The impact of deliberate reflection with WISE-MD™ modules on surgical clerkship students’ critical thinking: a prospective, randomized controlled pilot study

Abstract

Purpose

Critical thinking underlies several Association of American Medical Colleges (AAMC)-defined core entrustable professional activities (EPAs). Critical-thinking ability affects health care quality and safety. Tested tools to teach, assess, improve, and nurture good critical-thinking skills are needed. This prospective randomized controlled pilot study evaluated the addition of deliberate reflection (DR), guidance with Web Initiative in Surgical Education (WISE-MD™) modules, to promote surgical clerks’ critical-thinking ability. The goal was to promote the application of reflective awareness principles to enhance learning outcomes and critical thinking about the module content.

Participants and methods

Surgical clerkship (SC) students were recruited from two different blocks and randomly assigned to a control or intervention group. The intervention group was asked to record responses using a DR guide as they viewed two selected WISE-MD™ modules while the control group was asked to view two modules recording free thought. We hypothesized that the intervention group would show a significantly greater pre- to postintervention increase in critical-thinking ability than students in the control group.

Results

Neither group showed a difference in pre- and posttest free-thought critical-thinking outcomes; however, the intervention group verbalized more thoughtful clinical reasoning during the intervention.

Conclusion

Despite an unsupported hypothesis, this study provides a forum for discussion in medical education. It took a sponsored tool in surgical education (WISE-MD™) and posed the toughest evaluation criteria of an educational intervention; does it affect the way we think? and not just what we learn, but how we learn it? The answer is significant and will require more resources before we arrive at a definitive answer.

Keywords:

• simulation
• clinical reasoning
• medical education strategies

Acknowledgments

This work was partially supported by a $21,963.00 grant from the Institute for Innovative Technology in Medical Education (iInTIME).

The authors wish to acknowledge the SC students who participated in the study and provided important feedback and the valuable assistance and support from Victoria Rossetti, Education and Clinical Services Librarian, Lamar Soutter Library, University of Massachusetts Medical School. This article reports on the second pilot study (surgical clerkship students) that used exactly the same study design as the initial pilot with nurse practitioner students, which was published in the Journal of Nursing Education and Practice.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

JMT served as a voluntary member of the Editorial Board of WISE-MD⁽™⁾ Leadership 2013–2017. The authors report no other conflicts of interest in this work.