Abstracts
Abstract
Introduction: Self-explanation (SE), an individual learning strategy for the development of clinical reasoning skills, has been implemented in undergraduate medical curricula. A tool for documenting students’ appropriate use of SE is needed to ensure benefit on learning. The objective of this project was to develop such a tool and report on evidence of its validity.
Methods: We used DeVellis’s eight steps to develop the tool. Assessors applied the tool to 85 audio-recorded SEs. We calculated students’ mean number of inferences (biomedical, clinical, monitoring) and case elements used when self-explaining to document validity evidence of content. We used interrater agreement, with intraclass correlation coefficients, to document validity evidence of response processes.
Results: Three assessors documented the students’ use of SE with the tool. They found means of 13.33 to 17.76 biomedical inferences, 16.27 to 27.04 clinical inferences, 2.03 to 3.10 monitoring statements, and listed 21.77 to 26.87 case elements. Interrater reliability varied from 0.53 to 0.96.
Discussion: We developed the tool using the principles underlying SE. The way students used SE aligned with our expectations. Assessors used the tool in a consistent way. The tool could document students’ use of SE in experimental or educational contexts.
Résumé
Introduction : L'auto-explication (AE), une activité pédagogique favorisant l'acquisition de compétences en raisonnement clinique, a été étudiée et implantée dans des programmes médicaux. Un outil est nécessaire pour évaluer la qualité de l'AE. L'objectif de ce projet était de développer un outil évaluant la qualité de l'AE et de démontrer sa validité.
Méthodes : Nous avons suivi les huit étapes de DeVellis pour élaborer l'outil. Les évaluateurs ont appliqué l'outil à 85 AE enregistrées. Pour la validité du contenu, nous avons calculé le nombre moyen d'inférences (biomédicales, cliniques, de monitoring) et d'éléments du cas utilisés. Pour la validité des processus de réponse, nous avons utilisé l'accord inter-juges.
Résultats : Trois évaluateurs ont mesuré la qualité de l'AE des étudiants. Ils ont trouvé en moyenne 13,33 à 17,76 inférences biomédicales, 16,27 à 27,04 inférences cliniques, 2,03 à 3,10 éléments de monitoring, et 21,77 à 26,87 éléments du cas. La fidélité inter-juges variait de 0,53 à 0,96.
Discussion : L'outil a été développé sur les principes de l'AE. L'AE des étudiants correspond à nos attentes. Les évaluateurs ont utilisé l'outil d'une façon standardisée. L'outil pourrait être utile pour documenter l'engagement des étudiants à faire de l'AE en contexte expérimental ou pédagogique.
Appendices
Bibliography
- Schmidt HG, Mamede S. How to improve the teaching of clinical reasoning: a narrative review and a proposal. Med Educ. 2015;49(10):961‑73. https://doi.org/10.1111/medu.12775.
- Torre D, Chamberland M, Mamede S. Implementation of three knowledge-oriented instructional strategies to teach clinical reasoning: self-explanation, a concept mapping exercise, and deliberate reflection: AMEE Guide No. 150. Med Teach. 2023;45(7):676-84. https://doi.org/10.1080/0142159X.2022.2105200
- Chamberland M, St‐Onge C, Setrakian J, Lanthier L, Bergeron L, Bourget A, et al. The influence of medical students’ self‐explanations on diagnostic performance. Med Educ. 2011;45(7):688‑95. https://doi.org/10.1111/j.1365-2923.2011.03933.x.
- Chamberland M, Mamede S. Self-explanation, an instructional strategy to foster clinical reasoning in medical students. Health Prof Educ. 2015;1(1):24‑33. https://doi.org/10.1016/j.hpe.2015.11.005
- Chebbihi H, Varpio L, St-Onge C, Chamberland M. Self-explanation to support knowledge development for clinical reasoning: perspectives from third year medical clerks. MedEdPublish. 2019;8. https://mededpublish.org/articles/8-225
- Chamberland M, Mamede S, Bergeron L, Varpio L. A layered analysis of self-explanation and structured reflection to support clinical reasoning in medical students. Perspect Med Educ. 2021;10:171‑9. https://doi.org/10.1007/s40037-020-00603-2.
