Effect of enhanced analytic reasoning on diagnostic accuracy: a randomized controlled study.

BACKGROUND: Diagnostic error can be caused by several types of cognitive bias, which may be reversed by enhancing analytic reasoning. AIMS: To evaluate whether enhancing analytic reasoning can increase diagnostic accuracy in objective structured clinical examination (OSCE) in medical students. METHODS: All fourth-year medical students, randomly assigned to the analytic reasoning or control groups, undertook the OSCE with four cases using standardized patients. The analytic reasoning group was requested to list differential diagnoses and findings compatible or not compatible with each diagnosis prior to providing a diagnosis, while the control group provided a diagnosis without these processes. Mean diagnostic accuracy scores (perfect score, 4.0) from four cases of OSCE were compared between the two groups. RESULTS: One hundred forty-five students were randomly assigned to the analytic reasoning group (n = 65) or the control group (n = 80). The baseline characteristics, including grade point average and the scores from each patient encounter, were comparable between groups. Mean diagnostic accuracy scores were significantly higher in the analytic reasoning group than in the control group (3.40 ± 0.66 versus 3.05 ± 0.98; p = 0.011). CONCLUSION: Enhancement of analytic reasoning may improve diagnostic accuracy in novice doctors.

Experience of Teaching a Class with a Film: Cognitive Changes with Regard to HIV.

PURPOSE: The aim of this study was to describe our experience of a class, using a film that deals with the social issues of human immunodeficiency virus (HIV), and the results of surveys before and after the class. METHODS: One hundred fifty-six second-year medical students were surveyed with self-questionnaires (9-point Likert scale) before, immediately after, and 2 years after a class that viewed a film ('Philadelphia', 1993). The same survey, comprising 4 items, was administered to 81 non-medical students in the same university. RESULTS: In 156 medical students, 153 (98%) answered the questionnaires. Before the class, there was no significant difference between medical and non-medical students with regard to the cognition of social isolation of HIV-infected persons (4.13 vs. 4.43, p=0.307). immediately after the class, medical student' cognition changed significantly in the positive direction on all items, irrespective of age, sex, and course grade. Two years after the class, this positive effect remained significant on 2 items: 'social isolation of HIV-infected persons' and 'casual contact with an HIV-infected person.' CONCLUSION: A film can be used to reinforce medical education in the affective domain.

Correlations of Communication and Interpersonal Skills between Medical Students and Residents.

PURPOSE: Medical students' communication and interpersonal skills can be evaluated by standardized patients in a clinical performance examination (CPX). The purpose of this study is to investigate which communication and interpersonal skills are more closely correlated between medical students and residents. METHODS: This study included 2nd-year residents in 2009 who took the eight-station CPX as 4th-year medical students in 2006. In-patients who were cared for by the residents were asked the seven items related to interpersonal and communication skills. The correlation between the scores of these seven items in the 2006 CPX and the scores in the 2009 patient survey was evaluated. RESULTS: Twenty-six residents, 11 in medical wards and 15 in surgical wards, participated in the study. The medical students' total scores tended to be correlated with the residents' scores (r=0.381, p=0.055). There was significant correlation between the scores for students and residents for 'Explaining more explicably' (r=0.470, p=0.015), and marginally significant correlation (r=0.385, p=0.052) for 'Listening attentively.' There was no significant correlation for the other five items. CONCLUSION: 'Explaining more explicably' and 'Listening attentively', these skills were more closely correlated between medical students and residents. These basic communication skills should be included in graduate or licensing evaluations.