Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum

被引:9
|
作者
Choi, Justin J. [1 ,2 ,6 ]
Gribben, Jeanie [2 ]
Lin, Myriam [3 ]
Abramson, Erika L. [4 ,5 ]
Aizer, Juliet [2 ,3 ]
机构
[1] Weill Cornell Med, Div Gen Internal Med, New York, NY 10021 USA
[2] Weill Cornell Med, Dept Med, New York, NY 10021 USA
[3] Hosp Special Surg, Div Rheumatol, New York, NY USA
[4] Weill Cornell Med, Dept Pediat, New York, NY 10021 USA
[5] Weill Cornell Med, Dept Populat Hlth Sci, New York, NY 10021 USA
[6] Weill Cornell Med, Dept Med, Div Gen Internal Med, 420 East 70th St, LH-355, New York, NY 10021 USA
来源
MEDICAL EDUCATION ONLINE | 2023年 / 28卷 / 01期
关键词
Clinical reasoning; cognitive bias; experiential learning; dual process theory; curriculum; QUALITATIVE CONTENT-ANALYSIS; DIAGNOSTIC ERRORS; MALPRACTICE CLAIMS; FORCING STRATEGIES; CONTEXTUAL FACTORS; DELAYED DIAGNOSES; KNOWLEDGE; PERSPECTIVE; EXPERTISE; EDUCATION;
D O I
10.1080/10872981.2022.2153782
中图分类号
G40 [教育学];
学科分类号
040101 ; 120403 ;
摘要
Background Most medical students entering clerkships have limited understanding of clinical reasoning concepts. The value of teaching theories of clinical reasoning and cognitive biases to first-year medical students is unknown. This study aimed to evaluate the value of explicitly teaching clinical reasoning theory and cognitive bias to first-year medical students. Methods Using Kolb's experiential learning model, we introduced dual process theory, script theory, and cognitive biases in teaching clinical reasoning to first-year medical students at an academic medical center in New York City between January and June 2020. Due to the COVID-19 pandemic, instruction was transitioned to a distance learning format in March 2020. The curriculum included a series of written clinical reasoning examinations with facilitated small group discussions. Written self-assessments prompted each student to reflect on the experience, draw conclusions about their clinical reasoning, and plan for future encounters involving clinical reasoning. We evaluated the value of the curriculum using mixed-methods to analyze faculty assessments, student self-assessment questionnaires, and an end-of-curriculum anonymous questionnaire eliciting student feedback. Results Among 318 total examinations of 106 students, 254 (80%) had a complete problem representation, while 199 (63%) of problem representations were considered concise. The most common cognitive biases described by students in their clinical reasoning were anchoring bias, availability bias, and premature closure. Four major themes emerged as valuable outcomes of the CREs as identified by students: (1) synthesis of medical knowledge; (2) enhanced ability to generate differential diagnoses; (3) development of self-efficacy related to clinical reasoning; (4) raised awareness of personal cognitive biases. Conclusions We found that explicitly teaching clinical reasoning theory and cognitive biases using an experiential learning model provides first-year medical students with valuable opportunities for developing knowledge, skills, and self-efficacy related to clinical reasoning.
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页数:12
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