Effects of reflective practice on the accuracy of medical diagnoses.
Med Educ
; 42(5): 468-75, 2008 May.
Article
em En
| MEDLINE
| ID: mdl-18412886
CONTEXT: Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy. METHODS: Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables. RESULTS: A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases. CONCLUSIONS: Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Competência Clínica
/
Diagnóstico
/
Medicina Interna
/
Internato e Residência
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
Revista:
Med Educ
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Holanda
País de publicação:
Reino Unido