Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
Med Teach. 2024 Jan;46(1):65-72. doi: 10.1080/0142159X.2023.2229504. Epub 2023 Jul 4.
on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty.
One-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis).
The deliberate-reflection condition recalled more features for the diagnosis than the control condition ( = .013) regardless of described difficulty. They also recalled more features related to their diagnosis on the first three cases ( = .004), but on the last three cases (described as difficult), there was no difference.
Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases.
初步诊断发现可纠正诊断错误。我们调查了教授学生使用深思熟虑的方法来反思未来病例的有效性，以及他们是否会根据对病例难度的感知来使用这种方法。
119 名医学生要么通过深思熟虑的方法来解决病例，要么在没有指导反思的情况下解决病例。一周后，所有参与者都要解决六个病例，每个病例都有两个同样可能的诊断，但病例中的一些症状只与其中一个诊断有关（）。参与者提供一个诊断，然后写下他们从该诊断中记得的所有内容。在解决了前三个病例后，他们被告知接下来的三个病例将是困难的病例。通过回忆的鉴别特征的比例来衡量反思（整体；与他们提供的诊断相关；与替代诊断相关）。
深思熟虑的方法比对照组（ = .013）无论描述的难度如何，都能回忆出更多与 诊断相关的特征。他们在前三个病例中也能回忆出更多与他们的 诊断相关的特征（ = .004），但在最后三个病例（描述为困难）中，两者没有差异。
学习深思熟虑的方法有助于学生在解决未来病例时进行更多的反思性推理。
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