Adding guidance to deliberate reflection improves medical student’s diagnostic accuracy
Context Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students’ diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical case...
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| Veröffentlicht in: | Medical education 2021-10, Vol.55 (10), p.1161-1171 |
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| container_title | Medical education |
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| creator | Fernandes, Rachel Aparecida Ferreira Malloy‐Diniz, Leandro Fernandes Vasconcellos, Marcos Carvalho Camargos, Paulo Augusto Moreira Ibiapina, Cássio |
| description | Context
Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students’ diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students.
Method
Eighty third‐year and 62 sixth‐year medical students participated in this three‐phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text‐based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category.
Results
There was a significant primary effect of experimental condition (P |
| doi_str_mv | 10.1111/medu.14563 |
| format | Article |
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Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students’ diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students.
Method
Eighty third‐year and 62 sixth‐year medical students participated in this three‐phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text‐based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category.
Results
There was a significant primary effect of experimental condition (P < .001), year of training (P < .001) and study phase (P < .001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P < .001), regardless of participants’ seniority. In the delayed test, this benefit was maintained for simple cases (P < .001). For complex cases, the benefit was maintained only for senior students (P < .001). The cued reflection and worked example groups did not differ in performance (P > .05), but both groups surpassed the free reflection group (P < .001), regardless of the students' learning stage and case complexity.
The authors demonstrate that guiding deliberate reflection improves diagnostic competence both in the solution of simple cases and in the solution of complex cases by novice and senior students.]]></description><identifier>ISSN: 0308-0110</identifier><identifier>EISSN: 1365-2923</identifier><identifier>DOI: 10.1111/medu.14563</identifier><identifier>PMID: 33978967</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Accuracy ; Critical thinking ; Medical diagnosis ; Medical education ; Medical students ; Reflective practice</subject><ispartof>Medical education, 2021-10, Vol.55 (10), p.1161-1171</ispartof><rights>2021 Association for the Study of Medical Education and John Wiley & Sons Ltd.</rights><rights>This article is protected by copyright. All rights reserved.</rights><rights>2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3573-f6f3139cf5ac50090d146bede527fb2f2710dea006081dfd93f9e92fe49f8fe53</citedby><cites>FETCH-LOGICAL-c3573-f6f3139cf5ac50090d146bede527fb2f2710dea006081dfd93f9e92fe49f8fe53</cites><orcidid>0000-0003-3607-8857</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fmedu.14563$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fmedu.14563$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33978967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernandes, Rachel Aparecida Ferreira</creatorcontrib><creatorcontrib>Malloy‐Diniz, Leandro Fernandes</creatorcontrib><creatorcontrib>Vasconcellos, Marcos Carvalho</creatorcontrib><creatorcontrib>Camargos, Paulo Augusto Moreira</creatorcontrib><creatorcontrib>Ibiapina, Cássio</creatorcontrib><title>Adding guidance to deliberate reflection improves medical student’s diagnostic accuracy</title><title>Medical education</title><addtitle>Med Educ</addtitle><description><![CDATA[Context
Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students’ diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students.
Method
Eighty third‐year and 62 sixth‐year medical students participated in this three‐phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text‐based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category.
Results
There was a significant primary effect of experimental condition (P < .001), year of training (P < .001) and study phase (P < .001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P < .001), regardless of participants’ seniority. In the delayed test, this benefit was maintained for simple cases (P < .001). For complex cases, the benefit was maintained only for senior students (P < .001). The cued reflection and worked example groups did not differ in performance (P > .05), but both groups surpassed the free reflection group (P < .001), regardless of the students' learning stage and case complexity.
