gms | German Medical Science

Introduction: Understanding diagnostic competence and how it can be fostered is a major challenge in medical education research. Although different strategies to improve diagnostic accuracy have been investigated, little is known about students' diagnostic efficiency operationalized as correct diagnoses per time. Following the theoretical bases, scaffolds for case representation could be a promising approach to make the diagnostic process of intermediate medical students more efficient.

Objectives: The aims of this study were to measure the effects of case representation scaffolding on the diagnostic efficiency and to investigate the diagnostic processes of medical students in an electronically based learning environment.

Material & methods: Clinical case processing of 88 4^th and 5^th year medical students was analyzed in a randomized, controlled laboratory study. Cases with medical encounter dyspnea were provided in an electronic learning environment (CASUS). All cases differed in diagnosis and pathophysiology. Students could freely choose the time, amount and sequence of clinical information. Diagnostic efficiency was operationalized as the number of correct diagnoses divided by the time needed for diagnosing.

Results: During processing of the assessment cases efficiency was significantly improved by the representation scaffolding (M=20.8 minutes (SD=7.15) vs. M=24.6 (SD=7.42), p=.01) with an intermediate effect size of Cohens d=0.5. The diagnostic accuracy, however, did not differ between both groups. CASUS enabled analysis of the diagnostic process of the participants which differed between the groups regarding the sequence of clinical information and the time spent on different diagnostics.

Conclusion: For the first time, diagnostic efficiency as part of the diagnostic process of medical students has been studied economically and standardized by an electronic learning environment (CASUS). This provides the opportunity of further research in the area of the diagnostic process. Furthermore, intervention by scaffolding for case representations significantly improved diagnostic efficiency of 4^th and 5^th year medical students. Further studies should face the effects of representation scaffolding on experts' diagnostic efficiency.