title: Does medical students' diagnostic performance improve by observing examples of self-explanation provided by peers or experts?
abstract: Educational strategies that promote the development of clinical reasoning in students remain scarce. Generating self-explanations (SE) engages students in active learning and has shown to be an effective technique to improve clinical reasoning in clerks. Example-based learning has been shown to support the development of accurate knowledge representations. The purpose of this study was to investigate the effect of combining student's SE and observation of peer's or expert's SE examples on diagnostic performance. Fifty-three third-year medical students were assigned to a peer SE example, an expert SE example or control (no example) group. All participants solved a set of the same four clinical cases (training cases), 1-after SE, 2-after listening to a peer or expert SE example or after a control task, and 3-1 week later. They solved a new set of four different cases (transfer cases) also 1 week later. For training cases, students improved significantly their diagnostic performance overtime but the main effect of group was not significant suggesting that students' SE mainly drives the observed effect. On transfer cases, there was no difference between the three groups (p > .05). Educational implications are discussed and further studies on different types of examples and additional strategies to help students actively process examples are proposed.
authors.affiliation: Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. martine.chamberland@usherbrooke.ca.
authors.forename: Martine
authors.initials: M
authors.lastname: Chamberland
authors.affiliation: Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.|Department of Psychology, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Mamede
authors.affiliation: Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: St-Onge
authors.affiliation: Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Setrakian
authors.affiliation: Department of Psychology, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: Schmidt
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D019937:Diagnostic Techniques and Procedures; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D019370:Observation; D010379:Peer Group; D018794:Problem-Based Learning; D011792:Quebec
keywords: Clerkship; Clinical reasoning; Example-based learning; Modeling; Self-explanations