Cultivating Reasoning Through Example-Based Or Self-explanation-based Teaching (CREST)?

Example-Based Teaching (EBT), grounded in Cognitive Load Theory, uses modeling to demonstrate expert diagnostic reasoning. Self-Explanation (SE) requires learners to rationalize clinical findings independently. We hypothesized EBT would be superior to SE for teaching clinical reasoning to novices by optimizing cognitive load.

Twenty-seven second-year medical students without ophthalmology knowledge were randomized to EBT or SE groups. After learning eye fundamentals, participants learned retinal diseases via their assigned method. Clinical reasoning was tested on days 10 and 40 using different case scenarios, graded by a masked assessor. Cognitive load was assessed using a validated questionnaire.

At day 10, the EBT group (n = 15) showed significantly higher clinical reasoning scores (median 54.63 vs. 48.15, p = 0.047) and germane cognitive load (76.17 vs. 71.25, p = 0.016) compared to SE (n = 12). No differences emerged at day 40. The questionnaire demonstrated good validity (CVI > 0.9) and reliability (ω > 0.8).

EBT was more effective than SE for early clinical reasoning acquisition in novices. The higher germane load with EBT suggests better schema formation, supporting its value in foundational medical education. Larger studies are needed to confirm these findings.