Education Research: A Behavioral Intervention to Improve Group-Based Diagnostic Quality and Educational Experience...

"Brain-writing" is a technique in which group members write down ideas individually, before a group discussion, to improve idea generation and individual engagement in group discussions. We assessed the feasibility of studying the impact of brain-writing on diagnostic quality and educational experience among neurology residents in a small case-based learning environment.

We conducted a repeated-measures study, conducted over 6 sessions consisting of groups of 3 to 5 neurology residents from different years of training. During each session, 3 cases were treated as control, "brainstorming," cases, and 3 were intervention, "brain-writing," cases, in which the group wrote down possible diagnoses and tests before engaging in a group discussion. Tests and diagnoses from the brain-writing exercise and group discussion as well as a post case survey on participant experience were recorded through a Qualtrics survey, and video recordings were reviewed to determine speaking order and number of tests and diagnoses verbalized by each member. Feasibility was determined by recruitment and ability to complete the study procedures in a pragmatic fashion that incorporated resident education. The primary outcome was accuracy of diagnoses, and secondary outcomes included number of tests and diagnoses generated, percent of "can't miss diagnoses mentioned," speaking order and psychological reactions of group members.

Twenty-five (9 PGY-2, 8 PGY-3, and 8 PGY-4) of 29 eligible residents participated in the sessions. There was no significant difference in accuracy of diagnosis between the brain-writing and brainstorming cases (mean = 73% vs 72%, p = 0.51). Brainstorming cases listed significantly more tests (mean = 11.9 vs 9.6, p = 0.001) but not more diagnoses (mean = 9.60 vs 9.12, p = 0.07). Junior residents spoke later and verbalized significantly fewer diagnoses and tests than senior residents in both brainstorming and brain-writing groups. There was no statistically significant difference in psychological outcomes of junior and senior residents in each group.

It is feasible to examine the impact of a behavioral-based intervention among medical trainees in a small case-based learning environment. This study, limited by a small sample size, did not find that brain-writing improved decision quality.