Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
Institute for Medical Education, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
Arch Gynecol Obstet. 2022 Nov;306(5):1563-1571. doi: 10.1007/s00404-022-06656-4. Epub 2022 Jul 13.
Clinical reasoning is an essential skill, the foundations of which should be acquired during medical school. Within the format of test-based learning, such examinations can also be used to support the long-term retention of procedural knowledge necessary for clinical reasoning. The aim was to investigate whether repeated exposure to clinical cases in obstetrics and gynecology (OBGYN) with built-in questions leads to higher learning outcome than pure reading cases and what influence the delay between the intervention and the final test has on the retention of the respective content.
In this non-randomised crossover study, 5th-year medical students (duration of the study is 6 years) taking a 1-week clinical attachment in OBGYN participated in computer-based case seminars in winter term 2020/2021, in which different case histories on gynecological-obstetric diseases were presented. Case content was identical for all groups, but the presentation format (cases with key feature questions vs read-only cases) of individual case vignettes changed weekly. The also intervention was repeated after 2 weeks for each group. Knowledge was assessed in an entry and an exit exam consisting of 40 short-answer questions.
A total of 94 out of 118 eligible students participated in the study (response rate: 79.7%). Learning outcome was significantly higher for items presented in the key feature format compared to items presented as read-only cases (74.2 ± 8.6% vs. 71.0 ± 9.2%; p = 0.017). Furthermore, the analysis showed that the temporal distance of the intervention package from the final examination had no influence on retention.
This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning in the subject of OGBYN. In this cross-over study, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing can thus improve learning outcomes for OBGYN.
临床推理是一项基本技能，其基础应该在医学院获得。在基于测试的学习形式中，此类考试也可用于支持长期保留临床推理所需的程序性知识。目的是调查在妇产科（OBGYN）中反复接触带有内置问题的临床病例是否比单纯阅读病例导致更高的学习效果，以及干预和最终测试之间的时间延迟对保留各自内容的影响。
在这项非随机交叉研究中，参加妇产科为期 1 周临床实习的 5 年级医学生（研究持续时间为 6 年）参加了 2020/2021 年冬季学期的基于计算机的案例研讨会，其中介绍了妇科-产科疾病的不同病史。所有组的病例内容都相同，但个别病例小插曲的呈现格式（带关键特征问题的病例与只读病例）每周都会发生变化。对于每个组，干预措施也在 2 周后重复。通过包含 40 个简答题的入门和结业考试来评估知识。
共有 94 名符合条件的学生中的 118 名（应答率：79.7%）参加了研究。与只读病例相比，以关键特征格式呈现的项目的学习效果明显更高（74.2±8.6%对 71.0±9.2%；p=0.017）。此外，分析表明，干预包与最终考试的时间距离对保留没有影响。
这是第一项证明在妇产科主题中测试增强学习对临床推理有影响的研究。在这项交叉研究中，重复测试比单独基于案例的重复学习更有效。因此，纵向关键特征测试的课程实施可以提高妇产科的学习效果。
