Interventions to improve diagnostic decision making: A systematic review and meta-analysis on reflective strategies

Consensus statement on the content of clinical reasoning curricula in undergraduate medical education

“…In the UK, patient safety training, with a focus on systems and human factors, is becoming established in undergraduate and postgraduate medical education (General Medical Council 2015), but effective clinical reasoning also requires a focus on cognitive strategies. Guided reflection has been shown to improve diagnostic performance and foster the learning of clinical knowledge (Chamberland et al 2015;Prakash et al 2019) and this process should be facilitated by educators.…”

“…Whether reflection during diagnostic decision making is simply a means of mobilising existing knowledge, or can also be understood within a broad framework of dual process theory (i.e. how we think), is a matter of ongoing debate (Norman et al 2017;Prakash et al 2019;Stanovich 2009).…”

“…Structured or guided reflection has been shown to improve diagnostic performance in medical students (Lambe et al 2016;Prakash et al 2019). The impact is greatest when the case is more complex relative to the learner (Norman et al 2017).…”

“…Strategies that promote effortful recall of information during teaching and learning lead to improvements in diagnostic performance. These include structured reflection (Norman et al 2017;Prakash et al 2019), low stakes quizzing (Green et al 2018;Larsen et al 2009), spaced practice (Kerfoot et al 2007) and contrastive learning (Ark et al 2007). Small changes in instruction and study habits can yield significant benefits in terms of retention and recall of information and higher order thinking (Dobson et al 2018).…”

Approach to making the availability heuristic less available

“…6 In particular, a recent review of 14 studies found that structured guided reflection was often a consistently successful strategy. 7 The effectiveness of guided reflection can be further strengthened if supplemented by deliberative stepwise evaluation of alternative hypotheses and by prompt feedback with contrasting examples (as included in the strategy by Mamede and colleagues). Conversely, earlier reviews Editorial have not found encouraging results from other strategies including generic prompts, debiasing workshops or computer support.…”