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The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters
Structured reflection has been shown to improve the diagnostic competence of undergraduate and postgraduate trainees in a range of experimental settings using written case scenarios. Evidence supporting the use of this strategy during real patient encounters is lacking. This paper reports on a study...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2017
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| _version_ | 1867614303632228352 |
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| access_status_str | Open Access |
| author | Rush, Colin James |
| author2 | Burch, Vanessa |
| author_browse | Burch, Vanessa Rush, Colin James |
| author_facet | Burch, Vanessa Rush, Colin James |
| author_sort | Rush, Colin James |
| collection | Thesis |
| description | Structured reflection has been shown to improve the diagnostic competence of undergraduate and postgraduate trainees in a range of experimental settings using written case scenarios. Evidence supporting the use of this strategy during real patient encounters is lacking. This paper reports on a study conducted to determine the effects of structured reflection on the diagnostic accuracy of postgraduate medical trainees during bedside tutorials using real patient encounters. Method Fifty-five postgraduate trainees in Internal Medicine at the University of Cape Town, South Africa, were prospectively studied during 18 beside tutorials using real patient encounters. Each patient encounter was conducted as a 4-stage diagnostic process and a diagnostic accuracy score (DAS) was calculated for all participants at each stage: • DAS 1: immediately upon arrival at the patient's bedside (visual cues only); • DAS 2: after an oral presentation of the interview and physical examination findings (pre-reflection); • DAS 3: after review of the clinical data using a process of structured reflection (post-reflection); • DAS 4: after discussion of the patient facilitated by the attending physician (facilitated reflection). Memory structure and flexibility in thinking of participants were evaluated using the Diagnostic Thinking Inventory (DTI) and compared to their post-reflection diagnostic accuracy scores. Results A total of 212 diagnostic events were studied. Friedman's test demonstrated a significant difference when comparing the median diagnostic accuracy scores (DAS) of the respective stages of the diagnostic process (χ² (3) = 406.34, p value < 0.001). The Wilcoxon signed-rank test confirmed that there was a significant difference between the immediate DAS (DAS 1) and the pre-reflection DAS (DAS 2) (Z = 8.66, p value < 0.001), the pre-reflection DAS (DAS 2) and the post reflection DAS (DAS 3) (Z = 4.98, p value < 0.001). Linear regression identified a significant relationship between DTI scores and DAS 3 (p value = 0.035), however this explains only a small portion of the variation in the data (r² = 0.093). Conclusion Structured reflection improved the diagnostic accuracy of postgraduate trainees during real patient encounters at the bedside. These data provide support for the suggestion that clinical teachers should consider adding structured reflection to their toolbox of bedside teaching strategies. In addition, DTI scores may help clinical teachers identify trainees struggling with the development of diagnostic expertise. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/22819 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:49:54.327Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/22819 The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters Rush, Colin James Burch, Vanessa Internal Medicine Structured reflection has been shown to improve the diagnostic competence of undergraduate and postgraduate trainees in a range of experimental settings using written case scenarios. Evidence supporting the use of this strategy during real patient encounters is lacking. This paper reports on a study conducted to determine the effects of structured reflection on the diagnostic accuracy of postgraduate medical trainees during bedside tutorials using real patient encounters. Method Fifty-five postgraduate trainees in Internal Medicine at the University of Cape Town, South Africa, were prospectively studied during 18 beside tutorials using real patient encounters. Each patient encounter was conducted as a 4-stage diagnostic process and a diagnostic accuracy score (DAS) was calculated for all participants at each stage: • DAS 1: immediately upon arrival at the patient's bedside (visual cues only); • DAS 2: after an oral presentation of the interview and physical examination findings (pre-reflection); • DAS 3: after review of the clinical data using a process of structured reflection (post-reflection); • DAS 4: after discussion of the patient facilitated by the attending physician (facilitated reflection). Memory structure and flexibility in thinking of participants were evaluated using the Diagnostic Thinking Inventory (DTI) and compared to their post-reflection diagnostic accuracy scores. Results A total of 212 diagnostic events were studied. Friedman's test demonstrated a significant difference when comparing the median diagnostic accuracy scores (DAS) of the respective stages of the diagnostic process (χ² (3) = 406.34, p value < 0.001). The Wilcoxon signed-rank test confirmed that there was a significant difference between the immediate DAS (DAS 1) and the pre-reflection DAS (DAS 2) (Z = 8.66, p value < 0.001), the pre-reflection DAS (DAS 2) and the post reflection DAS (DAS 3) (Z = 4.98, p value < 0.001). Linear regression identified a significant relationship between DTI scores and DAS 3 (p value = 0.035), however this explains only a small portion of the variation in the data (r² = 0.093). Conclusion Structured reflection improved the diagnostic accuracy of postgraduate trainees during real patient encounters at the bedside. These data provide support for the suggestion that clinical teachers should consider adding structured reflection to their toolbox of bedside teaching strategies. In addition, DTI scores may help clinical teachers identify trainees struggling with the development of diagnostic expertise. 2017-01-19T12:23:41Z 2017-01-19T12:23:41Z 2016 Master Thesis Masters MMed http://hdl.handle.net/11427/22819 eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Internal Medicine Rush, Colin James The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| thesis_degree_str | Master's |
| title | The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| title_full | The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| title_fullStr | The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| title_full_unstemmed | The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| title_short | The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| title_sort | effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters |
| topic | Internal Medicine |
| url | http://hdl.handle.net/11427/22819 |
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