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, Rotterdam, The Netherlands.
Med Educ. 2021 Mar;55(3):404-412. doi: 10.1111/medu.14410. Epub 2020 Nov 24.
Previous research suggests that, relative to generating a differential diagnosis, deliberate reflection during practice with clinical cases fosters learning from a subsequently studied scientific text and promotes interest in the subject matter. The present experiment aimed to replicate these findings and to examine whether motivational or cognitive mechanisms, or both, underlie the positive effects of reflection.
A total of 101 5th-year medical students participated in an experiment containing four phases: Students (a) diagnosed two clinical cases of jaundice-related diseases either through deliberate reflection or differential diagnosis; (b) reported their situational interest and awareness of knowledge gaps; (c) studied a text about jaundice, either under free or restricted time; and (d) recalled the text. Outcome measures were text-recall, situational interest and awareness of knowledge gaps.
A main effect of diagnostic approach on recall of the text was found, with the reflection group recalling more studied material than the differential diagnosis group (means: 72.56 vs 58.80; P = .01). No interaction between diagnostic approach and study time (free or restricted) emerged, nor was there a main effect of the latter. Relative to the differential diagnosis group, students who reflected upon the cases scored significantly higher on both situational interest (means: 4.45 vs 3.99, P < .001) and awareness of knowledge gaps (means: 4.13 vs 3.85, P < .01).
Relative to generating differential diagnoses, reflection upon clinical cases increased learning outcomes on a subsequent study task, an effect that was independent of study time, suggesting that cognitive mechanisms underlie this effect, rather than increases in motivation to study. However, higher scores on situational interest and awareness of knowledge gaps and a tendency towards larger gains when time was free suggest that higher motivation may also contribute to learning from reflection.
先前的研究表明，与生成鉴别诊断相比，在临床病例实践中进行深思熟虑的反思有助于从随后研究的科学文本中学习，并促进对主题的兴趣。本实验旨在复制这些发现，并探讨反思的积极影响是否基于动机或认知机制，或者两者兼而有之。
共有 101 名五年级医学生参与了一项实验，该实验包含四个阶段：（a）学生通过深思熟虑或鉴别诊断来诊断两个黄疸相关疾病的临床病例；（b）报告他们的情境兴趣和知识差距意识；（c）在自由或限时条件下学习有关黄疸的文本；（d）回忆文本。测量的结果是文本回忆、情境兴趣和知识差距意识。
发现诊断方法对文本回忆有主要影响，反思组比鉴别诊断组回忆更多学习材料（平均值：72.56 比 58.80；P =.01）。诊断方法和学习时间（自由或限时）之间没有交互作用，也没有后者的主要影响。与鉴别诊断组相比，对病例进行反思的学生在情境兴趣（平均值：4.45 比 3.99，P <.001）和知识差距意识（平均值：4.13 比 3.85，P <.01）方面的得分显著更高。
与生成鉴别诊断相比，对临床病例进行反思会增加随后学习任务的学习成果，这种效果独立于学习时间，这表明认知机制是这种效果的基础，而不是学习动机的提高。然而，情境兴趣和知识差距意识得分较高，以及自由时间时获得更大收益的趋势表明，更高的动机也可能有助于从反思中学习。
