Efeito da autoexplicação na acurácia diagnóstica de estudantes de medicina

Abstract

Self-Explanation (AE) is among the instructional strategies used to foster medical students´ development of clinical reasoning. An experimental study was conducted to evaluate the effect of AE based on physiopathological mechanisms on diagnostic accuracy of medical students for diseases of different clinical syndromes. One syndrome (anemia) included diseases with similar pathophysiological mechanisms while the other (thoracic pain) had diseases with different mechanisms. The study was divided in two phases with a one-week interval between them and included 41 3rd year medical students with one group (N = 20) using AE to solve clinical problems and the other group (N = 21) solving the same cases without AE. One week later, in the assessment phase, the students solved eight new clinical cases without any specific orientation. There was no statistically significant difference in the diagnostic accuracy between the AE and No Self-Explanation (SAE) groups, independently of the study phase and clinical syndrome analyzed. A statistically significant association (p <0.001) was observed between performance scores of the participants and the clinical syndrome in both groups, with better performance observed in anemia cases when compared to chest pain cases .The instructional approach of using AE oriented towards pathophysiological mechanisms of the diseases, in the present study, was not able to Improve diagnostic accuracy in medical students.