Teaching medical students to apply deliberate reflection

Abstract

Purpose: Deliberate reflection 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.

Method: 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 (discriminating features). 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).

Results: The deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p = .013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p = .004), but on the last three cases (described as difficult), there was no difference.

Conclusion: Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases.

Keywords: Deliberate reflection; diagnostic error; diagnostic reasoning; learning-by-teaching.

Figure 1.

Overview of the study design.

Figure 2.

Mean proportion of recalled discriminating features for both diagnoses, one’s own diagnosis, and the alternative diagnosis, split up by description of difficulty (none, difficult). error bars show ± 2 standard error.