrieval of medical knowledge from memory: meaning, encoding specificity (the context and sequence for learning), and practice on the task of remembering. Of the three, the strongest influence is the degree of meaning that can be imposed on the information. To achieve success, experts organize and “chunk” information into meaningful configurations, thereby reducing the memory load.

These meaningful configurations or systematically arranged networks of connected facts are termed schemata. As new information becomes available, it is integrated into schemes already in existence, thus permitting learning to take place. Knowledge organized into schemes (basic science and clinical information integrated into meaningful networks of concepts and facts) is useful for both information storage and retrieval. To become excellent in diagnosis, it is necessary to practice retrieving from memory information necessary for problem resolution, thus facilitating an organized approach to problem-solving (scheme-driven problem solving).

The domain of medicine can be broken down to 121 (±5) clinical presentations, which represent a common or important way in which a patient, group of patients, community or population presents to a physician, and expects the physician to recommend a method for managing the situation. For a given clinical presentation, the number of possible diagnoses may be sufficiently large that it is not possible to consider them all at once or even remember all the possibilities. By classifying diagnoses into schemes, for each clinical presentation, the myriad of possible diagnoses become more manageable ‘groups’ of diagnoses. This thus becomes a very powerful tool for both organization of knowledge memory (its primary role at the undergraduate medical education stage), as well as subsequent medical problem-solving.

There is no single right way to approach any given clinical presentation. Each of the schemes provided represents one approach that proved useful and meaningful to one experienced, expert author. A modified, personalized scheme may be better than someone else’s scheme, and certainly better than having no scheme at all. It is important to keep in mind, before creating a scheme, the five fundamentals of scheme creation that were used to develop this book.

If a scheme is to be useful, the answers to the next five questions should be positive:

  1. Is it simple and easy to remember? (Does it reduce memory load by “chunking” information into categories and subcategories?)
  2. Does it provide an organizational structure that is easy to alter?
  3. Does the organizing principle of the scheme enhance the meaning of the information?
  4. Does the organizing principle of the scheme mirror encoding specificity (both context and process specificity)?
  5. Does the scheme aid in problem-solving? (E.g. does it differentiate between large categories initially, and subsequently progressively smaller ones until a single diagnosis is reached?)

By adhering to these principles, the schemes presented in this book, or any modifications to them done by the reader, will enhance knowledge storage and long term retrieval from memory while making the medical problem-solving task a more accurate and enjoyable endeavour.

Dr. Henry Mandin

Dr. Sylvain Coderre


The Black Book Project may be contacted at:

Undergraduate Medical Education
Faculty of Medicine
University of Calgary
Health Sciences Centre
3330 Hospital Drive
Calgary, Alberta, Canada T2N 4H1


Medical presentation schemes conceived by Henry Mandin.
The Calgary Black Book Project founded by Brett Poulin.