Department of Medical Education Development, José do Rosário Vellano University (UNIFENAS) Medical School, Belo Horizonte, Brazil.
Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Center Rotterdam, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, the Netherlands.
Med Educ. 2019 Apr;53(4):390-397. doi: 10.1111/medu.13798. Epub 2019 Jan 24.
Reflection in practice is assumed to enhance interest in knowing more about a topic, increasing engagement in learning and learning outcomes. However, this claim lacks empirical evidence, particularly in medical education. The authors investigated the effects of deliberate reflection upon clinical cases on medical students' engagement in a learning activity and learning outcomes.
A three-task (diagnostic task; learning activity; test) experiment was conducted in August 2017. Seventy-two fourth-year students from UNIFENAS-BH Medical School, Brazil, diagnosed two clinical cases with jaundice as the chief complaint, either by following a deliberate reflection procedure or making differential diagnosis. Subsequently, all participants received the same study material on the diagnosis of jaundice. Finally, they took a recall test on the study material. Outcome measurements were study time and test scores.
There was a significant effect of experimental condition on students' engagement in the learning activity and on learning outcomes. Students who deliberately reflected upon the cases invested more time in studying the material than those who made a differential diagnosis (respectively, mean = 254.97, standard deviation = 115.45 versus mean = 194.96, standard deviation = 111.68; p = 0.02; d = 0.53). Deliberate reflection was also related to higher scores in the test relative to differential diagnosis (respectively, mean = 22.08, standard deviation = 14.94 versus mean = 15.75, standard deviation = 9.24; p = 0.03; d = 0.51). Medium effect sizes (Cohen's d) were observed in both measurements.
Relative to making differential diagnosis, deliberate reflection while diagnosing cases fostered medical students' engagement in learning and increased learning outcomes. Teachers can employ this relatively easy procedure, possibly both with simulated and real scenarios, to motivate their students and help them expand their knowledge, an important requirement for their professional development.
实践反思被认为可以增强对某一主题的了解兴趣，提高学习参与度和学习成果。然而，这一说法缺乏实证证据，尤其是在医学教育领域。作者研究了在临床病例诊断中进行刻意反思对医学生学习活动参与度和学习成果的影响。
2017 年 8 月进行了一项三任务（诊断任务、学习活动、测试）实验。来自巴西 UNIFENAS-BH 医学院的 72 名四年级学生，以黄疸为主要主诉诊断了两个临床病例，要么遵循刻意反思程序，要么进行鉴别诊断。随后，所有参与者都收到了关于黄疸诊断的相同学习材料。最后，他们对学习材料进行了回忆测试。结果测量是学习时间和测试成绩。
实验条件对学生的学习活动参与度和学习成果有显著影响。对案例进行刻意反思的学生比进行鉴别诊断的学生在学习材料上投入的时间更多（分别为平均=254.97，标准差=115.45 与平均=194.96，标准差=111.68；p=0.02；d=0.53）。与鉴别诊断相比，刻意反思也与测试成绩更高相关（分别为平均=22.08，标准差=14.94 与平均=15.75，标准差=9.24；p=0.03；d=0.51）。在这两个测量中都观察到了中等的效应大小（Cohen's d）。
与进行鉴别诊断相比，在诊断病例时进行刻意反思促进了医学生的学习参与度并提高了学习成果。教师可以采用这种相对简单的程序，无论是在模拟情景还是实际情景中，来激励学生并帮助他们扩展知识，这是他们专业发展的重要要求。
