The use of 'Precision Teaching' in enhancing medical students’ dermatological diagnostic skills

Abstract

Background Educators have been challenged to provide more effective dermatology teaching methods. Drawing from the discipline of Applied Behaviour Analysis, Precision Training (PT) (e.g. using flashcards during timed learning sessions) can promote fluency i.e. accuracy and speed in a particular skill. We aimed to determine the impact of PT on medical students' dermatology diagnostic skills. Methods A between-groups controlled interventional study was conducted. Third year medical students were allocated to an intervention (PT + traditional teaching) or control (traditional teaching) group. For the PT group, we designed 50 dermatological image flashcards. Flashcard practice (using the Say All Fast Minute Each Day Shuffle method) took place 2-3 times/day and students' data on accuracy recorded over 5 days. Pre / post-training tests were carried out to determine the impact of PT on students' diagnostic skills. Results In total, 70 students (intervention group) / 65 (control group). Analysis of covariance was used to calculate the change score (comparing pre-and post-test). A statistically significant improvement of 8.8% (95% CIs; 4.9-12.7, p<0.001) was detected in the intervention group.

A pragmatic randomised controlled trial of SAFMEDS to produce fluency in interpretation of electrocardiograms

“…A large effect size of the intervention was discerned with an average of only 42.5 min of practice time across the intervention group. Our findings are consistent with other studies in medical education showing the efficacy of fluency-based instructional methods [2,3] and the effects of SAFMEDS observed in other educational domains [2,9,10,21,28]. The positive impact of SAFMEDS may not be entirely surprising given the well-established impact of testenhanced learning in medical education [29] and the dearth of opportunities for practice, or examples, offered by many educational programs [6].…”

“…Behavioural fluency requires both accuracy and pace. There is precedent to using percentage accuracy in evaluations of SAFMEDS using between-groups experimental designs [2,21,22]. The secondary outcome was attainment of behavioural fluency.…”

“…SCCs are widely used to record behaviour and improve performance [26]. The use of the SCC is sometimes presented as a core component of the SAFMEDS intervention [28], but has not been used in other studies of SAFMEDS in medical education [2,22]. Researchers could usefully assess the impact of SAFMEDS with and without the provision of this feedback in order to empirically establish the degree of change which appears attributable to this detailed feedback alone.…”

“…In practice, fluency looks like automaticity in behaviour, correct responding without hesitation, or effortless performance [1]. Behavioural fluency differs from traditional concepts of mastery (commonly used in simulationbased education), as behavioural fluency focuses not only on the accuracy or correctness of performance, but also its pace [2]. Behaviours taught to fluency have been shown to maintain better over time (Retention), to transfer to other contexts (Generalisation) and to endure despite distraction [1,3,4].…”

“…SAFMEDS has been used effectively in a number of educational settings with a variety of different learners and many different target behaviours [9,10]. Among medical students, SAFMEDS has been shown to produce significantly better outcomes in dermatology diagnostic skills than usual teaching only [2].…”