The Effects of an In-classroom Diagnostic Thinking Program on Medical Students: a quasi-experimental study

Document Type : Original Article

Authors

1 Oncology Department of Internal Medicine, Valiasr Hospital, Birjand University of medical science, Birjand, Iran

2 Education Development Center (EDC), Birjand University of Medical Sciences, Birjand, Iran

3 Medical School, Birjand University of Medical Sciences, Birjand, Iran

10.22038/fmej.2024.71441.1538

Abstract

Background: One of the expected competencies of physicians is clinical reasoning. Therefore, diagnostic thinking in medical students is important. The aim of this study was to investigate the effect of diagnostic thinking instructional program on medical students.
Method: The research was quasi-experimental. The target group was medical students who spent their internship in the internal department. The sample size for each group was 20 participants. 20 interns in the three-month rotation of autumn 2018 were considered as control and 20 interns entering the department in the winter rotation of the same year were considered as the intervention group. Students were evaluated using Diagnostic Thinking Questionnaire (DTI). Data analysis was done with descriptive and analytical statistics.
Results: The two groups did not differ in terms of the number of participants, age, grade point average and mean DTI score in the pre-test (P>0.05). The pre-test scores of two groups in the flexibility of thinking (P=0.09), memory structure (P=0.68), and the total score of diagnostic thinking (P=0.4) were not significantly different. The post-test scores of students in the sections of flexibility of thinking, memory structure, and the total score of diagnostic thinking of both groups did not change significantly compared to the pre-test scores (P>0.05). There was a significant relationship between only the two variables of grade point average and memory structure score in the post-test (r=0.46, P=0.004).
Conclusion: The in-class diagnostic thinking instructional program did not affect students' diagnostic thinking in the absence of patients which is probably due to the lack of patient encounters.

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  1. Barrows HS, Feltovich PJ. The clinical reasoning process. Med Educ [Internet]. 1987 Mar 1 [cited 2023 Mar 29];21(2):86–91. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2923.1987.tb00671.x
  2. Young ME, Thomas A, Lubarsky S, Gordon D, Gruppen LD, Rencic J, et al. Mapping clinical reasoning literature across the health professions: a scoping review. BMC Med Educ. 2020; 20(1):107.
  3. Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online. 2011;16(1):5890.
  4. Sandhu H, Carpenter C, Freeman K, Nabors SG, Olson A. Clinical Decisionmaking: Opening the Black Box of Cognitive Reasoning. Ann Emerg Med. 2006;48(6):713–9.
  5. Young M, Thomas A, Gordon D, Gruppen L, Lubarsky S, Rencic J, et al. The terminology of clinical reasoning in health professions education: Implications and considerations. https://doi.org/101080/0142159X20191635686 [Internet]. 2019 Nov 2 [cited 2023 Mar 29];41(11):1277–84. Available from: https://www.tandfonline.com/doi/abs/10.1080/0142159X.2019.1635686
  6. Connor DM, Durning SJ, Rencic JJ. Clinical Reasoning as a Core Competency. Acad Med. 2020; 95(8):1166–71.
  7. Nunes JGP, Amendoeira JJP, DA Cruz D de ALM, Lasater K, Morais SCRV, De Carvalho EC. Clinical judgment and diagnostic reasoning of nursing students in clinical simulation. Rev Bras Enferm [Internet]. 2020 Sep 21 [cited 2023 Oct 25];73(6):e20180878. Available from: https://www.scielo.br/j/reben/a/GX8QPcPmDxK3GCzwppH833d/?lang=en
  8. Bordage G, Grant J, Marsden P. Quantitative assessment of diagnostic ability. Med Educ [Internet]. 1990 Sep 1 [cited 2023 Oct 25];24(5):413–25. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2923.1990.tb02650.x
  9. Hayward RA. Counting Deaths Due to Medical Errors. JAMA [Internet]. 2002 Nov 20 [cited 2023 Mar 29];288(19):2404–2404. Available from: https://jamanetwork.com/journals/jama/fullarticle/1845203
  10. Berner ES, Graber ML. Overconfidence as a Cause of Diagnostic Error in Medicine. Am J Med. 2008;121(5):S2–23.
  11. Graber ML, Wachter RM, Cassel CK. Bringing Diagnosis Into the Quality and Safety Equations. JAMA [Internet]. 2012 Sep 26 [cited 2023 Mar 29];308(12):1211–2. Available from: https://jamanetwork.com/journals/jama/fullarticle/1362034
  12. Thammasitboon S, Cutrer WB. Diagnostic Decision-Making and Strategies to Improve Diagnosis. Curr Probl Pediatr Adolesc Health Care. 2013;43(9):232–41.
  13. Monteiro SM, Norman G. Diagnostic Reasoning: Where We’ve Been, Where We’re Going. https://doi.org/101080/104013342013842911 [Internet]. 2013 Jan [cited 2023 Mar 29];25(SUPPL.1). Available from: https://www.tandfonline.com/doi/abs/10.1080/10401334.2013.842911
  14. Cox M, Irby DM, Bowen JL. Educational Strategies to Promote Clinical Diagnostic Reasoning. https://doi.org/101056/NEJMra054782 [Internet]. 2006 Nov 23 [cited 2023 Mar 29];355(21):2217–25. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra054782
  15. Soltani Arabshahi SK, Monajemi A, Kuhpayehzadeh J, Gholami T, Khajavi M. Evaluation of clinical reasoning of interns and residents of Iran University of Medical Sciences, 2013. RJMS [Internet]. 2015 Jun 1;22(132):18–25. Available from: http://rjms.iums.ac.ir/article-1-3881-en.html. Persian.
  16. Page G, Bordage G, Allen T. Developing key-feature problems and examinations to assess clinical decision-making skills. Acad Med [Internet]. 1995 [cited 2023 Mar 29];70(3):194–201. Available from: https://pubmed.ncbi.nlm.nih.gov/7873006/
  17. Elvén M, Dean E. Factors influencing physical therapists’ clinical reasoning: qualitative systematic review and meta-synthesis. https://doi.org/101080/1083319620171289647 [Internet]. 2017 Mar 4 [cited 2023 Mar 29];22(1–2):60–75. Available from: https://www.tandfonline.com/doi/abs/10.1080/10833196.2017.1289647
  18. Sobocan M, Turk N, Dinevski D, Hojs R, Pecovnik Balon B. Problem-based learning in internal medicine: virtual patients or paper-based problems? Intern Med J [Internet]. 2017 Jan 1 [cited 2023 Oct 25];47(1):99–103. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13304