Self-explanation in learning clinical reasoning: the added value of examples and prompts

ContextRecent studies suggest that self-explanation (SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example-based learning framework justifies an exploration of students' use of their own SEs combined with the study of examples. This study aimed to assess the impact on medical students' diagnostic performance of: (i) combining students' SEs with their listening to examples of residents' SEs, and (ii) the addition of prompts (specific questions) while working with examples. MethodsThis study consisted of a training phase and an assessment phase conducted 1week later. In the training phase, 54 Year3 medical students were randomly assigned to one of three groups. In all groups, students first solved four clinical cases using SE. Subsequently, Group1 listened to examples of residents' SEs with prompts; Group2 listened to examples of residents' SEs without prompts, and the control group solved word puzzles. Then, all students again solved the same four cases. One week later, all students solved four similar and four different cases. Students' diagnostic performance and diagnostic accuracy scores were assessed for each case at each time-point. ResultsAlthough all groups' diagnostic accuracy scores on similar cases improved significantly between the training and the assessment phase, Group1 showed a significantly higher diagnostic performance score after 1week than the control group (p=0.037). On different cases, Group1 obtained significantly higher diagnostic accuracy (p=0.011) and diagnostic performance (p