Teaching medical students to apply deliberate reflection

Purpose: Deliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty. Method:One-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (discriminating features). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis). Results:The deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p =.013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p =.004), but on the last three cases (described as difficult), there was no difference. Conclusion:Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases. Practice points Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases, regardless of described difficulty. Students who had not been taught deliberate reflection remembered more discriminating features (i.e. engaged in more reflective reasoning) when they expected cases to be difficult compared to cases that had not been described as difficult. Future studies should investigate whether teaching medical students the deliberate reflection procedure would also lead to improved diagnostic accuracy.</p

Improving medical residents’ self-assessment of their diagnostic accuracy: does feedback help?

When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate diagnostic calibration, diagnostic errors or overtesting can occur. A previous study showed that physicians’ diagnostic calibration for easy cases improved, after they received feedback on their previous diagnoses. We investigated whether diagnostic calibration would also improve from this feedback when cases were more difficult. Sixty-nine general-practice residents were randomly assigned to one of two conditions. In the feedback condition, they diagnosed a case, rated their confidence in their diagnosis, their invested mental effort, and case complexity, and then were shown the correct diagnosis (feedback). This was repeated for 12 cases. Participants in the control condition did the same without receiving feedback. We analysed calibration in terms of (1) absolute accuracy (absolute difference between diagnostic accuracy and confidence), and (2) bias (confidence minus diagnostic calibration). There was no difference between the conditions in the measurements of calibration (absolute accuracy, p =.204; bias, p =.176). Post-hoc analyses showed that on correctly diagnosed cases (on which participants are either accurate or underconfident), calibration in the feedback condition was less accurate than in the control condition, p =.013. This study shows that feedback on diagnostic performance did not improve physicians’ calibration for more difficult cases. One explanation could be that participants were confronted with their mistakes and thereafter lowered their confidence ratings even if cases were diagnosed correctly. This shows how difficult it is to improve diagnostic calibration, which is important to prevent diagnostic errors or maltreatment

Can We Teach Reflective Reasoning in General-Practice Training Through Example-Based Learning and Learning by Doing?

Purpose: Flaws in physicians’ reasoning frequently result in diagnostic errors. The method of deliberate reflection was developed to stimulate physicians to deliberately reflect upon cases, which has shown to improve diagnostic performance in complex cases. In the current randomised controlled trial, we investigated whether deliberate reflection can be taught to general-practice residents. Additionally, we investigated whether engaging in deliberate reflection or studying deliberate-reflection models would be more effective. Methods: The study consisted of one learning session and two test sessions. Forty-four general-practice residents were randomly assigned to one of three study conditions in the learning session: (1) control without reflecting (n = 14); (2) engaging in deliberate reflection (n = 11); or (3) studying deliberate-reflection models (n = 19). To assess learning, they diagnosed new cases in both a same-day test and a delayed test one week later. In the delayed test, participants were additionally asked to elaborate on their decisions. We analysed diagnostic accuracy and whether their reasoning contained key elements of deliberate reflection. Results: We found no significant differences between the study conditions in diagnostic accuracy on the same-day test, p = .649, or on diagnostic accuracy, p = .747, and reflective reasoning, p = .647, on the delayed test. Discussion: Against expectations, deliberate reflection did not increase future reflective reasoning. Future studies are needed to investigate whether residents either did not sufficiently learn the procedure, did not adopt it when diagnosing cases without instructions to reflect, or whether the reflective-reasoning process as itself cannot be taught

Teaching diagnostic reasoning in medical training: investigating interventions to teach deliberate reflection and improve diagnostic calibration

investigating interventions to teach deliberate reflection and improve diagnostic calibratio

Can We Teach Reflective Reasoning in General-Practice Training Through Example-Based Learning and Learning by Doing?

