Teaching clinical reasoning through hypothetico-deduction is (slightly) better than self-explanation in tutorial groups: An experimental study

Abstract

BackgroundSelf-explanation while individually diagnosing clinical cases has proved to be an effective instructional approach for teaching clinical reasoning. The present study compared the effects on diagnostic performance of self-explanation in small groups with the more commonly used hypothetico-deductive approach.MethodsSecond-year students from a six-year medical school in Saudi Arabia (39 males; 49 females) worked in small groups on seven clinical vignettes (four criterion cases representing cardiovascular diseases and three ‘fillers’, i.e. cases of other unrelated diagnoses). The students followed different approaches to work on each case depending on the experimental condition to which they had been randomly assigned. Under the self-explanation condition, students provided a diagnosis and a suitable pathophysiological explanation for the clinical findings whereas in the hypothetico-deduction condition students hypothesized about plausible diagnoses for signs and symptoms that were presented sequentially. One week later, all students diagnosed eight vignettes, four of which represented cardiovascular diseases. A mean diagnostic accuracy score (range: 0–1) was computed for the criterion cases. One-way ANOVA with experimental condition as between-subjects factor was performed on the mean diagnostic accuracy scores.ResultsStudents in the hypothetico-deduction condition outperformed those in the self-explanation condition (mean = 0.22, standard deviation = 0.14, mean = 0.17; standard deviation = 0.12; F(1, 88) = 4.90, p = 0.03, partial η2 = 0.06, respectively).ConclusionsStudents in the hypothetico-deduction condition performed slightly better on a follow-up test involving similar cases, possibly because they were allowed to formulate more than one hypothesis per case during the learning phase.

How cognitive psychology changed the face of medical education research

“…The approach has rarely been investigated. While two studies showed the approach to have no effect on students’ diagnostic accuracy relative to a control group (Windish 2000 ; Windish et al 2005 ), a recent study showed a slight advantage of using serial-cue during a learning session over employing self-explanation (Al Rumayyan et al 2018 ). Its similarity to real practice may explain the widespread use of the serial cue approach, but it has been argued that it may be overwhelming for students who do not have yet developed illness scripts to guide the search for information.…”

Clinical reasoning – an approach for decision-making in education and training for biomedical scientists

“…Systematic reasoning for those first beginning professional practice can lead to a lack of reflection on patterns of reasoning and can mean that reasoning processes are not adapted to specific situations [27]. CR enables a complex understanding of cases and encourages diagnostic performance during education if, along with systematic practice, other perspectives are integrated into specific decision-making processes [12], [13], [19], [28], [29]. Woods describes that for diagnostic decisions which are made with increasing professional experience, the knowledge gained from that experience along with intuition are increasingly drawn upon, while basic knowledge is pushed into the background.…”

“…In Germany, CR in medical education has been more implicitly taught, even though the explicit embedding of CR in the curriculum appears very promising [11], [12], [13]. In the therapeutic occupations, such as physiotherapy and occupational therapy, a more direct grappling with CR has had a long tradition and has been anchored in the curriculum in many ways [7], [14], [15], [16], [17].…”

Developing Clinical Reasoning in Medical Students - A Scoping Review

“…Clinical reasoning (cr) is, perhaps, the most important competence of the physicians' job, or at least a fundamental aspect of medical practice; thus, teaching cr must be in the core of medical curricula (1). Errors in establishing diagnoses or therapeutic plans or prognosis may lead to serious problems for physicians and patients alike, including potentially harmful health care, malpractice lawsuits, or increased health care costs (2,3).…”