Schuelper Nikolai, Ludwig Sascha, Anders Sven, Raupach Tobias
Department of Haematology and Medical Oncology, University Medical Centre Göttingen, Göttingen, Germany.
Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany.
JMIR Med Educ. 2019 Jul 22;5(2):e13386. doi: 10.2196/13386.
Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences.
The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own.
In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories.
Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams.
Despite students' overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods.
使用关键特征问题进行反复的形成性评估已被证明可增强临床推理能力。通过呈现临床案例的视频增强的关键特征问题可能比基于文本的问题更有效，尤其是在医学生可以自由选择他们想要使用的格式的环境中。本研究根据学生的个人偏好，调查了使用基于视频或文本的关键特征问题的学生在临床推理方面的学习成果。
本研究的目的是检验以下假设：如果允许学生自行在不同格式之间进行选择，那么反复接触基于视频的关键特征问题比反复接触基于文本的关键特征问题能在更大程度上增强临床推理能力。
在这项单中心、前瞻性、非随机试验中，四年级医学生参加了12次基于计算机的案例研讨会，期间他们处理包含关键特征问题的病例史。病例有文本和视频两种格式。学生在每次案例研讨会开始时选择他们喜欢的呈现格式。在形成性入学、结业和留存考试中评估学生在关键特征问题上的表现，并根据之前接触基于视频或文本的病例史进行分析。
在102名符合条件的学生中，75名在所有研究考试中提供了书面同意并提供了完整数据（回复率=73.5%）。大多数学生（n=52）主要选择基于文本的格式。与这些学生相比，更喜欢基于视频格式的学生在结业考试中取得的分数略高但无统计学意义（平均76.2%[标准差12.6]对70.0%[标准差19.0]；P=0.15），在留存考试中取得的分数显著更高（平均75.3%[标准差16.6]对63.4%[标准差20.3]；P=0.02）。该效应与在各自考试中设置为默认的基于视频或文本的呈现格式无关。
尽管学生总体上更喜欢基于文本的病例史，但接触基于视频项目更多的学生在临床推理方面的学习成果更高。任务时间是对这些效应的一种可能解释，因为处理基于视频的项目更耗时。学生的基线表现水平不能解释结果，因为之前两组的总结性考试成绩相当。鉴于大量学生选择了效果较差的呈现格式，可能需要向学生介绍使用基于视频的病例史的有益效果，以便他们能够对自己的学习方法做出明智的选择。
