Urushibara-Miyachi Yuka, Kikukawa Makoto, Ikusaka Masatomi, Otaki Junji, Nishigori Hiroshi
Faculty of Medicine, Kyoto University, Yoshida konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Kyushu University, Fukuoka, Japan.
BMC Med Educ. 2021 Apr 23;21(1):234. doi: 10.1186/s12909-021-02652-5.
Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus.
The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018.
This modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation.
The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students' contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.
对比学习在教授医学生如何在临床推理中生成诊断假设方面已被证明是有效的。然而，对于本科医学课程应涵盖的不同医学学科中常见体征和症状的诊断考量清单，国际上尚未达成共识。在日本，本科医学教育的国家示范核心课程于2016年进行了修订，37种常见体征、症状和病理生理学的潜在诊断清单被纳入课程。本研究旨在基于专家共识验证这些项目清单。
作者采用改良德尔菲法，在来自日本各地的23名临床推理专家医师教师组成的小组中达成共识。该小组根据医学专业最后一年的学生在考虑给定的体征、症状或病理生理学时是否应假设某种疾病，以5分李克特量表对项目进行评估。他们还添加了其他应假设的疾病。积极共识的定义为小组同意率达到75%，且在5分制量表上的平均分为4分或更高，标准差小于1分。该研究于2017年9月至2018年3月进行。
这项改良德尔菲研究确定了275个基本项目以及67个除基本项目之外的重要项目，这些项目对应于日本医学生毕业前应掌握的37种常见体征、症状和病理生理学的潜在诊断。
本研究制定的清单可通过鼓励学生进行对比学习，有助于教授和学习如何生成初始假设。尽管这些清单侧重于日本的教育背景，但清单及验证过程可推广至其他国家，以就医学教育课程内容达成全国性共识。
