Learning deliberate reflection in medical diagnosis: does learning-by-teaching help?
Kuhn, Josepha; Mamede, Silvia; van den Berg, Pieter; Zwaan, Laura; van Peet, Petra; Bindels, Patrick; van Gog, Tamara
(2023) Advances in Health Sciences Education, volume 28, issue 1, pp. 13 - 26
(Article)
Abstract
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
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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.
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Keywords: Critical thinking, Diagnostic error, General practice, Instructional design, Reflective reasoning, Education
ISSN: 1382-4996
Publisher: Springer
Note: Funding Information: This research was funded by ZonMW [839130007]. Funding Information: This research was supported with funding by ZonMW. The authors would like to thank Jacky Hooftman and Jessica de Graaf, for their help with the data collection and coding of the data, Kees in 't Veld, Herman Bueving, Marloes Jacobs, Robert Zegers, Arjen Muller, Boris Schouten, Michael Kevenaar, Roos Balvert, Ivonne van Trier, Hilde van Meer, and Charlotte van Sassen for writing and evaluating the cases and deliberate reflection examples, and Yvonne van Trier, Boris Schouten, Robert Zegers, Charlotte van Sassen, and Michiel Bos for scoring the data. Publisher Copyright: © 2022, The Author(s).
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