Abstract
BackgroundContrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus.MethodsThe authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018.ResultsThis modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation.ConclusionsThe lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.
Highlights
Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning
Greater educational support is required for students to acquire the competence to anticipate a set of differential diagnoses from the earliest phase of the diagnostic process, gather confirming and refuting information according to an initial hypothesis, select and perform the relevant history taking and physical examination, and interpret the findings to confirm or deny the initial hypothesis
Of the 23 participants who took part in the study, 22 completed the first and second rounds (96%), and 20 completed the additional round (87%). This modified Delphi study identified 275 basic and 67 essential other than basic diseases as the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation
Summary
Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. Greater educational support is required for students to acquire the competence to anticipate a set of differential diagnoses from the earliest phase of the diagnostic process, gather confirming and refuting information according to an initial hypothesis, select and perform the relevant history taking and physical examination, and interpret the findings to confirm or deny the initial hypothesis. In this context, the lack of development of diagnostic hypotheses remains an issue in the teaching of clinical reasoning to medical students. Recent studies in cognitive load theory have described that such fragmented reasoning may lead to diagnostic errors [5]
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