Learning deliberate reflection in medical diagnosis: does learning-by-teaching help?

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 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.

Teaching medical students to apply deliberate reflection

“…Furthermore, it would be interesting in future research to test whether this intervention and measurement approach is only effective when used with students or also with more experienced residents and physicians, with whom we did not find an effect in previous studies (Kuhn et al. 2020 , 2021 ).…”

“…Kuhn et al. 2021 ), and more importantly, that they did in fact seem to apply it autonomously (without being triggered by a description of case difficulty) when diagnosing new cases five to nine days later.…”

“…In a recent study with residents in general-practice training (Kuhn et al. 2021 ), we started to investigate whether learning deliberate reflection via a learning-by-teaching approach, would affect future diagnostic reasoning. In that study, participants who practised with deliberate reflection first studied examples that showed how the procedure was used (i.e.…”

Perspectiva das neurociências para otimizar a aprendizagem e o método de aprendizagem Feynman

“…Como já mencionado, a aplicação isolada de algumas dessas técnicas tem eficácia limitada. Nesse sentido, Kuhn et al (2023) É interessante também ressaltar que a MAF pode ser igualmente útil a aspectos cognitivos, que envolvem as memórias explícitas, quanto os aspectos psicomotores, relacionados a memórias implícitas. Dado que a segunda etapa do processo, que envolve transmissão de conhecimento, pode adaptado para contextos práticos e ensino de habilidades, a técnica tem potencial para se mostrar igualmente eficaz para ambos os sistemas de memória.…”