Abstract
BackgroundOver-testing of patients is a significant problem in clinical medicine that can be tackled by education. Clinical reasoning learning (CRL) is a potentially relevant method for teaching test ordering and interpretation. The feasibility might be improved by using an interactive whiteboard (IWB) during the CRL sessions to enhance student perceptions and behaviours around diagnostic tests. Overall, IWB/CRL could improve their skills.MethodsThird-year undergraduate medical students enrolled in a vertically integrated curriculum were randomized into two groups before clinical placement in either a respiratory disease or respiratory physiology unit: IWB-based CRL plus clinical mentoring (IWB/CRL + CM: n = 40) or clinical mentoring only (CM-only: n = 40). Feasibility and learning outcomes were assessed. In addition, feedback via questionnaire of the IWB students and their classmates (n = 233) was compared.ResultsAnalyses of the IWB/CRL sessions (n = 40, 27 paperboards) revealed that they met validated learning objectives. Students perceived IWB as useful and easy to use. After the IWB/CRL + CM sessions, students mentioned more hypothesis-based indications in a test ordering file (p < 0.001) and looked for more nonclinical signs directly on raw data tests (p < 0.01) compared with students in the CM-only group. Last, among students who attended pre- and post-assessments (n = 23), the number of diagnostic tests ordered did not change in the IWB/CRL + CM group (+ 7%; p = N.S), whereas it increased among CM-only students (+ 30%; p < 0.001). Test interpretability increased significantly in the IWB/CRL + CM group (from 4.7 to 37.2%; p < 0.01) but not significantly in the CM-only group (from 2.4 to 9.8%; p = 0.36).ConclusionsIntegrating IWB into CRL sessions is feasible to teach test ordering and interpretation to undergraduate students. Moreover, student feedback and prospective assessment suggested a positive impact of IWB/CRL sessions on students’ learning.
Highlights
Over-testing of patients is a significant problem in clinical medicine that can be tackled by education
40 out of the 178 eligible students were randomly assigned to the interactive whiteboard (IWB)/Clinical reasoning learning (CRL) + CM group and 40 to the clinical mentoring only (CM-only) group
Gender (F/M) did not significantly differ for eligible students (55%/45%), students in the IWB/CRL + CM group (65%/35%; p = 0.291), students who responded to the questionnaire (48%/52%; p = 0.539), or students who participated in pre- and post-tests (56%/44%, p = 1.00)
Summary
Over-testing of patients is a significant problem in clinical medicine that can be tackled by education. Clinical reasoning learning (CRL) is a potentially relevant method for teaching test ordering and interpretation. The feasibility might be improved by using an interactive whiteboard (IWB) during the CRL sessions to enhance student perceptions and behaviours around diagnostic tests. Inappropriate test ordering can be improved by education and training in test requests, interpretation and use [3, 4], as the inappropriateness is often due to the physician’s uncertainty about the test indications, performance, feasibility, contraindications, and risk, as well as a lack of knowledge about better alternatives [10]. Education in clinical assessment (pre-analytical) and interpretation of first-line diagnostic tests may reduce the need for more invasive and expensive tools
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