Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.
Department of Dermatology, SMG-SNU Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
BMC Med Educ. 2020 May 8;20(1):146. doi: 10.1186/s12909-020-02063-y.
There are few studies that directly compared different interventions to improve medical students' clinical reasoning for dermatologic conditions.
To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students' ability in evaluating skin lesions.
The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, who were enrolled to take a 2-week dermatology elective course (n = 87). Students were assigned to one of the three educational interventions: 2-h training involving 10 written clinical cases (experimental); 1-h lecture and 1-h outpatient clinic (lecture); and 2-h outpatient clinic (no intervention). Before and at the end of rotation, diagnostic accuracy was estimated using 20 written clinical cases with photographs (10 novel cases presented in diagnostic training [training set], 10 cases with diagnoses not included in training [control set]).
There was a significant interaction effect of intervention×set×time. A post hoc analysis indicated that the students in the experimental group outperformed students in the other two groups only in the training set of the final tests; after completing the 2-week rotation, for the training set, the mean score was higher in the experimental group (7.5 ± 1.3) than in the lecture (5.7 ± 1.6) and no intervention (5.6 ± 1.3) groups, producing an effect size of 1.2 standard deviation (SD) and 1.5 SD, respectively.
Practicing written clinical cases with reflection and feedback is superior to a lecture-based approach and yields additional benefits to a dermatology elective, thereby enhancing medical students' ability to accurately diagnose skin lesions.
ClinicalTrials.gov, NCT03472001. Registered 21 March 2018.
直接比较不同干预措施以提高医学生皮肤病临床推理能力的研究较少。
调查在传统皮肤科选修课中增加实践与反思和即时反馈对提高医学生评估皮肤病变能力的效果。
参与者为韩国首尔国立大学医学院四年级医学生，他们被选入为期 2 周的皮肤科选修课（n=87）。学生被分配到三种教育干预措施之一：涉及 10 个书面临床病例的 2 小时培训（实验组）；1 小时讲座和 1 小时门诊（讲座组）；以及 2 小时门诊（无干预组）。在轮转前后，使用包含照片的 20 个书面临床病例来评估诊断准确性（10 个新病例在诊断培训中呈现[培训集]，10 个病例的诊断不包括在培训中[对照组]）。
干预措施×设置×时间存在显著的交互作用。事后分析表明，实验组学生仅在最终测试的培训集中表现优于其他两组学生；在完成 2 周的轮转后，对于培训集，实验组的平均分数（7.5±1.3）高于讲座组（5.7±1.6）和无干预组（5.6±1.3），产生了 1.2 个标准差（SD）和 1.5 SD 的效应量。
与基于讲座的方法相比，练习书面临床病例与反思和反馈更具优势，并且为皮肤科选修课带来额外的益处，从而提高医学生准确诊断皮肤病变的能力。
ClinicalTrials.gov，NCT03472001。2018 年 3 月 21 日注册。
