Abstract
BackgroundThe Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome.MethodsIn a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies. Following an entry exam, fourth-year undergraduate medical students attended 10 weekly computer-based seminars during which they studied patient case histories. Each case contained five key feature questions (items) on the diagnosis and treatment of the presented patient. Students were randomly allocated to read text cases (control condition) or watch videos (intervention), and assignment to either text or video was switched between groups every week. Using a within-subjects design, student performance on video-based and text-based items was assessed 13 weeks (exit exam) and 9 months (retention test) after the first day of term. The primary outcome was the within-subject difference in performance on video-based and text-based items in the exit exam.ResultsOf 125 eligible students, 93 provided data for all three exams (response rate 74.4%). Percent scores were significantly higher for video-based than for text-based items in the exit exam (76.2 ± 19.4% vs. 72.4 ± 19.1%, p = 0.026) but not the retention test (69.2 ± 20.2% vs. 66.4 ± 20.3%, p = 0.108). An additional Bayesian analysis of this retention test suggested that video-based training is marginally more effective than text-based training in the long term (Bayes factor 2.36). Regardless of presentation format, student responses revealed a high prevalence of erroneous beliefs that, if applied to the clinical context, could place patients at risk.ConclusionRepeated video-based key feature testing produces superior short-term learning outcome compared to text-based testing. Given the high prevalence of misconceptions, efforts to improve clinical reasoning training in medical education are warranted. The Choosing Wisely campaign lends itself to being part of this process.
Highlights
The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians
Clinical reasoning abilities are a prerequisite for making ‘wise choices’ in clinical medicine, suggesting that teaching interventions aimed at fostering clinical reasoning may enhance performance with regard to the recommendations derived from the Choosing Wisely campaign
We recently reported the findings of a randomised study of repeated testing with key feature questions on outcomes related to clinical reasoning [20], wherein 6 months after the intervention, students retained significantly more content that had been presented in key feature questions compared to content that had been presented in a didactic format but without interspersed questions (56% vs. 49%; p < 0.001)
Summary
The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome. Clinical reasoning abilities are a prerequisite for making ‘wise choices’ in clinical medicine, suggesting that teaching interventions aimed at fostering clinical reasoning may enhance performance with regard to the recommendations derived from the Choosing Wisely campaign. Vice versa, these recommendations result from a stringent application of the principles of clinical reasoning. Given the limitations of these formats regarding resource intensity and availability of patients with rare but important diseases, computer-assisted case-based learning with virtual patients [10] has been proposed as a viable approach to teaching clinical reasoning [11, 12]
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