JMIR Publications

ABSTRACT

Background:

Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences.

Objective:

To test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own.

Methods:

In this monocentric, prospective, non-randomised trial, fourth-year medical students attended twelve computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit and retention exams and analysed with respect to preceding exposure to video- or text-based case histories.

Results:

Of 102 eligible students, 75 provided written consent and complete data at all study exams (re-sponse rate 73.5%). A majority of students (n = 52) predominantly chose the text-based format. Compared to these, students preferring the video-based format achieved a non-significantly higher score in the exit exam (76.2 ± 12.6% vs. 70.0 ± 19.0%; p=0.154) and a significantly higher score in the retention exam (75.3 ± 16.6% vs. 63.4 ± 20.3%; p=0.016). The effect was independent of the presentation format in the respective exams.

Conclusions:

Despite students’ overall preference for text-based case histories, learning outcome regarding clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. Baseline performance levels of students does not account for the results as preceding summative exam results were comparable across the two groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories in order to be able to make in-formed choices about their study methods. Clinical Trial: None.