Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information
Article first published online: 28 NOV 2007
Volume 41, Issue 12, pages 1152–1158, December 2007
How to Cite
Eva, K. W., Hatala, R. M., LeBlanc, V. R. and Brooks, L. R. (2007), Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information. Medical Education, 41: 1152–1158. doi: 10.1111/j.1365-2923.2007.02923.x
- Issue published online: 28 NOV 2007
- Article first published online: 28 NOV 2007
- Received 1 May 2007; editorial comments to authors 1 August 2007; accepted for publication 9 September 2007
- *clinical competence;
- education, medical, undergraduate/*methods;
Objective Previous research has revealed a pedagogical benefit of instructing novice diagnosticians to utilise a combined approach to clinical reasoning (familiarity-driven pattern recognition combined with a careful consideration of the presenting features) when diagnosing electrocardiograms (ECGs). This paper reports 2 studies demonstrating that the combined instructions are especially valuable in helping students overcome biasing influences.
Methods Undergraduate psychology students were trained to diagnose 10 cardiac conditions via ECG presentation. Half of all participants were instructed to reason in a combined manner and half were given no explicit instruction regarding the diagnostic task. In Study 1 (n = 60), half of each group was biased towards an incorrect diagnosis through presentation of counter-indicative features. In Study 2 (n = 48), a third of the test ECGs were presented with a correct diagnostic suggestion, a third with an incorrect suggestion, and a third without a suggestion.
Results Overall, the instruction to utilise a combined reasoning approach resulted in greater diagnostic accuracy relative to leaving students to their own intuitions regarding how best to approach new cases. The effect was particularly pronounced when cases were made challenging by biasing participants towards an incorrect diagnosis, either through mention of a specific feature or by making an inaccurate diagnostic suggestion.
Discussion These studies advance a growing body of evidence suggesting that various diagnostic strategies identified in the literature on clinical reasoning are not mutually exclusive and that trainees can benefit from explicit guidance regarding the value of both analytic and non-analytic reasoning tendencies.