{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T02:33:13Z","timestamp":1790130793488,"version":"4.0.1"},"reference-count":31,"publisher":"Walter de Gruyter GmbH","funder":[{"name":"FAPESP \u2013 S\u00e3o Paulo Research Foundation","award":["2018\/15642-1"],"award-info":[{"award-number":["2018\/15642-1"]}]},{"name":"FAPESP \u2013 S\u00e3o Paulo Research Foundation","award":["2023\/05552-3"],"award-info":[{"award-number":["2023\/05552-3"]}]},{"name":"FAPESP \u2013 S\u00e3o Paulo Research Foundation","award":["2024\/18713-8"],"award-info":[{"award-number":["2024\/18713-8"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2026-0061_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Deliberate reflection (DR) is an instructional strategy that enhances clinical reasoning by prompting learners to systematically compare diagnostic hypotheses with case findings. DR protocols often allow learners to revisit the written case during reflection, which may reduce cognitive effort but limit the benefits of effortful retrieval for long-term retention. This study examined whether allowing or restricting case revisitation during DR affects medical students\u2019 diagnostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2026-0061_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a randomized, two-arm experimental study with 67 third- and fourth-year medical students enrolled in a six-year undergraduate medical program in Brazil. During the intervention phase, after providing an initial diagnosis, students engaged in DR either with or without access to the case description. After a 15-day interval, participants diagnosed four cases of previously studied diseases and four cases of adjacent diseases. Outcomes included diagnostic accuracy, confidence, and recall of correct propositions, analyzed using a generalized linear mixed\u00a0model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2026-0061_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No overall group differences were found in diagnostic accuracy. However, a significant interaction emerged between group and disease type (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (1)=7.68, p=0.006). For previously studied diseases, students in the without-access-DR group performed better (OR=1.77, 95\u202f% CI [0.76, 2.78], p=0.050), whereas for adjacent diseases, those in the with-access-DR group performed better (OR=0.56, 95\u202f% CI [0.24, 0.89], p=0.050). Diagnostic accuracy was positively associated with confidence (OR=1.12, 95\u202f% CI [1.01, 1.24], p=0.028) and recall (OR=1.06, 95\u202f% CI [1.01, 1.12], p=0.027).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2026-0061_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Restricting case revisitation enhanced accuracy for previously studied diseases, consistent with retrieval effort theory, whereas allowing revisitation supported transfer to adjacent diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2026-0061","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:55:30Z","timestamp":1787748930000},"source":"Crossref","is-referenced-by-count":1,"title":["Effects of case revisitation during deliberate reflection on medical students\u2019 diagnostic accuracy: a randomized experiment"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4220-2642","authenticated-orcid":false,"given":"Francisco Carlos","family":"Specian Junior","sequence":"first","affiliation":[{"name":"School of Medical Sciences, University of Campinas (UNICAMP) , Campinas , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Beatriz","family":"Aliscantes Silva Brito","sequence":"additional","affiliation":[{"name":"Faculty of Medicine , Pontifical Catholic University of Campinas , Campinas , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-2392","authenticated-orcid":false,"given":"Silvia","family":"Mamede","sequence":"additional","affiliation":[{"name":"Wenckebach Institute, Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen (UMCG) , Groningen , The Netherlands"},{"name":"Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Augusto","family":"Goulart Campos","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, University of Campinas (UNICAMP) , Campinas , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Martins","family":"Santos","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, University of Campinas (UNICAMP) , Campinas , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Mazzo","sequence":"additional","affiliation":[{"name":"Bauru School of Medicine (FMBRU-USP), University of S\u00e3o Paulo , Bauru , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8746-1680","authenticated-orcid":false,"given":"Dario","family":"Cecilio-Fernandes","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, University of Campinas (UNICAMP) , Campinas , SP , Brazil"},{"name":"Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026082612552716031_j_dx-2026-0061_ref_001","doi-asserted-by":"crossref","unstructured":"Graber, ML, Kissam, S, Payne, VL, Meyer, AND, Sorensen, A, Lenfestey, N, et al.. 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