Fostering novice students'
diagnostic ability: the value of guiding deliberate reflection.
Abstract
BACKGROUND:
Deliberate reflection when practising the
diagnosis of clinical cases has been shown to develop medical students'
diagnostic competence. Adding guidance by cueing reflection or providing
modelling of reflection increased the benefits of reflection for advanced
(Years 5-6) students. The present study investigated whether we could replicate
and extend these findings by comparing the effects of free, cued and modelled
reflection on novice students' diagnostic competence.
METHODS:
A total of 80 third-year medical students
participated in a two-phase experiment. In the learning phase, students
diagnosed nine clinical cases under one of three conditions: free reflection;
cued reflection, and modelled reflection. Two weeks later, all students
diagnosed four new examples of the diseases studied in the learning phase and
four cases of non-studied related diseases ('adjacent diseases'). The main
outcome measurements were diagnostic accuracy scores (range 0-1) on studied and
adjacent diseases.
RESULTS:
For studied diseases, there was a significant
effect of experimental condition on diagnostic accuracy (p < 0.02), with the
cued-reflection group (mean = 0.58, standard deviation [SD] = 0.23) performing
significantly better than the free-reflection group (mean = 0.41, SD = 0.20; p
< 0.02). The cued-reflection and modelled-reflection groups (mean = 0.54, SD
= 0.22) did not differ in diagnostic accuracy (p > 0.05), nor did the
modelled-reflection group perform better than the free-reflection group (p >
0.05). For adjacent diseases, the three groups scored extremely low, without
significant differences in performance (p > 0.05). Cued reflection and free
reflection were rated as requiring similar effort (p > 0.05) and both were
more demanding than studying examples of reflection (both p < 0.001) in the
learning phase.
CONCLUSIONS:
Simply cueing novice students' reflection to
focus it on relevant diseases was sufficient to increase diagnostic performance
relative to reflection without any guidance. Cued reflection and studying
examples of reflection appear to be equally useful approaches for teaching
clinical diagnosis to novice students. Students found studying examples of
reflection required less effort but cued reflection will certainly demand much
less investment from teachers.
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