Delavari Somayeh, Monajemi Alireza, Baradaran Hamid Reza, Myint Phyo Kyaw, Yaghmaei Minoo, Soltani Arabshahi Seyed Kamran
Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Philosophy of Science, Institute for Humanities and Cultural Studies, Tehran, Iran.
Med J Islam Repub Iran. 2020 Feb 20;34:9. doi: 10.34171/mjiri.34.9. eCollection 2020.
Although theory explains the development of illness script, it does not provide answers how medical students develop scripts in their learning. To fill the knowledge gap of developing illness script in medical students and interns, this study aimed to investigate the impact of educational strategies inspired by theory in the development of illness scripts. A total of 15 medical students and 12 interns participated in an educational intervention that included theory-driven strategies. To evaluate the impact of this intervention, clinical reasoning problem (CRP) and key features (KF) tests were used for before and after the intervention. In addition to descriptive statistics, the differences in participants' pretest and posttest variables were tested using Wilcoxon. Significance level was set at p≤0.05 for all tests. Interns significantly recognized more KF in the posttest. However, no significant difference was found between the pretest and posttest scores in total diagnostic accuracy (5.41±1.16 vs 4.91±1.44; p=0.111) and total correct discriminating score (0.41±0.66 vs 1.41±2.06; p=0.146). Medical students produced less total key features in the posttest, indicating that they became less elaborate in their case processing. However, no significant difference was observed in common KF score (0.4 [0.25-0.78] vs 0.9 [0.6-1]; p=0.791) and discriminative key features score (0.33 [0.16-0.33] vs 0.22 [0.11-0.44]; p=0.972) in the posttest compared to the pretest. This study showed that theory-driven educational strategies have an impact on illness script development specifically in interns. It is recommended that this intervention would be tested on those in higher levels of expertise (ie, residents).
虽然理论解释了疾病脚本的发展，但它并未提供医学生在学习过程中如何形成脚本的答案。为了填补医学生和实习生在形成疾病脚本方面的知识空白，本研究旨在调查受该理论启发的教育策略对疾病脚本发展的影响。共有15名医学生和12名实习生参与了一项包含理论驱动策略的教育干预。为评估该干预的影响，在干预前后使用了临床推理问题（CRP）和关键特征（KF）测试。除描述性统计外，使用Wilcoxon检验参与者测试前和测试后变量的差异。所有测试的显著性水平设定为p≤0.05。实习生在测试后显著识别出更多的关键特征。然而，在总诊断准确性（5.41±1.16对4.91±1.44；p = 0.111）和总正确区分分数（0.41±0.66对1.41±2.06；p = 0.146）的测试前和测试后分数之间未发现显著差异。医学生在测试后产生的总关键特征较少，表明他们在病例处理中变得不那么详尽。然而，与测试前相比，测试后在常见关键特征分数（0.4 [0.25 - 0.78]对0.9 [0.6 - 1]；p = 0.791）和区分性关键特征分数（0.33 [0.16 - 0.33]对0.22 [0.11 - 0.44]；p = 0.972）方面未观察到显著差异。本研究表明，理论驱动的教育策略对疾病脚本的发展有影响，特别是对实习生。建议在更高专业水平的人群（即住院医师）中测试这种干预措施。
