Teaching medical students to apply deliberate reflection

Figures & data

Figure 1. Overview of the study design.

Table 1. Clinical conditions that were presented in the cases, excluding cases of the unrelated filler task.

Learning session	Delayed test session
Both conditions:	pneumonia/ pulmonary embolism (10 d.f.)
irritable bowel syndrome (IBS)	myocardial infarction/ stomach ulcer (10 d.f.)
chronic pancreatitis	migraine/ subarachnoidal haemorrhage (8 d.f.)
irritable bowel disease (IBD)	stomach ulcer/ cholelithiasis (10 d.f.)
Control condition only:	Gout/ cellulite (4 d.f.)
Bell’s palsy	lung carcinoma/ chronic obstructive pulmonary disease (COPD) (10 d.f.)
rosacea
multiple sclerosis

For the cases in the test session, the number of discriminating features (d.f.) that were counted for both diagnoses together, are shown in brackets. Six cases were used for each session. During the learning session, the control condition did an additional filler task where they diagnosed three cases from internal medicine, which were unrelated to the general practice cases and showed patients with acute prostatitis, acute glomerulonephritis and deep vein thrombosis.

Table 2. Means and standard deviations for all outcome measures collected during the test phase.

		Cases without description		Cases described as difficult		All cases
	N	Mean	SD	Mean	SD	Mean	SD
Time to Diagnose
Control	61	104.53	46.85	110.77	37.63	107.65	36.66
Deliberate Reflection	58	112.06	41.63	118.63	42.32	115.34	36.23
Total	119	108.20	44.36	114.60	40.01	111.40	36.50
Proportion of Recalled Discriminating Features for Both Diagnoses
Control	61	.55	.16	.59	.15	.57	.14
Deliberate Reflection	58	.63	.13	.62	.15	.63	.12
Total	119	.59	.15	.61	.15	.60	.14
Proportion of Recalled Discriminating Features for Own Diagnosis
Control	61	.60	.17	.63	.18	.62	.14
Deliberate Reflection	58	.69	.16	.61	.19	.65	.15
Total	119	.64	.17	.62	.18	.63	.15
Proportion of Recalled Discriminating Features for Alternative Diagnosis
Control	61	.50	.23	.55	.19	.53	.18
Deliberate Reflection	58	.58	.16	.63	.20	.60	.14
Total	119	.54	.20	.59	.20	.56	.16
Confidence
Control	61	6.17	1.29	5.35	1.43	5.76	1.20
Deliberate Reflection	58	6.01	1.23	5.43	1.42	5.72	1.20
Total	119	6.09	1.26	5.39	1.42	5.74	1.19
Mental Effort
Control	61	4.49	1.54	5.27	1.54	4.88	1.38
Deliberate Reflection	58	4.52	1.52	5.28	1.49	4.90	1.29
Total	119	4.50	1.52	5.28	1.51	4.89	1.33

Time to diagnose was measured in seconds; all proportions of recalled discriminating features range from 0–1; confidence and mental effort were scored on 9-point-Likert scales ranging from 1 (very, very little confidence/effort) to 9 (very, very much confidence/effort).

Figure 2. Mean proportion of recalled discriminating features for both diagnoses, one’s own diagnosis, and the alternative diagnosis, split up by description of difficulty (none, difficult). error bars show ± 2 standard error.

Data availability statement

The anonymised data set can be requested from the corresponding author.