Diagnostic errors during perceptual learning in dermatology: a prospective cohort study of Finnish undergraduate students

Abstract

Background Perceptual learning modules (PLMs) have been shown to significantly improve learning outcomes in teaching dermatology. Objectives We aimed to investigate the quantity and quality of diagnostic errors during undergraduate PLMs and their potential implications. Methods The study data was acquired during eight successive dermatology courses (2021-2023) from 142 undergraduate medical students. Digital PLMs were held before, during, and at course ends. We investigated the amount and distribution of diagnostic errors, differences between specific skin conditions and classified them based on the type of errors students made. Results Diagnostic errors were not randomly distributed. Some skin conditions were almost always correctly identified, whereas in some diagnoses significant number of errors were made. Errors could be classified in three groups: mostly systematic errors of relevant differential diagnoses (similarity errors), partly systematic errors (mixed errors) and random errors. While significant learning effect during the repeated measures was found in accuracy (p<.001, η²p=.64), confidence (p<.001, η²p=.60) and fluency (p<.001, η²p=.16), the three categories differed in all outcome measures (all p <.001, all η²p>.47). Visual learning was more difficult in the similarity category (all p <.001, all η²p>.12) than in the mixed and random categories. Conclusions Error analysis of PLMs provided relevant information about learning efficacy and progression, systematic errors of tasks, and more difficult to learn conditions. This information can be used in the development of adaptive, individual error-based PLMs to improve learning outcomes, both in dermatology and medical education in general.