Teaching medical students to apply deliberate reflection

PurposeDeliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty.MethodOne-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (discriminating features). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis).ResultsThe deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p = .013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p = .004), but on the last three cases (described as difficult), there was no difference.ConclusionLearning deliberate reflection helped students engage in more reflective reasoning when solving future cases.Practice pointsLearning deliberate reflection helped students engage in more reflective reasoning when solving future cases, regardless of described difficulty.Students who had not been taught deliberate reflection remembered more discriminating features (i.e. engaged in more reflective reasoning) when they expected cases to be difficult compared to cases that had not been described as difficult.Future studies should investigate whether teaching medical students the deliberate reflection procedure would also lead to improved diagnostic accuracy.