Abstract
BackgroundSelf-explanation while individually diagnosing clinical cases has proved to be an effective instructional approach for teaching clinical reasoning. The present study compared the effects on diagnostic performance of self-explanation in small groups with the more commonly used hypothetico-deductive approach.MethodsSecond-year students from a six-year medical school in Saudi Arabia (39 males; 49 females) worked in small groups on seven clinical vignettes (four criterion cases representing cardiovascular diseases and three ‘fillers’, i.e. cases of other unrelated diagnoses). The students followed different approaches to work on each case depending on the experimental condition to which they had been randomly assigned. Under the self-explanation condition, students provided a diagnosis and a suitable pathophysiological explanation for the clinical findings whereas in the hypothetico-deduction condition students hypothesized about plausible diagnoses for signs and symptoms that were presented sequentially. One week later, all students diagnosed eight vignettes, four of which represented cardiovascular diseases. A mean diagnostic accuracy score (range: 0–1) was computed for the criterion cases. One-way ANOVA with experimental condition as between-subjects factor was performed on the mean diagnostic accuracy scores.ResultsStudents in the hypothetico-deduction condition outperformed those in the self-explanation condition (mean = 0.22, standard deviation = 0.14, mean = 0.17; standard deviation = 0.12; F(1, 88) = 4.90, p = 0.03, partial η2 = 0.06, respectively).ConclusionsStudents in the hypothetico-deduction condition performed slightly better on a follow-up test involving similar cases, possibly because they were allowed to formulate more than one hypothesis per case during the learning phase.
Highlights
The acquisition of competence in the skill of diagnostic reasoning is perhaps the most important task a medical student is confronted with, a task that is fraught with difficulties
The test required candidates to diagnose a set of eight new clinical cases, of which four criterion cases represented new exemplars of the clinical presentations encountered in the learning phase and four represented “fillers”
The purpose of the present experiment was to study the effectiveness of self-explanation of clinical cases in small tutorial groups relative to a hypothetico-deductive approach
Summary
Fifty-nine (out of 188) students declined and 41 students either failed to complete all the phases or provided insufficient data to be included. 49 female and 39 male students (mean age 22.1 years, standard deviation 1.98) participated in the study. Tab. 3 contains the descriptive statistics of the experiment. A univariate analysis of variance was conducted with experimental condition as independent variable and diagnostic accuracy as the dependent variable. Students in the hypothetico-deduction condition performed better than those in the self-explanation condition, F(1, 86) = 4.20, p = 0.04. The effect size was small (Cohen’s d = 0.38) [18]. No differences in performance were observed on the filler cases, F(1, 86) = 0.91, p = 0.76, Cohen’s d = 0.05, suggesting that the groups were similar and randomization was successful
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