Purpose Flaws in physicians’ reasoning frequently result in diagnostic errors. The method of deliberate reflection was developed to stimulate physicians to deliberately reflect upon cases, which has shown to improve diagnostic performance in complex cases. In the current randomised controlled trial, we investigated whether deliberate reflection can be taught to general-practice residents. Additionally, we investigated whether engaging in deliberate reflection or studying deliberate-reflection models would be more effective. Methods The study consisted of one learning session and two test sessions. Forty-four general-practice residents were randomly assigned to one of three study conditions in the learning session: (1) control without reflecting (n = 14); (2) engaging in deliberate reflection (n = 11); or (3) studying deliberate-reflection models (n = 19). To assess learning, they diagnosed new cases in both a same-day test and a delayed test one week later. In the delayed test, participants were additionally asked to elaborate on their decisions. We analysed diagnostic accuracy and whether their reasoning contained key elements of deliberate reflection. Results We found no significant differences between the study conditions in diagnostic accuracy on the same-day test, p = .649, or on diagnostic accuracy, p = .747, and reflective reasoning, p = .647, on the delayed test. Discussion Against expectations, deliberate reflection did not increase future reflective reasoning. Future studies are needed to investigate whether residents either did not sufficiently learn the procedure, did not adopt it when diagnosing cases without instructions to reflect, or whether the reflective-reasoning process as itself cannot be taught

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

Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through ‘learning-by-teaching’ and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p =.263; time to diagnose, p =.598; mental effort ratings, p =.544; confidence ratings, p =.710; proportion of contradiction units (i.e. measure of deliberate reflection), p =.544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection

Can We Teach Reflective Reasoning in General-Practice Training Through Example-Based Learning and Learning by Doing?

Purpose: Flaws in physicians’ reasoning frequently result in diagnostic errors. The method of deliberate reflection was developed to stimulate physicians to deliberately reflect upon cases, which has shown to improve diagnostic performance in complex cases. In the current randomised controlled trial, we investigated whether deliberate reflection can be taught to general-practice residents. Additionally, we investigated whether engaging in deliberate reflection or studying deliberate-reflection models would be more effective. Methods: The study consisted of one learning session and two test sessions. Forty-four general-practice residents were randomly assigned to one of three study conditions in the learning session: (1) control without reflecting (n ¼ 14); (2) engaging in deliberate reflection (n ¼ 11); or (3) studying deliberate-reflection models (n ¼ 19). To assess learning, they diagnosed new cases in both a same-day test and a delayed test one week later. In the delayed test, participants were additionally asked to elaborate on their decisions. We analysed diagnostic accuracy and whether their reasoning contained key elements of deliberate reflection. Results: We found no significant differences between the study conditions in diagnostic accuracy on the same-day test, p ¼ .649, or on diagnostic accuracy, p ¼ .747, and reflective reasoning, p ¼ .647, on the delayed test. Discussion: Against expectations, deliberate reflection did not increase future reflective reasoning. Future studies are needed to investigate whether residents either did not sufficiently learn the procedure, did not adopt it when diagnosing cases without instructions to reflect, or whether the reflective-reasoning process as itself cannot be taught

The listening cube: a three dimensional auditory training program

Contains fulltext : 109874.pdf (publisher's version ) (Open Access)OBJECTIVES: Here we present the Listening Cube, an auditory training program for children and adults receiving cochlear implants, developed during the clinical practice at the KIDS Royal Institute for the Deaf in Belgium. We provide information on the content of the program as well as guidance as to how to use it. METHODS: The Listening Cube is a three-dimensional auditory training model that takes the following into consideration: the sequence of auditory listening skills to be trained, the variety of materials to be used, and the range of listening environments to be considered. During auditory therapy, it is important to develop training protocols and materials to provide rapid improvement over a relatively short time period. Moreover, effectiveness and the general real-life applicability of these protocols to various users should be determined. RESULTS: Because this publication is not a research article, but comes out of good daily practice, we cannot state the main results of this study. We can only say that this auditory training model is very successful. Since the first report was published in the Dutch language in 2003, more than 200 therapists in Belgium and the Netherlands followed a training course elected to implement the Listening Cube in their daily practice with children and adults with a hearing loss, especially in those wearing cochlear implants. CONCLUSION: The Listening Cube is a tool to aid in planning therapeutic sessions created to meet individual needs, which is often challenging. The three dimensions of the cube are levels of perception, practice material, and practice conditions. These dimensions can serve as a visual reminder of the task analysis and of other considerations that play a role in structuring therapy sessions