Learning deliberate reflection in medical diagnosis: does learning-by-teaching help?
Advances in Health Sciences Education, vol. 28, pp. 13–26
Abstract
Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through 'learning-by-teaching' and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p = .263; time to diagnose, p = .598; mental effort ratings, p = .544; confidence ratings, p = .710; proportion of contradiction units (i.e. measure of deliberate reflection), p = .544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection.
Authors 6
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Josepha Kuhn corresponding
Affiliation as printed
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands. j.kuhn@erasmusmc.nl
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands. j.kuhn@erasmusmc.nl
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
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Affiliation as printed
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
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Affiliation as printed
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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Affiliation as printed
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
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Affiliation as printed
Department of Education, Utrecht University, Utrecht, The Netherlands
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