Concurrent versus Post-Encounter Hypothesis-Driven Precepting

Background: Precepting in the context of a standardized patient (SP) encounter provides an opportunity to demonstrate and promote diagnostic reasoning skills. Hypothesis-Driven Precepting (HDP) encourages students to compare and contrast competing diagnoses and avoid premature closure. Aim: To compare reasoning of students experiencing HDP concurrent with the SP encounter (cHDP), including diagnostic timeouts and scaffolding, versus HDP provided in a post-encounter debriefing (pHDP). Methods: Thirty-nine second-year medical students were randomized into cHDP or pHDP groups. Students in both groups watched a video describing four diagnoses related to abdominal pain, then participated in a small-group SP encounter with either cHDP or pHDP. Reasoning skills were assessed immediately after the session (T1), and one week later (T2) in the context of three video SP encounters. Results: Concurrent HDP students provided better linkages of findings to diagnoses at T1. Post-encounter HDP sessions had very short SP encounters (mean 3.3 minutes) but lasted longer overall (18 minutes pHDP vs 15 minutes cHPD). pHDP interviewers asked only rote history questions, without exploring alternate diagnostic hypotheses. Conclusions: Both cHPD and pHDP were effective. cHDP with diagnostic timeouts provided more opportunities to scaffold metacognition and help students avoid premature closure.