Document Detail

Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information.
MedLine Citation:
PMID:  18045367     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Previous research has revealed a pedagogical benefit of instructing novice diagnosticians to utilise a combined approach to clinical reasoning (familiarity-driven pattern recognition combined with a careful consideration of the presenting features) when diagnosing electrocardiograms (ECGs). This paper reports 2 studies demonstrating that the combined instructions are especially valuable in helping students overcome biasing influences. METHODS: Undergraduate psychology students were trained to diagnose 10 cardiac conditions via ECG presentation. Half of all participants were instructed to reason in a combined manner and half were given no explicit instruction regarding the diagnostic task. In Study 1 (n = 60), half of each group was biased towards an incorrect diagnosis through presentation of counter-indicative features. In Study 2 (n = 48), a third of the test ECGs were presented with a correct diagnostic suggestion, a third with an incorrect suggestion, and a third without a suggestion. RESULTS: Overall, the instruction to utilise a combined reasoning approach resulted in greater diagnostic accuracy relative to leaving students to their own intuitions regarding how best to approach new cases. The effect was particularly pronounced when cases were made challenging by biasing participants towards an incorrect diagnosis, either through mention of a specific feature or by making an inaccurate diagnostic suggestion. DISCUSSION: These studies advance a growing body of evidence suggesting that various diagnostic strategies identified in the literature on clinical reasoning are not mutually exclusive and that trainees can benefit from explicit guidance regarding the value of both analytic and non-analytic reasoning tendencies.
Kevin W Eva; Rose M Hatala; Vicki R Leblanc; Lee R Brooks
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical education     Volume:  41     ISSN:  0308-0110     ISO Abbreviation:  Med Educ     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-29     Completed Date:  2008-04-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7605655     Medline TA:  Med Educ     Country:  England    
Other Details:
Languages:  eng     Pagination:  1152-8     Citation Subset:  IM    
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Cardiology / education*
Clinical Competence*
Education, Medical, Undergraduate / methods*
Psychology / education*
Teaching / methods*

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