McLaughlin Kevin, Coderre Sylvain, Mortis Garth, Mandin Henry
Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
Teach Learn Med. 2007 Winter;19(1):35-41. doi: 10.1080/10401330709336621.
The relation between knowledge structure and diagnostic performance is unclear. Similarly, variables affecting knowledge structure are poorly understood.
The 1st objective was to examine the relation between concepts in knowledge structure and diagnostic performance. The 2nd objective was to examine the relation between the use of diagnostic schemes by small-group preceptors and knowledge structure of medical students.
This was a cross-sectional study of 1st-year medical students in 4 clinical presentations: hyponatremia, hyperkalemia, metabolic acidosis, and metabolic alkalosis. The 1st dependent variable was diagnostic success with the number of expert-type concepts in knowledge structure (determined by concept sorting), diagnostic scheme use by preceptors, and clinical presentation as independent variables. The 2nd dependent variable was the number of expert-type concepts in knowledge structure with diagnostic scheme use by preceptors and clinical presentation as independent variables. Data were analyzed using multiple logistic and linear regression.
Thirty 1st-year medical students participated. After adjusting for clinical presentation and scheme use by preceptors, the number of expert-type concepts in knowledge structure was associated with increased odds of diagnostic success (odds ratio 1.18 [1.03, 1.35], p = .016). After adjustment for clinical presentation, scheme use by preceptors was associated with increased number of expert-type concepts in knowledge structure (2.22 vs. 1.86, p = .01, d = 0.23).
The number of expert-type concepts in knowledge structure is associated with increased odds of diagnostic success. Scheme use by small-group preceptors is associated with an increased number of expert-type concepts in knowledge structure.
知识结构与诊断表现之间的关系尚不清楚。同样，影响知识结构的变量也鲜为人知。
第一个目标是研究知识结构中的概念与诊断表现之间的关系。第二个目标是研究小组带教老师使用诊断方案与医学生知识结构之间的关系。
这是一项针对一年级医学生的横断面研究，涉及4种临床表现：低钠血症、高钾血症、代谢性酸中毒和代谢性碱中毒。第一个因变量是诊断成功率，将知识结构中专家型概念的数量（通过概念分类确定）、带教老师使用的诊断方案以及临床表现作为自变量。第二个因变量是知识结构中专家型概念的数量，将带教老师使用的诊断方案以及临床表现作为自变量。使用多元逻辑回归和线性回归分析数据。
30名一年级医学生参与了研究。在对临床表现和带教老师使用的方案进行调整后，知识结构中专家型概念的数量与诊断成功几率的增加相关（优势比为1.18 [1.03, 1.35]，p = .016）。在对临床表现进行调整后，带教老师使用的方案与知识结构中专家型概念数量的增加相关（2.22对1.86，p = .01，d = 0.23）。
知识结构中专家型概念的数量与诊断成功几率的增加相关。小组带教老师使用方案与知识结构中专家型概念数量的增加相关。
