What do medical students find useful to help them learn clinical problem solving?

Abstract

Background: Problem-solving is an essential clinical skill which medical students find challenging, particularly in Family Medicine settings where patients present with a range of undifferentiated problems. This study compared student perceptions of two interactive classroom activities to examine which features were most useful in helping students learn to problem solve. Summary of Work: All year 4 medical students (n=210) participated in two workshops. Workshop A used Team-based Learning (TBL). Workshop B used role-plays with surrogate patients (SPs). Workshops were case-based using primary care clinical scenarios. Students completed a survey on classroom engagement and provided written feedback on which workshop they preferred and why. Summary of Results: 201 and 178 surveys were returned after Workshop A and Workshop B. There was no significant difference in classroom engagement scores. 22.1% preferred TBL whilst 77.8% preferred role-play. Students liked the pre-reading, small-group brainstorming and gaming aspects of TBL; and the history-taking practice using role-play with provision of model answers. Discussion: Beneficial features of TBL included appropriate pre-reading for knowledge acquisition, small-group brainstorming to broaden their thinking, and gamification for engagement. Beneficial features of role-play included having a broad range of cases for history-taking and problem-solving practice and a step-by-step dissection of model answers to better understand the problem-solving process. Conclusions: Although the learning in TBL and role-play were both equally active in terms of student engagement, more students preferred role-play because it allowed them to practice both the skills of information gathering as well as problem-solving. Explanation of model answers helped students to grasp the conceptual processes involved in problem-solving. Take-home Messages: To make TBL more effective, application exercises need to be well designed and sufficiently challenging to stimulate team discussion of the best solution. Dissection of model answers and discussing the rationale for the best answer is useful in helping students understand the decision-making and prioritizing steps involved in clinical problem-solving.