Abstract
Educational strategies that promote the development of clinical reasoning in students remain scarce. Generating self-explanations (SE) engages students in active learning and has shown to be an effective technique to improve clinical reasoning in clerks. Example-based learning has been shown to support the development of accurate knowledge representations. The purpose of this study was to investigate the effect of combining student’s SE and observation of peer’s or expert’s SE examples on diagnostic performance. Fifty-three third-year medical students were assigned to a peer SE example, an expert SE example or control (no example) group. All participants solved a set of the same four clinical cases (training cases), 1—after SE, 2—after listening to a peer or expert SE example or after a control task, and 3—1 week later. They solved a new set of four different cases (transfer cases) also 1 week later. For training cases, students improved significantly their diagnostic performance overtime but the main effect of group was not significant suggesting that students’ SE mainly drives the observed effect. On transfer cases, there was no difference between the three groups (p > .05). Educational implications are discussed and further studies on different types of examples and additional strategies to help students actively process examples are proposed.
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References
Ajjawi, R., & Higgs, J. (2008). Learning to reason: A journey of professional socialisation. Advances in Health Sciences Education, 13(2), 133–150.
Bordage, G. (2007). Prototypes and semantic qualifiers: From past to present. Medical Education, 41(12), 1117–1121.
Chamberland, M., Mamede, S., St-Onge, C., Rivard, M., Setrakian, J., Lévesque, A., et al. (2013). Students’ self-explanations while solving unfamiliar cases: the role of biomedical knowledge. Medical Education, 47(11), 1109–1116.
Chamberland, M., St-Onge, C., Setrakian, J., Lanthier, L., Bergeron, L., Bourget, A., et al. (2011). The influence of medical students’ self-explanations on diagnostic performance. Medical Education, 45(7), 688–695.
Charlin, B., Boshuizen, H. P., Custers, E. J., & Feltovich, P. J. (2007). Scripts and clinical reasoning. Medical Education, 41(12), 1178–1184.
Chi, M. T. H. (2000). Self-explaining expository texts: the dual processes of generating inferences and repairing mental models. In R. Glaser (Ed.), Advances in instructional psychology (pp. 161–238). Mahwah, NJ: Lawrence Erlbaum Associates.
Chi, M. T. H., & Bassock, M. (1989). Learning from examples via self-explanations. In L. B. Resnick (Ed.), Knowing, learning, and instruction: essays in honor of robert glaser (pp. 251–282). Hillsdale, NJ: Lawrence Erlbaum Associates.
Dunlosky, J., Rawson, K. A., Marsh, E. J., Nathan, M. J., & Willingham, D. T. (2013). Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14(1), 4–58.
Eva, K. W. (2004). What every teacher needs to know about clinical reasoning. Medical Education, 39(1), 98–106.
Fonseca, B., & Chi, M. T. H. (2011). Instruction based on self-explanation. In R. E. Mayer & P. S. Alexander (Eds.), The handbook of research on learning and instruction (pp. 296–321). NY: Routledge Taylor and Francis Group.
Gruppen, L. D., & Frohna, A. Z. (2002). Clinical reasoning. In G. R. Norman, C. P. M. Van der Vleuten, & D. I. Newble (Eds.), International handbook of research in medical education (pp. 205–230). Dordrecht: Kluwer.
Kassirer, J. P. (2010). Teaching clinical reasoning: case-based and coached. Academic Medicine, 85(7), 1118–1124.
Larsen, D. P., Butler, A. C., & Roediger, H. L., I. I. I. (2013). Comparative effects of test-enhanced learning and self-explanation on long-term retention. Medical Education, 47(7), 674–682.
Mamede, S., van Gog, T., Moura, A. S., de Fabria, R. M. D., Peixoto, J. M., Rikers, R. M. J. P., & Schmidt, H. G. (2012). Reflection as a strategy to foster medical students’ acquisition of diagnostic competence. Medical Education, 46(5), 464–472.
Mayer, R. E. (2010). Applying the science of learning to medical education. Medical Education, 44(6), 543–549.
Mylopoulos, M., & Regehr, G. (2011). Putting the expert together again. Medical Education, 45(9), 920–926.
Norman, G. (2005). Research in clinical reasoning: Past history and current trends. Medical Education, 39(4), 418–427.
Renkl, A. (2011). Instruction based on examples. In R. E. Mayer & P. S. Alexander (Eds.), The handbook of research on learning and instruction (pp. 272–295). New York: Routledge Taylor and Francis Group.
Renkl, A. (2014). Toward an instructionnally oriented theory of example-based learning. Cognitive Science, 38, 1–37.
Rosen, M. A., Salas, E., Pavlas, D., Jensen, R., Fu, D., & Lampton, D. (2010). Demonstration-based training: A review of instructional features. Human Factors, 52(5), 596–609.
Rummel, N., Spada, H., & Hauser, S. (2009). Learning to collaborate while being scripted or by observing a model. International Journal of Computer-supported Collaborative Learning, 4, 69–92.
Schmidt, H. G., & Rikers, R. M. J. P. (2007). How expertise develops in medicine: knowledge encapsulation and illness script formation. Medical Education, 41(12), 1133–1139.
Schworm, S., & Renkl, A. (2007). Learning argumentation skills through the use of prompts for self-explaining examples. Journal of Educational Psychology, 99, 285–296.
van de Wiel, M. W. J., Van den Bossche, P., Janssen, S., & Jossberger, H. (2011). Exploring deliberate practice in medicine: How do physicians learn in the workplace? Advances in Health Sciences Education, 16(1), 81–95.
van Gog, T., & Rummel, N. (2010). Example-based learning: Integrating cognitive and social-cognitive research perspectives. Educational Psychology Review, 22, 155–174.
van Merriënboer, J. J. G., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85–93.
Wong, R. M. F., Lawson, M. J., & Keeves, J. (2002). The effects of self-explanation training on students’ problem-solving in high-school mathematics. Learning and Instruction, 12, 233–262.
Woods, N. N. (2007). Science is fundamental: The role of biomedical knowledge in clinical reasoning. Medical Education, 41(12), 1173–1177.
Woods, N. N., Brooks, L. R., & Norman, G. R. (2007a). It all makes sense: Biomedical knowledge, causal connections and memory in the novice diagnostician. Advances in Health Sciences Education, 12(4), 405–415.
Woods, N. N., Brooks, L. R., & Norman, G. R. (2007b). The role of biomedical knowledge in diagnosis of difficult clinical cases. Advances in Health Sciences Education, 12(4), 417–426.
Acknowledgments
The authors are thankful to the students and clinicians who participated in the study. Funding for this project was received from the Fonds de développement pédagogique 2011, Société des Médecins de l’Université de Sherbrooke (SMUS) and the Société des Médecins de l’Université de Sherbrooke Research Chair in Medical Education held by Christina St-Onge.
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Chamberland, M., Mamede, S., St-Onge, C. et al. Does medical students’ diagnostic performance improve by observing examples of self-explanation provided by peers or experts?. Adv in Health Sci Educ 20, 981–993 (2015). https://doi.org/10.1007/s10459-014-9576-7
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DOI: https://doi.org/10.1007/s10459-014-9576-7