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How can students’ diagnostic competence benefit most from practice with clinical cases? The effects of a structured reflection on future diagnosis of the same and novel diseases.

Authors: Silvia Mamede, MD, PhD, Tamara van Gog, PhD, Alexandre Sampaio Moura, MD, PhD, Rosa Malena Delbone de Faria, MD, PhD, José Maria Peixoto, MD, MSc, and 
Henk G. Schmidt, PhD

Acad Med 2014; 89:121-7.

Mamede and collaborators investigated the effects of reflection on cases compared with generating a single (immediate decision) or differential diagnosis. The authors hypothesized that to develop diagnostic competence, students should practice with many examples of clinical problems to build rich mental representations of diseases; however, it remains unknown how to enhance learning from practice. In this study 110 fourth-year medical students diagnosed four cases of two criterion diseases under three different experimental conditions: structured reflection, single-diagnosis, or differential diagnosis. One week later, they diagnosed two novel exemplars of each criterion disease and four cases of new diseases, which were plausible alternative diagnoses. Results showed that diagnostic performance did not differ among the groups in the learning phase; however, one week later, the reflection group obtained higher diagnostic accuracy scores than the other groups when diagnosing new exemplars of criterion diseases and cases of new diseases. The authors conclude that structured reflection while practicing with cases enhanced learning of diagnosis both of the diseases practiced and of their alternative diagnoses, suggesting that reflection not only could enrich mental representations of diseases practiced but also could influence the representations of adjacent but different diseases.

You can access this study by clicking here.

* I have no financial interest to disclose (GP).

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