Résumés
Abstract
Background: While educators observe gaps in clerkship students’ clinical reasoning (CR) skills, students report few opportunities to develop them. This study aims at exploring how students who used self-explanation (SE) and structured reflection (SR) for CR learning during preclinical training, applied these learning strategies during clerkship.
Methods: We conducted an explanatory sequential mixed-methods study involving medical students. With a questionnaire, we asked students how frequently they adopted behaviours related to SE and SR during clerkship. Next, we conducted a focus group with students to explore why they adopted these behaviours.
Results: Fifty-two of 198 students answered the questionnaire and five participated in a focus group. Specific behaviours adopted varied from 50% to 98%. We identified three themes about why students used these strategies: as “just in time” learning strategies; to deepen their understanding and identify gaps in knowledge; to develop a practical approach to diagnosis. A fourth theme related to the balance between learning and assessment and its consequence on adopting SE behaviours.
Conclusions: Students having experienced SE and SR regularly in preclinical training tend to transpose these strategies into the clerkship providing them with a practical way to reflect deliberately and capture learning opportunities of the unpredictable clinical context.
Résumé
Contexte : Alors que les éducateurs observent des lacunes dans les compétences de raisonnement clinique (RC) des étudiants en externat, ces derniers font état de peu d'occasions de les développer. Cette étude vise à explorer comment les étudiants qui ont utilisé l'auto-explication (SE) et la réflexion structurée (SR) pour l'apprentissage du raisonnement clinique pendant la formation préclinique, ont appliqué ces stratégies d'apprentissage pendant l'externat.
Méthodes : Nous avons mené une étude séquentielle explicative à méthodes mixtes auprès d'étudiants en médecine. À l'aide d'un questionnaire, nous avons demandé aux étudiants à quelle fréquence ils adoptaient des comportements liés à la SE et à la RS pendant l'externat. Ensuite, nous avons organisé un groupe de discussion avec les étudiants afin d'explorer les raisons pour lesquelles ils ont adopté ces comportements.
Résultats : Cinquante-deux étudiants sur 198 ont répondu au questionnaire et cinq ont participé à un groupe de discussion. Les comportements spécifiques adoptés variaient de 50 % à 98 %. Nous avons identifié trois thèmes concernant les raisons pour lesquelles les étudiants ont utilisé ces stratégies : comme stratégies d'apprentissage "juste à temps" ; pour approfondir leur compréhension et identifier les lacunes dans les connaissances ; pour développer une approche pratique du diagnostic. Un quatrième thème concernait l'équilibre entre l'apprentissage et l'évaluation et ses conséquences sur l'adoption de comportements SE.
Conclusions : Les étudiants qui ont fait l'expérience de l'ES et de la RS régulièrement au cours de leur formation préclinique ont tendance à transposer ces stratégies dans l'externat, ce qui leur fournit un moyen pratique de réfléchir délibérément et de saisir les opportunités d'apprentissage dans un contexte clinique imprévisible.
Parties annexes
Bibliography
- Williams R, Klamen D, Hoffman R. Medical student acquisition of clinical working knowledge. Teach Learn Med. 2008;20(1):5–10. https://doi.org/10.1080/10401330701542552
- Williams RG, Klamen DL, White CB, et al. Tracking development of clinical reasoning ability across five medical schools using a progress test. Acad Med. 2011 Sep;86(9):1148–54. https://doi.org/10.1097/ACM.0b013e31822631b3
- Williams RG, Klamen DL. Examining the diagnostic justification abilities of fourth-year medical students. Acad Med. 2012;87(8):1008–14. https://doi.org/10.1097/ACM.0b013e31825cfcff
- Williams RG, Klamen DL, Markwell SJ, Cianciolo AT, Colliver JA, Verhulst SJ. Variations in senior medical student diagnostic justification ability. Acad Med. 2014 May;89(5):790. https://doi.org/10.1097/ACM.0000000000000215
- Klamen DL. Getting real: embracing the conditions of the third-year clerkship and reimagining the curriculum to enable deliberate practice. Acad Med. 2015;90(10):1314–7. https://doi.org/10.1097/ACM.0000000000000733.
- Han H, Roberts NK, Korte R. Learning in the real place : Medical students ’ learning and socialization in clerkships at one medical school. Acad Med. 2015;90(2):231–9. https://doi.org/10.1097/ACM.0000000000000544
- Yardley S, Teunissen PW, Dornan T. Experiential learning: transforming theory into practice. Med Teach. 2012;34(2):161–4. https://doi.org/10.3109/0142159X.2012.643264
- Chamberland M, St‐Onge C, Setrakian J, et al. The influence of medical students’ self‐explanations on diagnostic performance. Med Educ. 2011 Jul 1;45(7):688–95. https://doi.org/10.1111/j.1365-2923.2011.03933.x
- Mamede S, Gog T van, Moura AS, et al. Reflection as a strategy to foster medical students’ acquisition of diagnostic competence. Med Educ. 2012 May 1;46(5):464–72. https://doi.org/10.1111/j.1365-2923.2012.04217.x
- Mamede S, van Gog T, Sampaio AM, de Faria RMD, Maria JP, Schmidt HG. How can students’ diagnostic competence benefit most from practice with clinical cases? The effects of structured reflection on future diagnosis of the same and novel diseases. Acad Med. 2014;89(1):121. https://doi.org/10.1097/ACM.0000000000000076
- Chi MTH. Self-explaining expository texts: The dual processes of generating inferences and repairing mental models. In: Glaser R, editor. Advances in Instructional Psychology. Mahaw, NJ: Lawrence Erlbaum Associates, Inc; 2000. p. 161–238.
- 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
- Renkl A, Eitel A. Self-explaning: Learning about principles and their application. In: Dunlosky J, Rawson KA, editors. The Cambridge handbook of cognition and education. Cambridge: Cambridge Cambridge University Press; 2019. p. 528–49.
- 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
- 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;11(6):333-340. https://doi.org/10.1007/s40037-022-00735-7
- Creswell JW, Clark VLP. Core mixed methods designs. In: Designing and conducting mixed methods research. Los Angeles: Sage publications; 2017. p. 51-99
- Osborne F, Paes P, Ellis J, Rothwell C. Twelve tips for conducting medical education research via videoconference. Med Teach. 2023;45(2):145-151. https://doi.org/10.1080/0142159X.2022.2053087.
- DeVellis RF. Guidelines in scale development. Scale development: theory and applications. Los Angeles: Sage publications; 1991.
- Braun V, Clarke V. Thematic analysis. In: APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. Washington, DC, US: American Psychological Association; 2012. p. 57–71.
- Chi MT, Wylie R. The ICAP framework: Linking cognitive engagement to active learning outcomes. Educ Psych. 2014;49(4):219–43. https://doi.org/10.1080/00461520.2014.965823
- 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 in Health Sci Educ. 2015;20(4):981–93. https://doi.org/10.1007/s10459-014-9576-7
- Mamede S, Schmidt HG. The structure of reflective practice in medicine. Med Educ. 2004;38(12):1302–8. https://doi.org/10.1111/j.1365-2929.2004.01917.x