MedEdPublish (Dec 2019)
Self-explanation to support knowledge development for clinical reasoning: Perspectives from third year medical clerks
Abstract
Background: Self-explanation (SE) used as a learning strategy with clinical cases, can benefit medical clerks' diagnostic performance. However, its specific contributions to students' knowledge development remain unexplored. We qualitatively investigated the students' perception of the impact of SE on knowledge development relevant to clinical reasoning. Methods: Eleven medical clerks orally self-explained and listened to examples of SE while solving clinical cases. One week later, we interviewed them after they diagnosed new cases, asking if SE contributed to their knowledge development, and if yes, the nature of that contribution. Verbatim transcripts were analyzed first inductively in an iterative approach, then deductively using Schmidt's theory of expertise. Results: Students commented that SE allowed reactivation and elaboration of knowledge. SE forced them to explicitly describe underlying pathophysiological mechanisms. SE allowed them to identify specific gaps in their medical knowledge. One week later when solving new clinical cases, students reported being able to recognize more easily relevant illness scripts and to better argument their diagnosis. Conclusions: According to students, using SE while solving cases valuably supported knowledge elaboration and enrichment of illness scripts. Our participants emphasized that verbalisation when self-explaining and listening to a resident' SE might have further contributed to this support.
