Enhancing Cognitive Reflection in Medical Trainees and Physicians: An EBM-CBL-PBL Integrated Teaching Model.

BACKGROUND

Insufficient cognitive reflection in medical trainees and early-career physicians is a root cause of diagnostic errors, yet research on enhancing cognitive reflection in complex surgical settings remains limited. This study aimed to evaluate whether an integrated evidence-based medicine, case-based learning, and problem-based learning (EBM-CBL-PBL) teaching model can improve cognitive reflection.

METHODS

A two-phase design was employed. Cognitive reflection was assessed using the Cognitive Reflection Test (CRT). A generalized linear mixed model analyzed associations between sex, clinical experience, and CRT performance. In the intervention phase, trainees were randomized to traditional teaching (n = 18) or an EBM-CBL-PBL group (n = 18). CRT response patterns (intuitive vs. reflective) and teaching satisfaction were compared between groups.

RESULTS

41.18% of medical trainees exhibited an "All-Reflective" response, whereas 11.76% exhibited an "All-Intuitive" response; among resident physicians, the corresponding rates were 51.85% and 14.81%, and among attending/consulting physicians, they were 57.14% and 8.57%, respectively. No significant overall gender difference was observed (P > 0.05); however, senior female physicians demonstrated significantly stronger analytical thinking (odds ratio [OR] = 5.92, P = 0.005). The "All-Reflective" response rate in the EBM-CBL-PBL group (61.11%) was significantly higher than that in the traditional teaching group (44.44%), with an OR of 3.39 (P = 0.003); furthermore, teaching satisfaction improved significantly in the EBM-CBL-PBL group (P < 0.001).

CONCLUSION

Cognitive reflection ability improves with increasing clinical experience in clinical practice, with senior female physicians demonstrating the most pronounced enhancement. The integrated EBM-CBL-PBL teaching model adopted in the surgical field shows promise for fostering cognitive reflection. Sustained educational exposure and long-term clinical practice appear essential for consolidating these cognitive gains.