Intuitive concepts in internal medicine and their occurrence in undergraduate medical students in different semesters

Background: Dealing with errors in medical practice is of great importance for patient safety. In the natural sciences, intuitive concepts, so-called misconceptions, are increasingly coming into focus of teaching because they lead to a faulty understanding of contexts and thus to faulty scientific reasoning. In medicine, intuitive concepts still play a subordinate role. However, once intuitive concepts have been memorized, they can become firmly established and, under certain circumstances, lead to diagnostic and treatment errors in medical practice. The aim of this study was to identify potential intuitive concepts in internal medicine and to analyze their occurrence in medical students from different semesters. Methods: Eight internists from different subspecialties were asked about intuitive concepts by means of a structured interview. A total of 17 intuitive concepts were identified. Using these concepts, a multiple-choice test was created with 17 patient cases. For each case, there were four possible answers: the correct answer, an incorrect answer that included the intuitive concept, the answer "both are incorrect", and the answer "I am not sure", which is to be understood in the sense of "I do not know whether one of the three answers is correct". As an online multiple-choice test, these 17 cases were made available to all 2^nd, 6^th, and 12^th semester students (N=1170, n=418 from the 2nd semester, n=425 from the 6^th semester, and n=327 from the 12^th semester, i.e., the final year) for four weeks in June 2015. The test had to be answered within nine minutes. A mixed logistic regression model was used for evaluation. Results: Of the N=317 participating students (n=97 from the 2^nd semester, n=124 from the 6^th semester, and n=96 from the internship year, overall response rate 27.1%), on average, students from all three groups chose the intuitive concept most often, approximately 40%, although the correct answer increased toward the final year with simultaneously decreasing uncertainty and decreasing feeling of not knowing, respectively. In the final year, compared to the 2^nd semester, the intuitive concept was selected significantly more often for two questions (p<0.01). For four questions, the intuitive concept was selected significantly less frequently in the final year (p<0.01). Conclusion: Intuitive concepts can be identified in internal medicine and do not appear to be significantly reduced in students during the course of their studies. This suggests that this could also be the case for other medical subjects. Therefore, similar studies should be conducted for other medical subjects in order to identify potential sources of error in clinical work. In addition, suitable didactic methods should be developed and tested with which students learn not to succumb to intuitive concepts as far as possible in order to prevent diagnostic or therapeutic errors in later medical practice.