Fostering novice students' diagnostic ability: the value of guiding deliberate reflection

Sílvia Mamede; Taciana Figueiredo-Soares; Silvana M. Elói Santos; Rosa M.D. de Faria; Henk G. Schmidt; Tamara van Gog

doi:10.1111/medu.13829

Fostering novice students' diagnostic ability: the value of guiding deliberate reflection

Sílvia Mamede^*, Taciana Figueiredo-Soares, Silvana M. Elói Santos, Rosa M.D. de Faria, Henk G. Schmidt, Tamara van Gog

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

20 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	628-637
Number of pages	10
Journal	Medical Education
Volume	53
Issue number	6
DOIs	https://doi.org/10.1111/medu.13829
Publication status	Published - Jun 2019

Bibliographical note

Funding Information:
Contributors: all authors (SM, TF-S, SMES, RMDdF, HGS and TvG) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Study concept and design: SM and TvG. Acquisition of data: TF-S, SMES, RMDdF. Statistical analysis: SM. Analysis and interpretation of data: SM, TF-S, SMES, RMDdF, HGS and TvG. Drafting of the manuscript: SM. Critical revision of the manuscript for important intellectual content: SM, TF-S, SMES, RMDdF, HGS and TvG. Administrative, technical or material support: TF-S, SMES, RMDdF and SM. Study supervision: SM and TvG. Acknowledgments: the authors are grateful to the students who gave their time to participate in the study. Funding: the study was supported by a grant provided by the Coordenac©ão de Aperfeic©oamento de Pessoal de Nıvel Superior (CAPES)/Edital Pro-Ensino da Saude 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. Conflicts of interest: none. Ethical approval: ethical approval for the study was provided by the Research Ethics Committee of the Faculty of Medicine, Federal University of Minas Gerais (CAAE # 48555915.4.0000.5149).

Funding Information:
the study was supported by a grant provided by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)/Edital Pró-Ensino da Saúde 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. the authors are grateful to the students who gave their time to participate in the study.

Publisher Copyright:
© 2019 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd

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Cite this

@article{bff7eda9ea884bd6b98a51dc05f3d5ac,

title = "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 ({\textquoteleft}adjacent diseases{\textquoteright}). 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.",

author = "S{\'i}lvia Mamede and Taciana Figueiredo-Soares and {El{\'o}i Santos}, {Silvana M.} and {de Faria}, {Rosa M.D.} and Schmidt, {Henk G.} and {van Gog}, Tamara",

note = "Funding Information: Contributors: all authors (SM, TF-S, SMES, RMDdF, HGS and TvG) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Study concept and design: SM and TvG. Acquisition of data: TF-S, SMES, RMDdF. Statistical analysis: SM. Analysis and interpretation of data: SM, TF-S, SMES, RMDdF, HGS and TvG. Drafting of the manuscript: SM. Critical revision of the manuscript for important intellectual content: SM, TF-S, SMES, RMDdF, HGS and TvG. Administrative, technical or material support: TF-S, SMES, RMDdF and SM. Study supervision: SM and TvG. Acknowledgments: the authors are grateful to the students who gave their time to participate in the study. Funding: the study was supported by a grant provided by the Coordenac{\textcopyright}{\~a}o de Aperfeic{\textcopyright}oamento de Pessoal de Nıvel Superior (CAPES)/Edital Pro-Ensino da Saude 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. Conflicts of interest: none. Ethical approval: ethical approval for the study was provided by the Research Ethics Committee of the Faculty of Medicine, Federal University of Minas Gerais (CAAE # 48555915.4.0000.5149). Funding Information: the study was supported by a grant provided by the Coordena{\c c}{\~a}o de Aperfei{\c c}oamento de Pessoal de N{\'i}vel Superior (CAPES)/Edital Pr{\'o}-Ensino da Sa{\'u}de 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. the authors are grateful to the students who gave their time to participate in the study. Publisher Copyright: {\textcopyright} 2019 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd",

year = "2019",

month = jun,

doi = "10.1111/medu.13829",

language = "English",

volume = "53",

pages = "628--637",

journal = "Medical Education",

issn = "0308-0110",

publisher = "John Wiley & Sons Inc.",

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TY - JOUR

T1 - Fostering novice students' diagnostic ability

T2 - the value of guiding deliberate reflection

AU - Mamede, Sílvia

AU - Figueiredo-Soares, Taciana

AU - Elói Santos, Silvana M.

AU - de Faria, Rosa M.D.

AU - Schmidt, Henk G.

AU - van Gog, Tamara

N1 - Funding Information: Contributors: all authors (SM, TF-S, SMES, RMDdF, HGS and TvG) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Study concept and design: SM and TvG. Acquisition of data: TF-S, SMES, RMDdF. Statistical analysis: SM. Analysis and interpretation of data: SM, TF-S, SMES, RMDdF, HGS and TvG. Drafting of the manuscript: SM. Critical revision of the manuscript for important intellectual content: SM, TF-S, SMES, RMDdF, HGS and TvG. Administrative, technical or material support: TF-S, SMES, RMDdF and SM. Study supervision: SM and TvG. Acknowledgments: the authors are grateful to the students who gave their time to participate in the study. Funding: the study was supported by a grant provided by the Coordenac©ão de Aperfeic©oamento de Pessoal de Nıvel Superior (CAPES)/Edital Pro-Ensino da Saude 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. Conflicts of interest: none. Ethical approval: ethical approval for the study was provided by the Research Ethics Committee of the Faculty of Medicine, Federal University of Minas Gerais (CAAE # 48555915.4.0000.5149). Funding Information: the study was supported by a grant provided by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)/Edital Pró-Ensino da Saúde 1606/2011 (CAAE # 03896812.4.0000.5149), Ministry of Education, Brazil. the authors are grateful to the students who gave their time to participate in the study. Publisher Copyright: © 2019 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd

PY - 2019/6

Y1 - 2019/6

N2 - 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.

AB - 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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U2 - 10.1111/medu.13829

DO - 10.1111/medu.13829

M3 - Article

C2 - 30917406

SN - 0308-0110

VL - 53

SP - 628

EP - 637

JO - Medical Education

JF - Medical Education

IS - 6

ER -

Fostering novice students' diagnostic ability: the value of guiding deliberate reflection

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