The authors demonstrate that guiding deliberate reflection improves diagnostic competence both in the solution of simple cases and in the solution of complex cases by novice and senior students.]]></description><subject>Accuracy</subject><subject>Critical thinking</subject><subject>Medical diagnosis</subject><subject>Medical education</subject><subject>Medical students</subject><subject>Reflective practice</subject><issn>0308-0110</issn><issn>1365-2923</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kL9OwzAQhy0EoqWw8ADIEgtCCpztOIlHVMofCcQCA1Pk2ufKKE1KnIC68Rq8Hk-CS4GBgVtOOn363U8fIfsMTlic0zna_oSlMhMbZMhEJhOuuNgkQxBQJMAYDMhOCE8AkMu02CYDIVReqCwfkscza309o7PeW10bpF1DLVZ-iq3ukLboKjSdb2rq54u2ecFA4ztvdEVD11usu4-390Ct17O6CZ03VBvTt9osd8mW01XAve89Ig8Xk_vxVXJzd3k9PrtJjJC5SFzmBBPKOKmNBFBgWZpN0aLkuZtyx3MGFjVABgWzzirhFCruMFWucCjFiBytc2O95x5DV859MFhVusamDyWXPGMi56AievgHfWr6to7tIpWnGeNpsaKO15RpmxCigXLR-rlulyWDciW8XAkvv4RH-OA7sp_G8y_6YzgCbA28-gqX_0SVt5Pzh3XoJ1jvjNY</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Fernandes, Rachel Aparecida Ferreira</creator><creator>Malloy‐Diniz, Leandro Fernandes</creator><creator>Vasconcellos, Marcos Carvalho</creator><creator>Camargos, Paulo Augusto Moreira</creator><creator>Ibiapina, Cássio</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3607-8857</orcidid></search><sort><creationdate>202110</creationdate><title>Adding guidance to deliberate reflection improves medical student’s diagnostic accuracy</title><author>Fernandes, Rachel Aparecida Ferreira ; Malloy‐Diniz, Leandro Fernandes ; Vasconcellos, Marcos Carvalho ; Camargos, Paulo Augusto Moreira ; Ibiapina, Cássio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3573-f6f3139cf5ac50090d146bede527fb2f2710dea006081dfd93f9e92fe49f8fe53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Accuracy</topic><topic>Critical thinking</topic><topic>Medical diagnosis</topic><topic>Medical education</topic><topic>Medical students</topic><topic>Reflective practice</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernandes, Rachel Aparecida Ferreira</creatorcontrib><creatorcontrib>Malloy‐Diniz, Leandro Fernandes</creatorcontrib><creatorcontrib>Vasconcellos, Marcos Carvalho</creatorcontrib><creatorcontrib>Camargos, Paulo Augusto Moreira</creatorcontrib><creatorcontrib>Ibiapina, Cássio</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical education</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fernandes, Rachel Aparecida Ferreira</au><au>Malloy‐Diniz, Leandro Fernandes</au><au>Vasconcellos, Marcos Carvalho</au><au>Camargos, Paulo Augusto Moreira</au><au>Ibiapina, Cássio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adding guidance to deliberate reflection improves medical student’s diagnostic accuracy</atitle><jtitle>Medical education</jtitle><addtitle>Med Educ</addtitle><date>2021-10</date><risdate>2021</risdate><volume>55</volume><issue>10</issue><spage>1161</spage><epage>1171</epage><pages>1161-1171</pages><issn>0308-0110</issn><eissn>1365-2923</eissn><abstract><![CDATA[Context
Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students’ diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students.
Method
Eighty third‐year and 62 sixth‐year medical students participated in this three‐phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text‐based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category.
Results
There was a significant primary effect of experimental condition (P < .001), year of training (P < .001) and study phase (P < .001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P < .001), regardless of participants’ seniority. In the delayed test, this benefit was maintained for simple cases (P < .001). For complex cases, the benefit was maintained only for senior students (P < .001). The cued reflection and worked example groups did not differ in performance (P > .05), but both groups surpassed the free reflection group (P < .001), regardless of the students' learning stage and case complexity.
The authors demonstrate that guiding deliberate reflection improves diagnostic competence both in the solution of simple cases and in the solution of complex cases by novice and senior students.]]></abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33978967</pmid><doi>10.1111/medu.14563</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-3607-8857</orcidid></addata></record> |
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| ispartof | Medical education, 2021-10, Vol.55 (10), p.1161-1171 |
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| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete; Education Source |
| subjects | Accuracy Critical thinking Medical diagnosis Medical education Medical students Reflective practice |
| title | Adding guidance to deliberate reflection improves medical student’s diagnostic accuracy |
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