Abstract
Despite tremendous progression in the medical field, levels of diagnostic error remain unacceptably high. Cognitive failures in clinical reasoning are believed to be the major contributor to diagnostic error. There is evidence in the literature that teaching problem-based, inductive reasoning has the potential to improve clinical reasoning skills. In this study, 47 final-year veterinary medicine students at the Royal Veterinary College (RVC) were presented with a complex small animal medicine case. The participants were divided into two groups, one of which received a prioritized problem list in addition to the history, physical exam, and diagnostic test results provided to both groups. The students' written approaches to the case were then analyzed and assigned a diagnostic accuracy score (DAS) and an inductive reasoning score (IRS). The IRS was based on a series of predetermined characteristics consistent with the inductive reasoning framework taught at the RVC. No significant difference was found between the DAS scores of each group, indicating that the provision of a prioritized problem list did not impact diagnostic accuracy. However, a significant positive correlation between the IRS and DAS was illustrated for both groups of students, suggesting increased use of inductive reasoning is associated with increased diagnostic accuracy. These results contribute to a body of research proposing that inductive, problem-based reasoning teaching delivered in an additive model, can enhance the clinical reasoning skills of students and reduce diagnostic error.
Highlights
Medical research demonstrates that 10-15% of clinical cases culminate in misdiagnosis.[1,2] Cognitive failures are a significant contributor to these levels.[3,4] Current psychological theory, supported by neuroanatomical research, states that human reasoning is a continuous interaction between two processing systems; a fast, intuitive system (Type 1) and a slow, reflective system (Type 2).[5,6,7]In medical clinical reasoning, Type 1 processing has been referred to as ‘patternrecognition’- a cognitive function which relies on mental networks known as “illness scripts” embedded in long term memory.[8]
This study examines the clinical approaches of final year veterinary medicine students at the Royal Veterinary College (RVC), with the aim of assessing the impact inductive reasoning has on diagnostic accuracy
An inductive reasoning score (IRS) calculated by analysing their answers for a pre-determined list of characteristics associated with the inductive reasoning framework taught at the RVC (Table 1)
Summary
Medical research demonstrates that 10-15% of clinical cases culminate in misdiagnosis.[1,2] Cognitive failures are a significant contributor to these levels.[3,4] Current psychological theory, supported by neuroanatomical research, states that human reasoning is a continuous interaction between two processing systems; a fast, intuitive system (Type 1) and a slow, reflective system (Type 2).[5,6,7]. Scheme-inductive reasoning is a highly structured form of forward reasoning which has experimentally shown more accuracy than backward reasoning.[15,25] The Royal Veterinary College (RVC) has incorporated problem-based, inductive reasoning teaching into its clinical curriculum This strategy has similarities with schemeinductive frameworks and involves encouraging students to firstly identify specific problems in any presenting case and formulate a prioritised list of those problems.[26] They work forward from that list defining and refining the problems, including the body systems and likely locations within those systems involved.[27] the aim is to condense the problem to the point where a manageable list of differentials can be considered, appropriate diagnostic tests applied and the primary lesion defined.[28]. The hypotheses are (1) that providing a prioritised problem list improves diagnostic accuracy (based on the findings of Auclair[30] that presenting medical students with a formulated version of a complex case resulted in improved diagnostic accuracy) and 2) that use of an inductive reasoning schema positively affects diagnostic accuracy
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