Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
Adv Health Sci Educ Theory Pract. 2023 Mar;28(1):13-26. doi: 10.1007/s10459-022-10138-2. Epub 2022 Aug 1.
Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through 'learning-by-teaching' and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p = .263; time to diagnose, p = .598; mental effort ratings, p = .544; confidence ratings, p = .710; proportion of contradiction units (i.e. measure of deliberate reflection), p = .544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection.
刻意反思已被发现可以促进对复杂病例或易导致认知偏差情况的诊断准确性。然而，目前尚不清楚该程序是否也可以通过“教学相长”来学习，并在没有反思指导的情况下自主应用于诊断未来病例。我们研究了普通科住院医师是否可以通过“教学相长”来学习刻意反思程序，并将其应用于诊断新病例。该研究是一个两阶段实验。在学习阶段，56 名普通科住院医师被随机分配到两种条件之一。他们要么（1）研究刻意反思的例子，然后通过视频向虚构的同伴解释该程序；要么（2）不进行反思（对照组）解决病例。在测试阶段，一到三周后，所有参与者在思考时大声诊断新病例。对测试阶段的分析显示，在任何结果衡量标准上，条件之间均无显著差异（诊断准确性，p=0.263；诊断时间，p=0.598；心理努力评分，p=0.544；信心评分，p=0.710；矛盾单元比例（即刻意反思的衡量标准），p=0.544）。与其他领域的教学相长学习发现相反，向虚构同伴教授刻意反思并没有增加未来病例诊断中的反思推理。未来研究可能会解决的潜在解释是，实验条件下的住院医师在测试阶段没有应用所学的刻意反思程序，或者对照组的住院医师也进行了反思。
