Effects of case revisitation during deliberate reflection on medical students' diagnostic accuracy: a randomized experiment.
Level 2 - randomized trial
Individual randomized experimental trial (by design analogy, not clinical CEBM)
PubMed 42644626 · doi:10.1515/dx-2026-0061
What was done
A randomized, two-arm experimental study evaluated 67 third- and fourth-year medical students enrolled in a six-year undergraduate medical program in Brazil. During the intervention phase, after providing an initial diagnosis, students engaged in deliberate reflection either with or without access to the case description. After a 15-day interval, participants diagnosed four cases of previously studied diseases and four cases of adjacent diseases. Outcomes were diagnostic accuracy, confidence, and recall of correct propositions, analyzed using a generalized linear mixed model.
What was found
No overall group differences were found in diagnostic accuracy, but a significant interaction occurred between group and disease type (chi-square(1) = 7.68, p = 0.006). For previously studied diseases, students without case access during deliberate reflection had higher accuracy (OR = 1.77, 95% CI [0.76, 2.78], p = 0.050). For adjacent diseases, students with case access performed better (OR = 0.56, 95% CI [0.24, 0.89], p = 0.050). Diagnostic accuracy was positively associated with confidence (OR = 1.12, 95% CI [1.01, 1.24], p = 0.028) and recall of correct propositions (OR = 1.06, 95% CI [1.01, 1.12], p = 0.027).
Why it matters
This study shows a functional trade-off in clinical reasoning training: closed-case deliberate reflection reinforces retention of studied conditions through retrieval effort, whereas open-case reflection supports diagnostic transfer to related diseases.
Limits
The sample was small (67 students) and limited to a single medical school. Subgroup effect estimates reached borderline significance (p = 0.050) with wide confidence intervals. Diagnostic reasoning was tested only with written case vignettes at 15 days, leaving real-world clinical performance and longer-term retention unmeasured.
Cited by
- context Scientific literature demonstrates that reflecting on material later causes people to learn it faster and retain it longer.