The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation.

Abstract

Within a Hospital Medicine division at a large academic institution, an innovative program has been developed to offer third year medical learners enrolled in their Internal Medicine Clerkship the opportunity to deepen their diagnostic reasoning skills with a weekly case-based learning activity entitled "Hospital Medicine's Mystery Case of the Week". The mystery case curriculum has four primary learning objectives (1): To understand the value of employing a multisystem approach to a common presenting problem (2); To apply a diagnostic schema to a clinical problem (3); To apply knowledge of cost appropriate workups to a clinical case and (4) To identify cognitive biases that can influence decision making in the context of treating a clinical problem. A process evaluation of the mystery case curriculum was conducted over a 6-month implementation period. The process evaluation was guided by eight domains of focus: program acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited-efficacy testing. Measures included a pre/post mixed-methods survey, attendance log and timesheet. Pre/post survey data was analyzed via paired samples t-tests and open-ended responses were analyzed via a deductive content analysis. Process evaluation findings demonstrated the program had high levels of acceptability and demand. Survey findings suggest the curriculum may increase feelings of preparedness for Internal Medicine exams as well as student interest, comfort and confidence related to diagnostic processes. Future evaluations should work to understand the influence this curriculum has on diagnostic accuracy within a clinical setting.