Systematic instruction in laboratory medicine. Effects on the clinical problem solving performance of medical students.

Modified patient management problems were administered to senior medical students in pre- and postexamination formats to evaluate the effects of systematic instruction in laboratory medicine on clinical problem solving performance. Significant improvements were noted on several of the derived performance measures studied. Most improvements could be attributed to the course of instruction, some were problem dependent, and students with some prior clinical experience exhibited more improvement than did their less experienced colleagues. Evidence is presented to suggest that poor problem solving performance, as evident from pre-examination results, reflects not any inherent problem solving deficiency, but a specific lack of knowledge. The greater degree of improvement exhibited by inexperienced students toward greater hypothesis specificity and higher diagnostic goal indices leads us to speculate that inexperienced students structure knowledge differently from their experienced counterparts. It is concluded that systematic instruction aimed at improving laboratory utilization is capable of evaluation and, at least in simulated format, leads to improved clinical problem solving. The implications are discussed.