Beck A L, Bergman D A
J Med Educ. 1986 Sep;61(9 Pt 1):749-56. doi: 10.1097/00001888-198609000-00019.
In the study reported here, the authors assessed the use of efficient organization of knowledge and of problem-solving strategies to enhance medical students' clinical problem-solving skills. Thirty-five preclinical medical students were randomly assigned to a experimental or control group and given a knowledge base containing information on eight congenital heart diseases to learn. Information for the experimental group emphasized disease groupings (based on their similar clinical presentation), symptom-disease associations, and clinical problem-solving heuristics. The same information for the control group was presented in a textbook format that emphasized the pathophysiology of the diseases. The students then diagnosed three computerized diagnostic problems of varying difficulty while verbalizing their problem-solving strategies. The results showed that the experimental group acquired a higher ratio of diagnostic to nondiagnostic cues, mentioned the correct diagnosis sooner in their workups, and correctly diagnosed the most difficult case more often than the control group. These results provide support for revisions in the organization and presentation of information that are aimed at improving clinical problem-solving skills.
在本文所报告的研究中，作者评估了运用高效的知识组织和问题解决策略来提高医学生临床问题解决能力的情况。35名临床前医学生被随机分为实验组或对照组，并被给予一个包含8种先天性心脏病信息的知识库以供学习。实验组的信息强调疾病分组（基于相似的临床表现）、症状与疾病的关联以及临床问题解决启发法。对照组的相同信息以强调疾病病理生理学的教科书形式呈现。然后，学生们在阐述其问题解决策略的同时，诊断了三个难度各异的计算机化诊断问题。结果显示，与对照组相比，实验组获得的诊断线索与非诊断线索的比例更高，在检查过程中更快提及正确诊断，并且更频繁地正确诊断出最难的病例。这些结果为旨在提高临床问题解决能力的信息组织和呈现方式的修订提供了支持。
