The impact of a diagnostic reminder system on student clinical reasoning during simulated case studies

Introduction: Diagnostic reminder systems (DRS) may help students improve their clinical reasoning skill and gain competency in using informatics tools. This study explored the influence of Isabel PRO, a web-based DRS, on student diagnostic reasoning during simulated encounters.

Methods: Diagnostic reasoning was assessed in 20 fourth-year medical students during four simulated case scenarios. After seeing each case, students submitted diagnostic hypotheses before (Pre-Isabel) and after (Post-Isabel) using Isabel PRO. The quality of the Pre- and Post-Isabel diagnostic hypotheses was assessed and compared to determine the impact of a DRS on student diagnostic reasoning. A follow-up survey and focus group identified student perception toward the use of a DRS in educational settings.

Results: Paired t testing demonstrated that diagnostic accuracy significantly improved after using Isabel PRO (P < 0.05). Students found the software relatively simple to learn, felt that it helped them reflect on diagnostic options that they had not originally considered, and valued the opportunity to use the software in conjunction with simulated cases.

Conclusions: Despite limited experience, students were able to effectively use a DRS to improve their diagnostic accuracy. Use of a DRS within the context of a patient case represents a distinct clinical skill set requiring appropriate training. Providing learners with gold standard examples of how to best use a specific informatics tool within specific clinical situations is an essential learning component. Simulated case scenarios offer an appropriate platform for introducing diagnostic support tools to learners within a clinical context.