ส่งบทคัดย่อภาษาอังกฤษ เรื่องที่ 5
Fostering novice
students' diagnostic ability: the value of guiding deliberate reflection.
Abstract
BACKGROUND:
Deliberate
reflection when practising the diagnosis of clinical cases has been shown to
develop medical students' diagnostic competence. Adding guidance by cueing
reflection or providing modelling of reflection increased the benefits of
reflection for advanced (Years 5-6) students. The present study investigated
whether we could replicate and extend these findings by comparing the effects
of free, cued and modelled reflection on novice students' diagnostic
competence.
METHODS:
A
total of 80 third-year medical students participated in a two-phase experiment.
In the learning phase, students diagnosed nine clinical cases under one of
three conditions: free reflection; cued reflection, and modelled reflection.
Two weeks later, all students diagnosed four new examples of the diseases
studied in the learning phase and four cases of non-studied related diseases
('adjacent diseases'). The main outcome measurements were diagnostic accuracy
scores (range 0-1) on studied and adjacent diseases.
RESULTS:
For
studied diseases, there was a significant effect of experimental condition on
diagnostic accuracy (p < 0.02), with the cued-reflection group (mean = 0.58,
standard deviation [SD] = 0.23) performing significantly better than the
free-reflection group (mean = 0.41, SD = 0.20; p < 0.02). The
cued-reflection and modelled-reflection groups (mean = 0.54, SD = 0.22) did not
differ in diagnostic accuracy (p > 0.05), nor did the modelled-reflection
group perform better than the free-reflection group (p > 0.05). For adjacent
diseases, the three groups scored extremely low, without significant
differences in performance (p > 0.05). Cued reflection and free reflection
were rated as requiring similar effort (p > 0.05) and both were more
demanding than studying examples of reflection (both p < 0.001) in the
learning phase.
CONCLUSIONS:
Simply
cueing novice students' reflection to focus it on relevant diseases was
sufficient to increase diagnostic performance relative to reflection without
any guidance. Cued reflection and studying examples of reflection appear to be
equally useful approaches for teaching clinical diagnosis to novice students.
Students found studying examples of reflection required less effort but cued
reflection will certainly demand much less investment from teachers.
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