Document Detail

The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents.
MedLine Citation:
PMID:  17237966     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. METHODS: Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. RESULTS: Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. CONCLUSIONS: Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.
Laura Heemskerk; Geoff Norman; Sophia Chou; Marcy Mintz; Henry Mandin; Kevin McLaughlin
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2007-01-20
Journal Detail:
Title:  Advances in health sciences education : theory and practice     Volume:  13     ISSN:  1573-1677     ISO Abbreviation:  Adv Health Sci Educ Theory Pract     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9612021     Medline TA:  Adv Health Sci Educ Theory Pract     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  453-62     Citation Subset:  IM    
Department of Medicine, Foothills Hospital, University of Calgary, Calgary, AB, Canada.
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MeSH Terms
Cross-Sectional Studies
Education, Medical, Graduate / methods*
Educational Measurement
Internal Medicine / education*
Internship and Residency*
Logistic Models
Problem Solving*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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