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Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial.

ABSTRACT: BACKGROUND:There are few studies that directly compared different interventions to improve medical students' clinical reasoning for dermatologic conditions. OBJECTIVE:To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students' ability in evaluating skin lesions. METHODS:The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, who were enrolled to take a 2-week dermatology elective course (n?=?87). Students were assigned to one of the three educational interventions: 2-h training involving 10 written clinical cases (experimental); 1-h lecture and 1-h outpatient clinic (lecture); and 2-h outpatient clinic (no intervention). Before and at the end of rotation, diagnostic accuracy was estimated using 20 written clinical cases with photographs (10 novel cases presented in diagnostic training [training set], 10 cases with diagnoses not included in training [control set]). RESULTS:There was a significant interaction effect of intervention×set×time. A post hoc analysis indicated that the students in the experimental group outperformed students in the other two groups only in the training set of the final tests; after completing the 2-week rotation, for the training set, the mean score was higher in the experimental group (7.5?±?1.3) than in the lecture (5.7?±?1.6) and no intervention (5.6?±?1.3) groups, producing an effect size of 1.2 standard deviation (SD) and 1.5 SD, respectively. CONCLUSION:Practicing written clinical cases with reflection and feedback is superior to a lecture-based approach and yields additional benefits to a dermatology elective, thereby enhancing medical students' ability to accurately diagnose skin lesions. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03472001. Registered 21 March 2018.

SUBMITTER: Choi S

PROVIDER: S-EPMC7206810 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial.

Choi Sungjun S Oh Sohee S Lee Dong Hun DH Yoon Hyun-Sun HS

BMC medical education 20200508 1

<h4>Background</h4>There are few studies that directly compared different interventions to improve medical students' clinical reasoning for dermatologic conditions.<h4>Objective</h4>To investigate the effectiveness of adding practice with reflection and immediate feedback on traditional dermatology electives in improving medical students' ability in evaluating skin lesions.<h4>Methods</h4>The participants were fourth-year medical students of Seoul National University College of Medicine, Korea, ...[more]

PMID: 32384885

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Project description:BackgroundThe use of feedback has been integral to medical student learning, but rigorous evidence to evaluate its education effect is limited, especially in the role of patient feedback in clinical teaching and practice improvement. The aim of the Patient Teaching Associate (PTA) Feedback Study was to evaluate whether additional written consumer feedback on patient satisfaction improved consultation skills among medical students and whether multisource feedback (MSF) improved student performance.MethodsIn this single site, double-blinded randomised controlled trial, 71 eligible medical students from two universities in their first clinical year were allocated to intervention or control and followed up for one semester. They participated in five simulated student-led consultations in a teaching clinic with patient volunteers living with chronic illness. Students in the intervention group received additional written feedback on patient satisfaction combined with guided self-reflection. The control group received usual immediate formative multisource feedback from tutors, patients and peers. Student characteristics, baseline patient-rated satisfaction scores and tutor-rated consultation skills were measured.ResultsFollow-up assessments were complete in 70 students attending the MSF program. At the final consultation episodes, both groups improved patient-rated rapport (P = 0.002), tutor-rated patient-centeredness and tutor-rated overall consultation skills (P = 0.01). The intervention group showed significantly better tutor-rated patient-centeredness (P = 0.003) comparing with the control group. Distress relief, communication comfort, rapport reported by patients and tutor-rated clinical skills did not differ significantly between the two groups.ConclusionsThe innovative multisource feedback program effectively improved consultation skills in medical students. Structured written consumer feedback combined with guided student reflection further improved patient-centred practice and effectively enhanced the benefit of an MSF model. This strategy might provide a valuable adjunct to communication skills education for medical students.Trial registrationAustralian New Zealand Clinical Trials Registry Number ACTRN12613001055796 .

