Self-explanation in learning clinical reasoning: the added value of examples and prompts

Abstract

Self-explanation seems to be an effective technique to help medical students learn clinical reasoning. Its impact is increased significantly by combining it with examples of residents' SEs and prompts. Although students' exposure to examples of clinical reasoning is important, their 'active processing' of these examples appears to be critical to their learning from them.

Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

“…This goes in line with a renewed conceptualization of the term “script” where students are supposed to go beyond the illness of the patient, but see diagnostic actions as a stereotypic process in which they learn the content of illnesses [25]. Studies investigating the interplay of cognitive actions and knowledge categories with instructional methods such as self-explanation prompts [8, 21, 26, 27] are a promising next step in the endeavour to understand and foster clinical reasoning in medical students.…”

Medical Students’ Clinical Reasoning During a Simulated Viral Pandemic: Evidence of Cognitive Integration and Insights on Novices’ Approach to Diagnostic Reasoning

“…Analysis of students' hypotheses and treatment recommendations for this simulated viral pandemic activity provided data demonstrating evidence of cognitive integration of both previously encountered learning content from multiple • Identifies similarities between unknown pathogen's cellular/molecular structure and diseases with similar features a 95% (19) • Rationale for recommended treatments linked to diseases in the differential diagnosis for this case 95% (19) • Identifies similarities between patients' physical exam findings and diseases with similar presenting exam findings a 90% (18) • Identifies similarities between patients' geographic location and those of the diseases in the differential diagnosis a 70% (14)…”

“…Tasks applying ethics content % Reports (n) • Rationale for recommended resource allocation explicitly linked to relevant, sound ethical principles 95% (19) a Diagnostic reasoning task codes using a compare-contrast approach b Diagnostic reasoning task codes using a causal approach disciplines and newly acquired learning content. These reports also provided insights into first-year medical students' diagnostic reasoning approach, which consisted primarily of a compare-contrast process between the clinical features of patients in the case scenario versus illness scripts of known diseases, though a subset of students also applied a causal approach to identify candidate diseases.…”

“…Some investigators have found that the use of specific prompts can enhance the effectiveness of learners' selfexplanations on learning [19,34,35]: justification prompts (prompts to justify one's reasoning with underlying principles and concepts) are thought to trigger learners' biomedical knowledge by focusing them on the underlying pathophysiological mechanisms; by contrast, mental model revision prompts (prompts to compare and contrast one's existing knowledge to new knowledge) are thought to help students revise and make corrections to their existing knowledge. Despite the fact that justification prompts were included in the report template and student instruction documents for the simulated pandemic activity, our students' written diagnostic justifications did not include much discussion of pathophysiological mechanisms.…”

“…Previous studies have suggested that novices primarily utilize a pathophysiologic analytical (i.e., causal) approach to diagnostic reasoning and rely less on the compare-contrast analytical approach or on pattern recognition, both of which are thought to develop only after trainees begin building robust illness scripts based on clinical experience [11][12][13][14][15]. However, the novices in published studies examining diagnostic reasoning approaches have been limited to intermediate (third year or fourth year) medical students, resident physicians, or nonmedical health professions students (e.g., massage therapy students, undergraduate kinesiology students, physical therapy students) [5,8,[16][17][18][19][20]; little is known about the diagnostic reasoning approaches of early, preclinical medical students. Published studies involving preclinical medical students consist of intervention studies reporting results of knowledge-based testing or diagnostic accuracy rather than characterization of how these students formulate their differential or working diagnoses [9,[21][22][23][24].…”