PURPOSE: To investigate whether repeated exposure to simulated clinical cases, as employed in problem-based learning (PBL), accelerates the development of clinical expertise in veterinary students. METHOD: In 1995 all 122 second-year students at the Texas A&M University College of Veterinary Medicine were organized into 24 self-selected groups to complete four computer-based case simulations in veterinary neuroanatomy. A scoring rubric of four categories (poor, neutral, good, and excellent) was used to assign quality classifications for physical examination questions selected by the students. Each group's diagnostic efficiency was calculated for each case on the basis of these classifications. An analysis of variance (ANOVA) using a one-factor repeated-measures procedure was employed to examine the cumulative effects of the case simulations on diagnostic efficiency. Post hoc procedures involved the use of contrasts to determine the trend of diagnostic efficiency with repeated use of case simulations. A Pearson product-moment correlation coefficient was calculated to determine the strength of the relationship between the change in diagnostic efficiency for each group and the selected group characteristics, total hands-on veterinary experience, and average grade-point average (GPA). RESULTS: Because six of the 24 groups did not perform a physical examination in one of the cases, a rating of zero was given when no physical examination was done; the data were then analyzed with and without the six groups included, and compared. The ANOVA yielded a significant result for all 24 groups (F(3,69) = 2.75, p = .0491) and for the 18 groups that performed physical examinations in all four cases (F(3,51) = 3.03, p = .0377). Significant linear contrasts were also found for all 24 groups (F(1,69) = 7.21, p = .009) and for the 18 groups (F(1,51) = 4.25, p = .044). Improvement in diagnostic efficiency could not be correlated with GPAs and was only somewhat correlated with the total amount of prior clinical experience reported by the students. CONCLUSION: Study findings suggest that there is a significant relationship between the repeated use of case simulations in PBL and the accelerated development of clinical expertise.
(C) 1997 Association of American Medical Colleges