The influence of medical students’ self-explanations on diagnostic performance

Abstract

The present study shows the beneficial influence of generating self-explanations when dealing with less familiar clinical contexts. Generating self-explanations without feedback resulted in better diagnostic performance than in the control group at 1 week after the intervention.

Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

“…This goes in line with a renewed conceptualization of the term “script” where students are supposed to go beyond the illness of the patient, but see diagnostic actions as a stereotypic process in which they learn the content of illnesses [25]. Studies investigating the interplay of cognitive actions and knowledge categories with instructional methods such as self-explanation prompts [8, 21, 26, 27] are a promising next step in the endeavour to understand and foster clinical reasoning in medical students.…”

“…Thus far only a few studies take metacognitive knowledge into account. The few available studies take into regard interventional aspects, namely reflective practice [21–23]. There are many ways to assess metacognition.…”

Educational Implications of Expertise Reversal Effects in Learning and Performance of Complex Cognitive and Sensorimotor Skills

“…Although, in general, the literature on explanations indicates that generating explanations is beneficial to learning (for a review, see Lombrozo, 2006), the results presented in this paper suggest that self-explanation might have a detrimental effect on learning if the to-be-acquired knowledge and/or skills need to be integrated with automated prior knowledge. Some preliminary evidence for this suggestion was found in a recent study by Chamberland et al (2011). They studied the influence of self-explanations on medical students' learning of knowledge required to diagnose problems in familiar and less familiar clinical areas.…”

Using theory to interpret how senior clinicians define, learn, and teach clinical reasoning

“…This learning point may also be interpreted as how students can learn to signpost the structure and organisation of their clinical knowledge in their illness scripts. By 'encouraging case-based discussions', senior clinicians may be tacitly helping students learn to use self-explanation (Chamberland et al 2011, Chi et al 1994, identify enabling conditions (Schmidt & Mamede 2015) and practice deliberate reflection (Mamede et al 2012). …”

“…'Self-explanation', 'enabling conditions' and 'deliberate reflection' have been suggested to enhance students' construction of illness scripts. 'Self-explanation' involves a student explaining how a patient's signs and symptoms are related to possible diagnoses (Chamberland et al 2011, Chi et al 1994. 'Enabling conditions' refers to "knowledge of the conditions under which disease manifests" (Schmidt & Mamede 2015 p. 969).…”