title: Bringing explicit insight into cognitive psychology features during clinical reasoning seminars: a prospective, controlled study.
abstract: BACKGROUND
  Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored.
  
  
  OBJECTIVE
  This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning.
  
  
  METHODS
  Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups.
  
  
  RESULTS
  Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02).
  
  
  CONCLUSIONS
  This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.
authors.affiliation: University ofGeneva Faculty of Medicine, Geneva. mathieu.nendaz@hcuge.ch
authors.forename: Mathieu R
authors.initials: MR
authors.lastname: Nendaz
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gut
authors.forename: Martine
authors.initials: M
authors.lastname: Louis-Simonet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Nu V
authors.initials: NV
authors.lastname: Vu
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D003937:Diagnosis, Differential; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013337:Students, Medical / Q000523:psychology*; D013557:Switzerland; D013850:Thinking