Enhancing diagnostic accuracy among nonexperts through use of video cases.

OBJECTIVE: The goal was to determine whether the diagnostic accuracy of nonexperts in selected learning environments would improve with the use of patient video cases (PVCs). METHODS: We designed a stepwise, team-based, learning approach with a (1) text-based patient presentation, (2) first review of a PVC, (3) small-group discussion, (4) second review of a PVC, and (5) large-group discussion and listening to think-aloud modeling by a content expert. Four pediatric neurology PVCs were analyzed by 44 physicians. After each step, the diagnostic accuracy was assessed with a questionnaire with open-ended questions measuring the frequency of relevant diagnoses and clinical diagnostic reasoning processes. RESULTS: The first review of the PVC was followed by a large number of relevant clinical diagnostic reasoning processes. Small-group discussions and listening to a think-aloud procedure with an expert were particularly effective in increasing the diagnostic accuracy of the nonexperts. CONCLUSIONS: The diagnostic accuracy of nonexperts was clearly enhanced by interaction in small-group discussions and subsequent listening to a think-aloud procedure with a content expert. Learning through PVCs in clinical settings thus is improved through the interactive participation of junior and senior clinicians. Such an environment (a "virtual examination room") may be introduced at grand rounds, case conferences, or morning rounds, to stimulate the development of diagnostic accuracy in nonexperts.