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Enhancing Cognitive Reflection in Medical Trainees and Physicians: An EBM-CBL-PBL Integrated Teaching Model.

Xianzhi Chen¹, Lei Xu², Manman Xu²

¹Department of Thyroid and Breast Surgery, The First Hospital of Anhui University of Science & Technology, Huainan, Anhui, 232007, People's Republic of China.

Advances in Medical Education and Practice

|July 15, 2026

Summary

An integrated teaching model improved cognitive reflection in medical trainees, reducing diagnostic errors. Senior female physicians showed the most significant gains, highlighting the model's potential in surgical education.

Keywords:

clinical reasoning cognitive reflection test dual-process theory generalized linear mixed model medical education

Related Experiment Videos

Area of Science:

Medical Education
Cognitive Psychology
Surgical Training

Background:

Diagnostic errors in medicine often stem from insufficient cognitive reflection among trainees and early-career physicians.
Research on enhancing cognitive reflection in complex surgical settings is limited.
This study addresses the need for effective teaching strategies to improve diagnostic reasoning in surgery.

Purpose of the Study:

To evaluate the effectiveness of an integrated Evidence-Based Medicine, Case-Based Learning, and Problem-Based Learning (EBM-CBL-PBL) teaching model.
To assess the impact of this model on cognitive reflection in medical trainees and physicians.
To compare the EBM-CBL-PBL model with traditional teaching methods.

Main Methods:

A two-phase study design was used, assessing cognitive reflection with the Cognitive Reflection Test (CRT).
Trainees were randomized to either traditional teaching or the EBM-CBL-PBL group.
Generalized linear mixed models analyzed associations between demographics, clinical experience, and CRT performance.

Main Results:

The EBM-CBL-PBL group showed a significantly higher rate of reflective responses (61.11%) compared to traditional teaching (44.44%).
Cognitive reflection improved with clinical experience, with senior female physicians exhibiting enhanced analytical thinking.
Teaching satisfaction significantly increased in the EBM-CBL-PBL group.

Conclusions:

The integrated EBM-CBL-PBL teaching model effectively enhances cognitive reflection in surgical trainees.
Cognitive reflection ability progresses with clinical experience, particularly in senior female physicians.
Sustained educational exposure and clinical practice are crucial for solidifying cognitive improvements.