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      The Impact of Medical Students’ Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning

      research-article
      , MD, MME 1 , , 2 , , MD, MME 3 , , MD, MME 4
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Medical Education
      JMIR Publications
      undergraduate medical education, case histories

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          Abstract

          Background

          Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences.

          Objective

          The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own.

          Methods

          In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories.

          Results

          Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams.

          Conclusions

          Despite students’ overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods.

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          Most cited references30

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          The Power of Testing Memory: Basic Research and Implications for Educational Practice.

          A powerful way of improving one's memory for material is to be tested on that material. Tests enhance later retention more than additional study of the material, even when tests are given without feedback. This surprising phenomenon is called the testing effect, and although it has been studied by cognitive psychologists sporadically over the years, today there is a renewed effort to learn why testing is effective and to apply testing in educational settings. In this article, we selectively review laboratory studies that reveal the power of testing in improving retention and then turn to studies that demonstrate the basic effects in educational settings. We also consider the related concepts of dynamic testing and formative assessment as other means of using tests to improve learning. Finally, we consider some negative consequences of testing that may occur in certain circumstances, though these negative effects are often small and do not cancel out the large positive effects of testing. Frequent testing in the classroom may boost educational achievement at all levels of education.
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            • Article: not found

            Expert performance: Its structure and acquisition.

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              Teaching clinical reasoning: case-based and coached.

              Optimal medical care is critically dependent on clinicians' skills to make the right diagnosis and to recommend the most appropriate therapy, and acquiring such reasoning skills is a key requirement at every level of medical education. Teaching clinical reasoning is grounded in several fundamental principles of educational theory. Adult learning theory posits that learning is best accomplished by repeated, deliberate exposure to real cases, that case examples should be selected for their reflection of multiple aspects of clinical reasoning, and that the participation of a coach augments the value of an educational experience. The theory proposes that memory of clinical medicine and clinical reasoning strategies is enhanced when errors in information, judgment, and reasoning are immediately pointed out and discussed. Rather than using cases artificially constructed from memory, real cases are greatly preferred because they often reflect the false leads, the polymorphisms of actual clinical material, and the misleading test results encountered in everyday practice. These concepts foster the teaching and learning of the diagnostic process, the complex trade-offs between the benefits and risks of diagnostic tests and treatments, and cognitive errors in clinical reasoning. The teaching of clinical reasoning need not and should not be delayed until students gain a full understanding of anatomy and pathophysiology. Concepts such as hypothesis generation, pattern recognition, context formulation, diagnostic test interpretation, differential diagnosis, and diagnostic verification provide both the language and the methods of clinical problem solving. Expertise is attainable even though the precise mechanisms of achieving it are not known.
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                Author and article information

                Contributors
                Journal
                JMIR Med Educ
                JMIR Med Educ
                JME
                JMIR Medical Education
                JMIR Publications (Toronto, Canada )
                2369-3762
                Jul-Dec 2019
                22 July 2019
                : 5
                : 2
                : e13386
                Affiliations
                [1 ] Department of Haematology and Medical Oncology University Medical Centre Göttingen Göttingen Germany
                [2 ] Department of Anaesthesiology University Medical Centre Göttingen Göttingen Germany
                [3 ] Department of Legal Medicine University Medical Centre Hamburg-Eppendorf Hamburg Germany
                [4 ] Division of Medical Education Research and Curriculum Development Study Deanery of University Medical Centre Göttingen Göttingen Germany
                Author notes
                Corresponding Author: Nikolai Schuelper nikolai.schuelper@ 123456med.uni-goettingen.de
                Author information
                http://orcid.org/0000-0001-9712-9780
                http://orcid.org/0000-0002-2449-6114
                http://orcid.org/0000-0002-1268-5022
                http://orcid.org/0000-0003-2555-8097
                Article
                v5i2e13386
                10.2196/13386
                6681636
                31333193
                d4a53609-fcae-4b28-abfa-073e588f15ae
                ©Nikolai Schuelper, Sascha Ludwig, Sven Anders, Tobias Raupach. Originally published in JMIR Medical Education (http://mededu.jmir.org), 22.07.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on http://mededu.jmir.org/.as well as this copyright and license information must be included.

                History
                : 13 January 2019
                : 28 February 2019
                : 2 April 2019
                : 16 May 2019
                Categories
                Original Paper
                Original Paper

                undergraduate medical education,case histories
                undergraduate medical education, case histories

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