Bedeutung von Elaboration und Kontrastierung von Falschantworten für die Entwicklung differentialdiagnostischer und -therapeutischer Entscheidungskompetenz im Medizinstudium

by Milena Maria Berens née Goldmann
Doctoral thesis
Date of Examination:2023-09-13
Date of issue:2023-09-12
Advisor:Prof. Dr. Tobias Raupach
Referee:Prof. Dr. Tobias Raupach
Referee:Prof. Dr. Michael Koziolek
Persistent Address: http://dx.doi.org/10.53846/goediss-10085

 

 

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Abstract

English

One of the main learning objectives during medical studies and training is the acquisition of clinial reasoning skills, enabling accurate diagnostic and therapeutic decision-making in clinical settings. A proven way to improve clinical reasoning skills are educational interventions such as repeated testing with case-based key feature questions during which students actively suggest the most appropriate next step (‘key feature’) in the management of a virtual patient. Previous studies revealed that such interventions could significantly improve medical students' learning outcomes, although the overall effect was still unsatisfactory. Theory suggests that students’ elaboration on learning content and cognitive errors deepens their understanding and retention of the content. Previous research also showed that the increased complexity of prompting students with errors could be compensated with elaborated feedback. To further enhance learning outcomes, we designed, conducted, analysed and interpreted an experimental field trial to assess the effects of additional elaboration and feedback specifically focusing on common misconceptions. The prospective randomised controlled cross-over study was conducted with 108 fourth-year undergraduate medical students starting winter term 2016/2017 at University Medical Center Göttingen (UMG) with a 4-month follow-up. In parallel to attending formal teaching in general medicine, the students completed 10 weekly digital case-based key-feature examinations assessing clinical reasoning. Some of the key-feature questions were followed by a written elaboration task: a prompt to contrast the correct answer with common errors in the clinical management of this case, which was then followed by a thorough feedback text (´intervention items´). 30 intervention items were distributed to two study groups, each of whom received half of the intervention items and served as control for the other half. The learning outcomes were assessed at the end of term and four months later. The end of term examination revealed a significantly better performance in intervention items than in control items. Four months later, there was no longer a significant effect. A linear regression model suggested that students underperforming in general medicine benefitted more from the intervention items. This study showed that elaboration elements can further enhance the short-term clinical reasoning outcomes of repeated testing with case-based key feature questions. Further studies should examine ways to improve long-term retention to further sustain the effect.
Keywords: Clinical Reasoning; Key-Feature; Medical Education; Undergraduate; Elaboration; Errors
Schlagwörter: Medizinstudium; Key-Feature-Prüfungen; Klinisches Denken; Elaboration; Falschantworten; Medizindidaktik
 
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