Impact of meta-memory techniques in generating effective differential diagnoses in a pediatric core clerkship

We primarily assessed differences in differential diagnosis (DDx) efficacy of initial and refined top diagnoses (tDDx) and "can't miss"DDx (CMDx) between 3 MMTs (Constellations, Mental CT, and VINDICATES). Pediatric clerkship students participated in two 1-h case-based sessions. The case was presented in three aliquots. Students were randomly assigned to MMT groups. Assigned MMTs were used to generate the initial tDDx and CMDx following aliquot 1. tDDx and CMDx were refined following both aliquots 2 and 3. Group DDx responses and student affective data were collected via survey. DDx efficacy was defined using pooled faculty responses and scoring was done by consensus. There was no significant difference in scores between MMT groups, except the second iteration of CMDx in Case A (Constellations 50% [interquartile range, IQR, 50-100], Mental CT 50% [50-100], VINDICATES 0% [0-50], p=0.02). Students' self-reported confidence in generating (p<0.001) and refining (p<0.001) their DDx significantly increased after the curriculum. Although prior studies identified a differential effect of MMTs on DDx generation, we did not observe a difference in initial or refined DDx efficacy between MMTs.