Students' self-explanations while solving unfamiliar cases: the role of biomedical knowledge

Area of Science:

• Medical Education
• Cognitive Science
• Clinical Reasoning

Background:

• Effective teaching strategies for clinical reasoning are limited.
• Self-explanation may enhance reasoning, particularly for unfamiliar clinical cases.
• Mechanisms underlying the benefit of self-explanation require further investigation.

Purpose of the Study:

• To explore the types of knowledge medical students utilize during self-explanation when solving familiar versus less familiar clinical cases.
• To investigate how case familiarity influences the self-explanation process in clinical clerks.

Main Methods:

• Analysis of verbal self-explanation protocols from third-year medical students.
• Comparison of protocols from familiar and less familiar clinical cases.
• Segmentation and coding of protocols into categories: paraphrases, biomedical inferences, clinical inferences, monitoring statements, and errors.

Main Results:

• Students generated more self-explanation segments for less familiar cases.
• Increased use of paraphrases and errors were observed in self-explanations.
• A significant interaction indicated more biomedical inferences for less familiar cases.

Conclusions:

• Case unfamiliarity prompts more extensive self-explanation in medical students.
• Less familiar cases activate biomedical knowledge, facilitating connections to clinical knowledge.
• This process supports the development of coherent mental representations of diseases, explaining the benefit of self-explanation for unfamiliar cases.