Artikel
The role of clinical knowledge in clinical reasoning activities: knowledge is not enough to solve the problems
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Autoren
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Ralf Schmidmaier
- Klinikum der Universität München (LMU), Medizinische Klinik und Poliklinik IV, Munich, Germany
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Jan Kiesewetter
- Klinikum der Universität München (LMU), Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Rene Ebersbach
- Klinikum der Universität München (LMU), Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Nike Tsalas
- Klinikum der Universität München (LMU), Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Matthias Holzer
- Klinikum der Universität München (LMU), Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Martin R. Fischer
- Klinikum der Universität München (LMU), Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
| Veröffentlicht: | 12. März 2015 |
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Gliederung
Text
Introduction: Clinical reasoning is a key competence in medicine. There is a lack of knowledge, how non-experts like medical students solve clinical problems. We have previously shown that they have difficulties applying conceptual knowledge to clinical cases [3], that they lack metacognitive awareness [2] and that higher level cognitive actions correlate with diagnostic accuracy [1]. The role of conceptual, strategic, conditional, and metacognitive knowledge for clinical reasoning is unknown.
Methods: Medical students (n=21) were exposed to three different clinical cases and instructed to use the think-aloud method. The recorded 63 sessions were transcribed and coded with regards to the four different types of knowledge (see above). The transcripts were coded using the frequencies and time-coding of the types of knowledge. The relationship between the coded data and accuracy of diagnosis was investigated with inferential statistical methods.
Results: The use of metacognitive knowledge is strongly correlated with application of conceptual and conditional knowledge, but only weakly with strategic knowledge. Furthermore, metacognitive knowledge application leads to longer time on task. However, in contrast to cognitive action levels the use of different dimensions of clinical knowledge was not associated with better diagnostic accuracy.
Discussion: The longer case work and the more intense application of conditional knowledge in individuals with high metacognitive activity may hint towards reduced premature closure as one of the major cognitive causes of errors in medicine. Additionally, for correct case solution the cognitive actions seem to be more important than the clinical knowledge dimensions.
References
- 1.
- Kiesewetter J, Ebersbach R, Görlitz A, Holzer M, Fischer MR, Schmidmaier R. Cognitive problem solving patterns of medical students correlate with success in diagnostic case solutions. PLoS One. 2013;8(8):e71486. DOI: 10.1371/journal.pone.0071486
- 2.
- Schmidmaier R, Ebersbach R, Schiller M, Hege I, Holzer M, Fischer MR. Using electronic flashcards to promote learning in medical students: retesting versus restudying. Med Educ. 2011;45(11):1101-1110. DOI: 10.1111/j.1365-2923.2011.04043.x
- 3.
- Schmidmaier R, Eiber S, Ebersbach R, Schiller M, Hege I, Holzer M, Fischer MR. Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting? BMC Med Educ. 2013;13:28. DOI: 10.1186/1472-6920-13-28
