Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
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Harisa Spahic
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Dana Goplerud
Abstract
Objectives
Clinical reasoning with generation and prioritization of differential diagnoses (DDx) is a key skill for medical students, but no consensus exists on the best method to teach these skills. Meta-memory techniques (MMTs) may be useful, but the efficacy of individual MMTs is unclear.
Methods
We designed a 3-part curriculum for pediatric clerkship students to teach one of 3 MMTs and provide practice in DDx generation through case-based sessions. Students submitted DDx lists during two sessions and completed pre- and post-curriculum surveys assessing self-reported confidence and perceived helpfulness of the curriculum. Results were analyzed using ANOVA with multiple linear regression.
Results
A total of 130 students participated in the curriculum, with 96 % (125/130) completing at least one DDx session, and 44 % (57/130) completing the post-curriculum survey. On average, 66 % of students rated all three sessions as “quite helpful” (4/5 on 5-point Likert scale) or “extremely helpful” (5/5) without difference between MMT groups. Students generated an average of 8.8, 7.1 and 6.4 diagnoses using the VINDICATES, Mental CT, and Constellations methods, respectively. When controlling for case, case order, and number of prior rotations, students using VINDICATES produced 2.8 more diagnoses than those using Constellations (95 % CI [1.1,4.5], p<0.001). There was no significant difference between VINDICATES and Mental CT (Δ=1.6, 95 % CI [−0.2,3.4], p=0.11) or Mental CT and Constellations (Δ=1.2, 95 % CI [−0.7,3.1], p=0.36).
Conclusions
Medical education should include curricula focused on enhancing DDx development. Although VINDICATES helped students produce the most DDx, further research is needed to identify which MMT generates more accurate DDx.
Acknowledgments
The authors wish to acknowledge the Osler Apprentice Program for allowing the generation and execution of this curriculum during the full academic year. The authors also acknowledge the use of Microsoft technology in generating the figures developed for this research.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/dx-2023-0038).
© 2023 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Cognitive biases in internal medicine: a scoping review
- Opinion Papers
- “Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template
- Developing a European longitudinal and interprofessional curriculum for clinical reasoning
- Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
- Reframing context specificity in team diagnosis using the theory of distributed cognition
- Original Articles
- Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
- Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations
- Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment
- Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care
- Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay
- Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood
- Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis
- Short Communications
- Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes
- Development of a student-created internal medicine frameworks website for healthcare trainees
- Case Report - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain
- Letters to the Editor
- Ample room for cognitive bias in diagnosing accidental hypothermia
- Auscultation order of lung and heart sounds and autonomous noise cancellation
- Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection
Artikel in diesem Heft
- Frontmatter
- Review
- Cognitive biases in internal medicine: a scoping review
- Opinion Papers
- “Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template
- Developing a European longitudinal and interprofessional curriculum for clinical reasoning
- Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
- Reframing context specificity in team diagnosis using the theory of distributed cognition
- Original Articles
- Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
- Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations
- Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment
- Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care
- Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay
- Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood
- Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis
- Short Communications
- Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes
- Development of a student-created internal medicine frameworks website for healthcare trainees
- Case Report - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain
- Letters to the Editor
- Ample room for cognitive bias in diagnosing accidental hypothermia
- Auscultation order of lung and heart sounds and autonomous noise cancellation
- Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection
