gms | German Medical Science

Background and research question: In the context of fostering diagnostic competence, previous research has yielded evidence for the effectiveness of reflection phases mainly in problem-centered instruction using text based cases. Evidence on the benefit of reflection phases and participatory role in simulation learning remains insufficient [1], [2]. Our study examines the effect of reflection phases and its association with participatory role (physician, patient and observer) on diagnostic competence gain in a cooperative live simulation with role play and their association with prior knowledge. To that end we employed a pre-post experimental design using a 3x3 between subject variation of reflection condition and participatory role in the intervention phase.

Methods: The sample consists of N= 430 medical students which were randomly assigned to one of three reflection conditions and one of three participatory roles for the intervention phase of the study. During the intervention phase, participants performed cooperative live simulations of three anamnestic interviews inhabiting one of three participatory roles (physician, patient, observer), each being asked to state the most likely diagnosis of the patient-case thereafter. Depending on their assigned experimental group, they received instructions to reflect either intermittent or following the anamnestic interview. The control group performed the task without the instruction to reflect. In a pre- and posttest, participants’ abilities were assessed via a strategic and conceptual knowledge test and their performance on diagnosing virtual patients 3-5 days prior to and following the intervention. Participation in the live-simulation was part of the medical curriculum, consent to participate in the study was voluntary.

Results: Participants that did not participate in the posttest were excluded from analyses. 232 participants were included in the final analyses. We used diagnostic accuracy (accordance with expert opinion) as our main outcome variable. An ANCOVA controlling for pretest performance found no difference in diagnostic accuracy at posttest between the three reflection conditions, nor between the three groups of participatory groups. There was no significant interaction. Both pretest conceptual knowledge and strategic knowledge were not associated with a benefit of reflection on learning or differential effect of participatory role on learning. Neither an effect of participatory role nor reflection on diagnostic accuracy was found.

Discussion: Our study does not support hypotheses of a benefit of reflection phases or effects of participatory role on diagnostic competence in live simulation based learning.