Article
The role of epistemic activities on diagnostic outcomes in medical students’ learning with two different virtual patient case formats
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Authors
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Pablo Schäffner
- Ludwig-Maximilians-Universität, Institut für Didaktik und Ausbildungsforschung in der Medizin, Deutschland
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Elisbeth Bauer
- Ludwig-Maximilians-Universität, Lehrstuhl für empirische Pädagogik und pädagogische Psychologie, Deutschland
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Claudia Schulz
- TU Darmstadt, Ubiquitous Knowledge Processing, Darmstadt, Deutschland
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Iryna Gurevych
- TU Darmstadt, Ubiquitous Knowledge Processing, Darmstadt, Deutschland
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Martin R. Fischer
- Ludwig-Maximilians-Universität, Institut für Didaktik und Ausbildungsforschung in der Medizin, Deutschland
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Jan Kiesewetter
- Ludwig-Maximilians-Universität, Institut für Didaktik und Ausbildungsforschung in der Medizin, Deutschland
| Published: | September 20, 2019 |
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Outline
Text
Background: Development of medical students’ clinical reasoning is a key task for medical schools. Virtual patients (VPs) have been found to help students learn [1]. During the diagnostic process, students are often asked to reflect upon their reasoning [2]. Thus far, the relationship of these reflections with the diagnostic outcomes has not been investigated. Recently, epistemic activities have been proposed as a way to investigate reasoning processes [3]. In our study we investigated which epistemic activities are crucial for diagnostic outcomes in VPs.
Summary of work: In our study N=142 medical students worked on eight VPs in two VP case formats (whole case N=71 and serial-cue N=71). After entering a final diagnosis they were asked to provide a reflection on their clinical reasoning. In a stepwise multivariate multiple regression, the coded EAs were used to explain variance in diagnostic accuracy (correct/incorrect diagnosis), time-on-task (first information until submission of diagnosis), knowledge gain (difference between pre- and posttest of a key-feature test).
Summary of results: Regression showed that drawing conclusions was significantly related to diagnostic accuracy (p=.02; B=.21; eta2 =.04). Further, regression showed a significant interaction between the serial-cue VP case format and drawing conclusions (p=.016, B=-.03, eta2=.04). For the time-on-task serial-cue VP case format and hypothesis generation interacted significantly (p=.04, B=-69.1, eta2=.03). We found no significant relationships of evidence generation(EG) and evidence evaluation(EE) on diagnostic outcomes.
Discussion and Conclusions: With the current study we found that indeed students’ clinical reasoning processes relate to diagnostic outcomes. Especially, drawing conclusions seems to have an impact on diagnostic accuracy. Yet, the correlation is negative, so the fewer conclusions were drawn, the more often they were associated with the correct diagnoses. Further, other EAs were not related to the diagnostic outcomes. Both these findings might indicate that the structuring of VPs in learning environments can also have an adverse effect on intuitive reasoning [4].
References
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