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Another Tool in the Toolbox
Effect of enhanced analytic reasoning on diagnostic accuracy: A randomized controlled study. Myung SJ et al. Medical Teacher 2013 35, 248-250.
Reviewed by Karen Forbes

What was the study question?
Could an analytical exercise used in an OSCE - improve diagnostic accuracy of fourth year medical students?

How was the study done?
Students at Seoul National University College of Medicine were randomized to ananalytic reasoning group or a control group for a four station, fourth year OSCE. After each station, students reported the most probable diagnosis. No further instructions were given to the control group while, the analytic reasoning group completed a table with differential diagnosis and symptoms or signs for or against each diagnosis. They were then asked to choose the most probable diagnosis. Diagnostic accuracy was assessed and compared between the two groups.

What were the results?
One-hundred and forty-five students participated in this study. OSCE scores did not differ between the control group (n=80) and the analytic reasoning group (n=65.. Analysis of the scores for each case, reported as percentage of students with the correct diagnosis, revealed a statistically significant difference in only one of the four cases (p=0.043). However, the mean diagnostic accuracy score for all cases combined, where a perfect score equals 4.0, was higher in the analytic reasoning group, reaching statistical significance (3.40 vs. 3.05, p = 0.016).

What are the implications of these findings?
Using a tool to promote analytic reasoning may help students’ diagnostic accuracy by encouraging them to consider alternate diagnoses, and may reduce some forms of cognitive bias. It is possible that practice in using such a tool during clinical training may further enhance students’ diagnostic reasoning skills.

Editor’s note: This report presents a potentially useful method to tweak an OSCE case to enhance clinical reasoning and improve students’ diagnostic acumen. As one of my colleagues says, “M. D. means ‘Make a Decision’” (RR).

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