Telvorn: A Different Way to Teach Clinical Reasoning

Consider two pharmacy students working on the same case. The patient has chronic kidney disease, has just been prescribed naproxen, and has been drinking an herbal remedy to help in their ailment. Both students reach the same decisions: withhold naproxen and reduce the metformin. Both receive full marks for their answers. But their explanations are very different.

The first writes “I looked it up” as her justification. The second writes three sentences explaining why an NSAID alongside an ACE inhibitor and a diuretic threatens kidney perfusion when the eGFR is already 34.

On a conventional marking scheme, the two are indistinguishable. Telvorn is designed to reveal the difference.

Why it matters

Pharmacy education needs to assess not only what students know, but how they reach clinical decisions and how well they judge their own performance. Recall-based assessment remains useful, but on its own it cannot reveal the quality of a student’s reasoning. Nor does a correct answer necessarily mean that a student understands why it is correct.

Telvorn makes that reasoning easier for both students and educators to see.

What Telvorn does

Telvorn is an AI-assisted platform for practising clinical reasoning in pharmacotherapeutics. Students work through simulated patient cases, taking a history from an AI patient who shares only what is asked. They then make decisions about assessment, medicines, monitoring, counselling and drug therapy problems, and justify their decisions in writing. Cases are set in a realistic clinical context, so the patient feels like someone a student might actually meet.

The platform brings together several parts of the learning experience. Students receive a reasoning portrait covering six dimensions of clinical reasoning. They compare their decisions with peers, contribute to a group answer, revisit their decisions after a tutor-led debrief and reconsider their original judgement when new clinical information becomes available. They then return to their reasoning portrait to see how their thinking has changed.

Educators receive an anonymised summary of where the class struggled or disagreed, helping them focus the debrief on the decisions that need the most attention. Educators can also build cases from a rough idea or adapt existing teaching cases using a structured editor.

The point is not simply to give students another clinical case to solve. It is to make their reasoning available for discussion, feedback and reconsideration.

Personalised learning

Every student receives a reasoning portrait covering six dimensions: data gathering, hypothesis generation, evidence justification, risk identification, communication with the patient, and whether the plan follows from the student’s own assessment.

The portrait looks at the reasoning behind the answer, not simply whether it matches the expected response. It aims to distinguish a correct answer with little justification from a well-supported alternative, although its agreement with expert human ratings is still being evaluated.

Students also record their confidence separately, allowing them to compare how certain they felt with how well they supported their decisions.

Group learning

Small groups see each member’s decisions and justifications side by side and submit one consensus answer. Disagreement becomes material for discussion, and the group has to defend its choices before submitting its answer.

This lets learners see how someone else reached a different conclusion, rather than simply discovering that they disagreed.

Learning from the debrief

Before the class discussion, the tutor receives an anonymised summary of where students’ answers diverged. The correct answers and teaching notes remain hidden until the tutor releases them.

Rather than working through every part of the case again, the tutor can concentrate on the decisions that divided the class. The discussion can therefore respond to what students actually found difficult, rather than relying entirely on what the tutor expected them to find difficult.

Reflection and reassessment

Once the answers have been released, students reflect on their decisions, identify where their reasoning differed from the expected approach and consider what they would do differently in a similar case.

They then encounter new clinical information and revisit their original plan. They decide whether to maintain, modify or reconsider it and explain their reasoning. The case continues with a pre-written patient outcome, so students can see what happened to the patient.

What matters is not simply whether students change their answers, but whether they can explain why. Retaining an original decision may be just as appropriate as changing it if the evidence still supports it.

Students then return to their reasoning portrait, where their first attempt and their reassessment sit side by side, in their own words. They can see what they thought, what changed and what they would now say about it.

A study plan then points each learner towards guidelines, teaching notes and practice exercises linked to the parts of their reasoning that need more work.

Formative by design

Telvorn carries no grades. Students can show uncertainty, explain their decisions and change their minds without the pressure of a grade.

The emphasis is on making their thinking visible while there is still an opportunity to improve it.

For educators: try it yourself

Telvorn is designed for educators who teach pharmacotherapeutics. Educators can try it from both sides: first by working through a case as a learner, and then by building or adapting one of their own.

• Work a case as a student. Take the history, make the decisions, write your justifications and see the reasoning portrait that results.
• Build a case from a rough idea. Describe the clinical scenario in a few lines and Telvorn drafts the case, including the patient history, decision fields, options and teaching notes.
• Bring your own case. Paste in a case you already teach and Telvorn extracts it into the case structure without rewriting the original content.
• Edit visually. Adjust individual fields, options and teaching notes in a structured editor.

Create an account and tell us your name, institution and the pharmacotherapeutics course you teach. Once approved, you can access the educator area and start exploring the platform. Access is free during the pilot.