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Learning deliberate reflection in medical diagnosis: does learning-by-teaching help?

Josepha Kuhn1,2, Silvia Mamede3, Pieter van den Berg4

  • 1Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands. j.kuhn@erasmusmc.nl.

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Summary

Learning to teach deliberate reflection did not improve diagnostic reasoning in general practice residents. Future studies should explore why this learning-by-teaching method failed to enhance diagnostic accuracy or reflective reasoning.

Keywords:
Critical thinkingDiagnostic errorGeneral practiceInstructional designReflective reasoning

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Area of Science:

  • Medical Education
  • Cognitive Psychology
  • Diagnostic Reasoning

Background:

  • Deliberate reflection enhances diagnostic accuracy in complex medical cases and mitigates cognitive bias.
  • The learnability and autonomous application of deliberate reflection in future diagnostic tasks remain under-investigated.

Purpose of the Study:

  • To determine if general practice residents can learn the deliberate reflection procedure via 'learning-by-teaching'.
  • To assess if residents autonomously apply the learned procedure in subsequent case diagnoses.

Main Methods:

  • A two-phase experiment involving 56 general practice residents.
  • Learning phase: participants either taught deliberate reflection to a fictitious peer or solved cases without reflection (control).
  • Test phase: all participants diagnosed new cases while thinking aloud, with outcomes measured for diagnostic accuracy, time, mental effort, confidence, and reflective reasoning.

Main Results:

  • No significant differences were observed between the teaching and control groups across all outcome measures.
  • Diagnostic accuracy (p=.263), time to diagnose (p=.598), mental effort (p=.544), confidence (p=.710), and reflective reasoning (p=.544) showed no improvement in the teaching group.
  • The 'learning-by-teaching' approach did not enhance reflective reasoning in future diagnostic tasks.

Conclusions:

  • Teaching deliberate reflection to a fictitious peer did not lead to its autonomous application or improved diagnostic reasoning in general practice residents.
  • Potential reasons for the lack of effect include non-application of the procedure by the experimental group or inherent reflection in the control group.
  • Further research is needed to understand the limitations of 'learning-by-teaching' for procedural skills in medical diagnostics.