Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Med Educ. 2021 Feb 2;21(1):87. doi: 10.1186/s12909-021-02522-0.
The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students' clinical reasoning skills in the diagnosis domain.
This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT).
Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students.
Teaching with the illness script method was an effective way to improve students' clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.
疾病脚本方法采用理论大纲（例如，流行病学、病理生理学、体征和症状、诊断测试、干预措施）来阐明临床医生如何在诊断领域为临床推理组织医学知识。我们假设，基于疾病脚本方法的教育干预将提高医学生在诊断领域的临床推理技能。
这是一项在伊朗 Shiraz 医学院进行的随机对照试验，涉及 100 名四年级医学生。将 50 名学生随机分为干预组，他们在一个临床场景中针对三种疾病接受基于疾病脚本方法的临床推理技能教学。另外 50 名学生被随机分为对照组，他们接受与干预组相同的三种疾病的基于体征和症状的临床表现教学。主要结局指标是学习者对干预的满意度以及内部开发的知识测试和脚本一致性测试（SCT）的后测分数。
在 100 名参与的四年级医学生中，有 47 名（47%）为男性，53 名（53%）为女性。在知识测试中，干预组和对照组的前测分数没有差异，表明两组的基线知识相似；然而，干预组的后测分数（20 分中得 15.74±2.47 分）明显高于对照组（20 分中得 14.38±2.59 分，P=0.009）。在 SCT 中，干预组的平均得分为 6.12±1.95 分，明显高于对照组（4.54±1.56 分，P=0.0001）。学习者满意度数据表明，该干预措施受到学生的好评。
基于疾病脚本方法的教学是提高学生在特定临床场景下诊断领域临床推理技能的有效方法，后测和 SCT 分数均表明这一点。这种方法是否能转化为真实临床环境中更广泛的临床推理技能的提高，值得进一步研究。