Project description:BackgroundUse of virtual patient educational tools could fill the current gap in the teaching of clinical reasoning skills. However, there is a limited understanding of their effectiveness. The aim of this study was to synthesise the evidence to understand the effectiveness of virtual patient tools aimed at improving undergraduate medical students' clinical reasoning skills.MethodsWe searched MEDLINE, EMBASE, CINAHL, ERIC, Scopus, Web of Science and PsycINFO from 1990 to January 2022, to identify all experimental articles testing the effectiveness of virtual patient educational tools on medical students' clinical reasoning skills. Quality of the articles was assessed using an adapted form of the MERSQI and the Newcastle-Ottawa Scale. A narrative synthesis summarised intervention features, how virtual patient tools were evaluated and reported effectiveness.ResultsThe search revealed 8,186 articles, with 19 articles meeting the inclusion criteria. Average study quality was moderate (M = 6.5, SD = 2.7), with nearly half not reporting any measurement of validity or reliability for their clinical reasoning outcome measure (8/19, 42%). Eleven articles found a positive effect of virtual patient tools on reasoning (11/19, 58%). Four reported no significant effect and four reported mixed effects (4/19, 21%). Several domains of clinical reasoning were evaluated. Data gathering, ideas about diagnosis and patient management were more often found to improve after virtual patient use (34/47 analyses, 72%) than application of knowledge, flexibility in thinking and problem-solving (3/7 analyses, 43%).ConclusionsUsing virtual patient tools could effectively complement current teaching especially if opportunities for face-to-face teaching or other methods are limited, as there was some evidence that virtual patient educational tools can improve undergraduate medical students' clinical reasoning skills. Evaluations that measured more case specific clinical reasoning domains, such as data gathering, showed more consistent improvement than general measures like problem-solving. Case specific measures might be more sensitive to change given the context dependent nature of clinical reasoning. Consistent use of validated clinical reasoning measures is needed to enable a meta-analysis to estimate effectiveness.

Project description:BackgroundSelf-explanation without feedback has been shown to improve medical students' diagnostic reasoning. While feedback is generally seen as beneficial for learning, available evidence of the value of its combination with self-explanation is conflicting. This study investigated the effect on medical students' diagnostic performance of adding immediate or delayed content-feedback to self-explanation while solving cases.MethodsNinety-four 3rd-year students from a Canadian medical school were randomly assigned to three experimental conditions (immediate-feedback, delayed-feedback, control). In the learning phase, all students solved four clinical cases by giving i) the most likely diagnosis, ii) two main arguments supporting this diagnosis, and iii) two plausible alternative diagnoses, while using self-explanation. The immediate-feedback group was given the correct diagnosis after each case; delayed-feedback group received the correct diagnoses only after the four cases; control group received no feedback. One week later, all students solved four near-transfer (i.e., same final diagnosis as the learning cases but different scenarios) and four far-transfer cases (i.e., different final diagnosis from the learning cases and different scenarios) by answering the same three questions. Students' diagnostic accuracy (score for the response to the first question only) and diagnostic performance (combined score of responses to the three questions) scores were assessed in each phase. Four one-way ANOVAs were performed on each of the two scores for near and far-transfer cases.ResultsThere was a significant effect of experimental condition on diagnostic accuracy on near-transfer cases (p < .05). The immediate-feedback and delayed-feedback groups performed equally well, both better than control (respectively, mean = 90.73, standard deviation =10.69; mean = 89.92, standard deviation = 13.85; mean = 82.03, standard deviation = 17.66). The experimental conditions did not significantly differ on far-transfer cases.ConclusionsProviding feedback to students in the form of the correct diagnosis after using self-explanation with clinical cases is potentially beneficial to improve their diagnostic accuracy but this effect is limited to similar cases. Further studies should explore how more elaborated feedback combined with self-explanation may impact students' diagnostic performance on different cases.

Project description:PurposeDeveloping medical students' clinical reasoning requires a structured longitudinal curriculum with frequent targeted assessment and feedback. Performance-based assessments, which have the strongest validity evidence, are currently not feasible for this purpose because they are time-intensive to score. This study explored the potential of using machine learning technologies to score one such assessment-the diagnostic justification essay.MethodFrom May to September 2018, machine scoring algorithms were trained to score a sample of 700 diagnostic justification essays written by 414 third-year medical students from the Southern Illinois University School of Medicine classes of 2012-2017. The algorithms applied semantically based natural language processing metrics (e.g., coherence, readability) to assess essay quality on 4 criteria (differential diagnosis, recognition and use of findings, workup, and thought process); the scores for these criteria were summed to create overall scores. Three sources of validity evidence (response process, internal structure, and association with other variables) were examined.ResultsMachine scores correlated more strongly with faculty ratings than faculty ratings did with each other (machine: .28-.53, faculty: .13-.33) and were less case-specific. Machine scores and faculty ratings were similarly correlated with medical knowledge, clinical cognition, and prior diagnostic justification. Machine scores were more strongly associated with clinical communication than were faculty ratings (.43 vs .31).ConclusionsMachine learning technologies may be useful for assessing medical students' long-form written clinical reasoning. Semantically based machine scoring may capture the communicative aspects of clinical reasoning better than faculty ratings, offering the potential for automated assessment that generalizes to the workplace. These results underscore the potential of machine scoring to capture an aspect of clinical reasoning performance that is difficult to assess with traditional analytic scoring methods. Additional research should investigate machine scoring generalizability and examine its acceptability to trainees and educators.

Dataset Information

Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial.

Publications

Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial.

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