The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation

Christopher Snyder; Michael Smith; Kailey Snyder

doi:10.1515/dx-2023-0053

Article

The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation

Christopher Snyder , Michael Smith and Kailey Snyder

Published/Copyright: July 28, 2023

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Diagnosis Volume 10 Issue 4

Abstract

Objectives

Within a Hospital Medicine division at a large academic institution, an innovative program has been developed to offer third year medical learners enrolled in their Internal Medicine Clerkship the opportunity to deepen their diagnostic reasoning skills with a weekly case-based learning activity entitled “Hospital Medicine’s Mystery Case of the Week”. The mystery case curriculum has four primary learning objectives (1): To understand the value of employing a multisystem approach to a common presenting problem (2); To apply a diagnostic schema to a clinical problem (3); To apply knowledge of cost appropriate workups to a clinical case and (4) To identify cognitive biases that can influence decision making in the context of treating a clinical problem.

Methods

A process evaluation of the mystery case curriculum was conducted over a 6-month implementation period. The process evaluation was guided by eight domains of focus: program acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited-efficacy testing. Measures included a pre/post mixed-methods survey, attendance log and timesheet. Pre/post survey data was analyzed via paired samples t-tests and open-ended responses were analyzed via a deductive content analysis.

Results

Process evaluation findings demonstrated the program had high levels of acceptability and demand. Survey findings suggest the curriculum may increase feelings of preparedness for Internal Medicine exams as well as student interest, comfort and confidence related to diagnostic processes.

Conclusions

Future evaluations should work to understand the influence this curriculum has on diagnostic accuracy within a clinical setting.

Keywords: diagnostic reasoning; mystery case; process evaluation

Corresponding author: Christopher Snyder, MD, MBA, Division of Hospital Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha NE 68130, USA, E-mail: Christopher.snyder@unmc.edu

Research ethics: IRB approval is not applicable as this work falls under the domain of University of Nebraska Medical Center IRB policy 5.4: Program evaluation is a systematic collection of information about activities, characteristics and outcomes of a specific program or model to contribute to continue program improvement and/or to inform decisions about future program development. Program assessments do not constitute human subject research under this policy.
Informed consent: Subjects were verbally informed the survey was voluntary.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw survey data can be obtained by reasonable request from the corresponding author.

References

1. Bowen, JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006;355:2217–25. https://doi.org/10.1056/nejmra054782.Search in Google Scholar PubMed

2. Eva, KW. What every teacher needs to know about clinical reasoning. Med Educ 2005;39:98–106. https://doi.org/10.1111/j.1365-2929.2004.01972.x.Search in Google Scholar PubMed

3. Imanieh, MH, Dehghani, SM, Sobhani, AR, Haghighat, M. Evaluation of problem-based learning in medical students’ education. J Adv Med Educ Prof 2014;2:1.Search in Google Scholar

4. Thistlethwaite, JE, Davies, D, Ekeocha, S, Kidd, JM, MacDougall, C, Matthews, P, et al.. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME guide no. 23. Med Teach 2012;34:e421–44. https://doi.org/10.3109/0142159x.2012.680939.Search in Google Scholar PubMed

5. Thomas, PA, Kern, DE, Hughes, MT, Tackett, SA, Chen, BY, editors. Curriculum development for medical education: a six-step approach. Baltimore, Maryland: JHU Press; 2022.Search in Google Scholar

6. Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. In: Balogh, EP, Miller, BT, Ball, JR, editors. Washington (DC): National Academies Press (US); 2015. PMID: 26803862.Search in Google Scholar

7. Rencic, J, Trowbridge, RLJr, Fagan, M, Szauter, K, Durning, S. Clinical reasoning education at US medical schools: results from a national survey of internal medicine clerkship directors. J Gen Intern Med 2017;32:1242–6. https://doi.org/10.1007/s11606-017-4159-y.Search in Google Scholar PubMed PubMed Central

8. Chamberland, M, Mamede, S, St-Onge, C, Setrakian, J, Bergeron, L, Schmidt, H. Self-explanation in learning clinical reasoning: the added value of examples and prompts. Med Educ 2015;49:193–202. https://doi.org/10.1111/medu.12623.Search in Google Scholar PubMed

9. Henderson, D. Games: making learning fun. Annu Rev Nurs Educ 2005;3:165.Search in Google Scholar

10. Ries, NM, Jansen, J. Physicians’ views and experiences of defensive medicine: an international review of empirical research. Health Pol 2021;125:634–42. https://doi.org/10.1016/j.healthpol.2021.02.005.Search in Google Scholar PubMed

11. Saunders, RP, Evans, MH, Joshi, P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract 2005;6:134–47, https://doi.org/10.1177/1524839904273387.Search in Google Scholar PubMed

12. University of Nebraska Medical Center Institutional Review Board Office. University of Nebraska medical center IRB policies and procedures. https://guides.unmc.edu/books/hrpp-policies-and-procedures/page/18-investigational-activities-requiring-irb-review-and-approval [Accessed 8 Jan 2022].Search in Google Scholar

13. Walsh, M. Teaching qualitative analysis using QSR NVivo. Qual Rep 2003;8:251–6.Search in Google Scholar

14. Society to Improve Diagnosis in Medicine. Assessment of reasoning tool. Available from: https://www.improvediagnosis.org/wpcontent/uploads/2018/10/ART_FINAL_for_download.pdf.Search in Google Scholar

15. Kusurkar, R, ten Cate, O. AM last page: education is not filling a bucket, but lighting a fire: self-determination theory and motivation in medical students. Acad Med 2013;88:904. https://doi.org/10.1097/acm.0b013e3182971e06.Search in Google Scholar

Received: 2023-05-01

Accepted: 2023-07-14

Published Online: 2023-07-28

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/dx-2023-0053

Keywords for this article

diagnostic reasoning; mystery case; process evaluation