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Decision making

Does guided reflection help medical students make better diagnoses?

Lambe KA, Hevey D, Kelly BD · Frontiers in psychology · 2018

Open access · cc by · source: Europe PMC

Slowing down to reflect and list alternative possibilities does not help medical students arrive at a more accurate final diagnosis.

Key findings

The study revealed that guiding students to reflect did not improve the accuracy of their final diagnoses compared to first-impression judgments. While reflective students were more likely to include the correct answer somewhere in their list of alternative ideas, they rarely changed their initial minds to select it. Furthermore, forcing students to generate more alternatives did not boost their accuracy or change their confidence, with participants in both reflection groups changing their minds in only 17% of cases.

Methodology

The researchers recruited 186 medical students to diagnose four clinical cases using different decision-making styles. Participants were randomly divided into three groups: a control group making immediate decisions, a short-reflection group listing two alternative diagnoses, and a long-reflection group listing six alternatives. The study measured whether this guided reflection changed their diagnostic accuracy or their confidence levels.

Limitations

The study cannot show how practicing clinicians would perform, as the participants were senior medical students rather than experienced doctors. It also cannot rule out floor effects, because the case scenarios were highly challenging and resulted in low overall diagnostic accuracy. Additionally, because students in the long-reflection group only listed an average of three alternatives instead of the requested six, the cognitive impact of highly exhaustive reflection remains unmeasured.

How this study connects

Role on claims

Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.

  • SupportsDual-Process Modelconcept

    Deliberately slowing down to engage in reflective, analytical processing (System 2) does not necessarily improve diagnostic accuracy over initial intuitive impressions (System 1) in challenging medical cases.

    Evidence for the claim as stated.

  • SupportsDual-Process Modelconcept

    Forcing decision-makers to list multiple alternative hypotheses during a reflective task does not boost their confidence levels or significantly alter their final diagnostic judgments.

    Evidence for the claim as stated.

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