Journal Article

Hybrid PBL and Pure PBL: Which one is more effective in developing clinical reasoning skills for general medicine clerkship?—A mixed-method study

Daiki Yokokawa, Tomoko Tsukamoto, Masatomi Ikusaka, Eri Sato, Kosuke Ishizuka, Shun Uchida, Nao Hanazawa, Kiyoshi Shikino, Hiroki Tamura, Shiho Yamashita, Yasutaka Yanagita, Yosuke Yamauchi, Kazutaka Noda, Yasushi Hayashi, Yu Li, Jumpei Kojima, Takanori Uehara

2023

Overview

This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students’ perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students’ perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in \"recalling appropriate differential diagnosis from patient’s chief complaint\" (F(1,97) = 5.295, p = 0.024) and \"practicing the appropriate clinical reasoning process\" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of \"recalling appropriate history, physical examination, and tests on clinical hypothesis generation\" (F(1,97) = 6.796, p = 0.011), \"verbalizing and reflecting appropriately on own mistakes,\" (F(1,97) = 4.352, p = 0.040) \"selecting keywords from the whole aspect of the patient,\" (F(1,97) = 5.607, p = 0.020) and \"examining the patient while visualizing his/her daily life\" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, \"acquisition of knowledge\" was the most frequent subcategory, followed by \"leading the discussion,\" \"smooth discussion,\" \"getting feedback,\" \"timely feedback,\" and \"supporting the clinical reasoning process.\" Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one’s own errors and selecting appropriate keywords from the whole aspect of the patient.

• Publisher: Public Library of Science (PLoS),Public Library of Science
• Subject: Biology and Life Sciences / Clinical competence / Colleges & universities / Content analysis / Differential diagnosis / Educational research / Evaluation / Feedback / Female / General Practice / Humans / Hypotheses / Independent study / Learning / Learning strategies / Likert scale / Male / Medical education / Medical students / Medicine / Methods / Mixed methods research / Patients / People and Places / Problem based learning / Problem Solving / Problem-Based Learning - methods / Psychological aspects / Q / Qualitative analysis / Qualitative reasoning / Questionnaires / R / Reasoning / Research and Analysis Methods / Research Article / Science / Self evaluation / Skills / Social Sciences / Students / Students, Medical / Training / Tutoring / Variance analysis