Multistage Problem-Based Case Discussion For Medical Students

Purpose: Students are presented with a variety of case formulas to promote the development of clinical reasoning.Methods: 120 third-year medical students at our medical university were randomly assigned to 18 small groups.After each ICM (Introduction to clinical Medicine) course, they were given a paper case. A few days later small group sessions were formed and students asked tutors some questions to have more history and physical examination data and discussed and developed a differential diagnosis list. Then, all small groups met in a large group session for further discussion. After that, back to small groups, students ordered paraclinical tests and they were given the results by tutor. At this stage, each group tried to further narrow the differential diagnosis list and to determine the most probable diagnosis. Finally, in the large group session a consensus diagnosis was reached after reflective observation. A questionnaire was used before and after intervention. The small group tutor rated student’s abilities at the end of first day and last day.Results: The attitude of students about the positive effects of MPCD increased significantly from the first day to the last day (P<0.05). the progress checklist of the student’s abilities showed a statistically significant improvement post intervention.Conclusion: Our study suggests that using MPCD method is an effective way to increase clinical reasoning skills of medical students.