title: Instructional authenticity and clinical reasoning in undergraduate medical education: a 2-year, prospective, randomized trial.
abstract: OBJECTIVE
  The purpose of the study was to investigate the relationship between authenticity (how close to actual practice) of preclerkship instructional formats and preclerkship and clerkship outcome measures. A secondary purpose was to investigate the effect of student's small-group assignment during preclerkship period on instructional formats and preclerkship and clerkship outcome measurements.
  
  
  METHODS
  A prospective, randomized, crossover study was carried out with preclerkship students taking a clinical reasoning course. Students were randomized to small groups and exposed to three formats of differing instructional authenticity across three subject areas. Three student cohorts were taught using one instructional format per subject area with each cohort receiving a different instructional format for each of the three areas. Outcome measures at the end of the preclerkship year and the clerkship year were selected to determine the effect of each instructional format. Hierarchical linear modeling was performed to assess impact of format on outcomes and to assess potential group effect on outcomes.
  
  
  RESULTS
  Increasingly authentic instructional formats did not significantly improve clinical reasoning performance. Small-group assignment did not significantly contribute to the outcomes providing evidence that teacher training was successful.
  
  
  CONCLUSIONS
  Increasing authenticity of instructional formats does not appear to significantly improve clinical reasoning performance. Faculty can be successfully trained to teach consistently in a clinical reasoning course. Medical educators should balance increasing authenticity with factors such as cognitive load and learner experience as well as engaging in frame-of-reference training to minimize group effects with designing new instructional formats.
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Durning
authors.forename: Ting
authors.initials: T
authors.lastname: Dong
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Artino
authors.forename: Jeffery
authors.initials: J
authors.lastname: LaRochelle
authors.forename: Louis N
authors.initials: LN
authors.lastname: Pangaro
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
authors.forename: Lambert
authors.initials: L
authors.lastname: Schuwirth
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence / Q000592:standards*; D018592:Cross-Over Studies; D003479:Curriculum; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000592:standards; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055815:Young Adult