- Cooper N, Bartlett M, Gay S, et al. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Med Teach. 2021;43(2):152‑9. https://doi.org/10.1080/0142159X.2020.1842343.
- Chi MTH. Self-explaining expository texts: the dual processes of generating inferences and repairing mental models. In: Glaser R, éditeur. Advances in Instructional Psychology. Mahaw, NJ: Lawrence Erlbaum Associates, Inc; 2000. p. 161‑238.
- Renkl A, Eitel A. Self-explaning: Learning about principles and their application. In: Dunlosky J, Rawson KA, éditeurs. The Cambridge handbook of cognition and education. Cambridge: Cambridge Cambridge University Press; 2019. p. 528‑49.
- Chamberland M, Mamede S, St‐Onge C, et al. Students’ self-explanations while solving unfamiliar cases: the role of biomedical knowledge. Med Educ. 2013;47(11):1109‑16. https://doi.org/10.1111/medu.12253.
- Kelekar A, Afonso N. Evaluation of the effect of a new clinical reasoning curriculum in a pre-clerkship clinical skills course. Perspect Med Educ. 2020;9(2):123‑7. https://doi.org/10.1007/s40037-020-00566-4.
- Chiu JL, Chi MT. Supporting self-explanation in the classroom. In: Benassi VA, Overson CE, & Hakala CM. Applying science of learning in education: Infusing psychological science into the curriculum. Retrieved from the Society for the Teaching of Psychology web site: http://teachpsych.org/ebooks/asle2014/index.php 2014;91‑103.
- Cianciolo AT, Regehr G. Learning theory and educational intervention: Producing meaningful evidence of impact through layered analysis. Acad Med. 2019;94(6):789‑94. https://doi.org/10.1097/ACM.0000000000002591.
- DeVellis RF. Scale development: Theory and applications. Vol. 26. Los Angeles: Sage publications; 2016.
- Chamberland M, Setrakian J, Bergeron L, Varpio L, St-Onge C, Thomas A. Harnessing a knowledge translation framework to implement an undergraduate medical education intervention: A longitudinal study. Perspect Med Educ. 2022;1‑8. https://doi.org/10.1007/s40037-022-00735-7.
- American Educational Research Association., American Psychological Association., National Council on Measurement in Education., Joint Committee on Standards for Educational and Psychological Testing (U.S.). Standards for educational and psychological testing. Washington, DC: American Educational Research Association; 2014.
- Shankar, S, St-Onge, Christina, Young, Meredith. When I say… response process validity evidence. Med Educ. 2022;56(9):878‑80. https://doi.org/10.1111/medu.14853.
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155‑63. https://doi.org/10.1016/j.jcm.2016.02.012.
- Al Rumayyan A, Ahmed N, Al Subait R, et al. Teaching clinical reasoning through hypothetico-deduction is (slightly) better than self-explanation in tutorial groups: an experimental study. Perspect Med Educ. 2018;7(2):93‑9. https://doi.org/10.1007/s40037-018-0409-x.
- Larsen DP, Butler AC, Roediger Iii HL. Comparative effects of test-enhanced learning and self-explanation on long-term retention. Med Educ. 2013;47(7):674‑82. https://doi.org/10.1111/medu.12141.
- Heitzmann N, Fischer F, Kühne‐Eversmann L, Fischer MR. Enhancing diagnostic competence with self-explanation prompts and adaptable feedback. Med Educ. Oct 2015;49(10):993‑1003. https://doi.org/10.1111/medu.12778.
- Dyer JO, Hudon A, Montpetit-Tourangeau K, Charlin B, Mamede S, Van Gog T. Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge. BMC Med Educ. 2015;15(1):1‑16. https://doi.org/10.1186/s12909-015-0308-3.
- Chamberland M, Setrakian J, St-Onge C, Bergeron L, Mamede S, Schmidt HG. Does providing the correct diagnosis as feedback after self-explanation improve medical students diagnostic performance? BMC Med Educ. 2019;19(1):194. https://doi.org/10.1186/s12909-019-1638-3.
- Chamberland M, Mamede S, St-Onge C, Setrakian J, Schmidt HG. Does medical students’ diagnostic performance improve by observing examples of self-explanation provided by peers or experts? Adv Health Sci Educ. 2015;20(4):981‑93. https://doi.org/10.1007/s10459-014-9576-7.