Getting Lost to Find Insights - A Prospective Cohort Evaluation of Outdoor Experiential Learning as a Method to Teach Clinical Decision-Making and Decision Science Concepts

Background : There is a high prevalence of errors related to decision-making biases that results in medical errors. Despite this, there is limited teaching on decision-making biases in medical education. Study hypothesis or Objective : This study aimed to evaluate outdoor experiential learning as a mechanism to teach decision-making to first year medical students. Methods : A prospective cohort study of first year medical students at our institution were invited to participate in a brief workshop that included an introductory discussion followed by a guided hiking experience. During the hike, the guides were instructed to get lost, allowing students to experience a decision-making error. Student experience was evaluated with a pre and post course test designed to evaluate participants' knowledge on the decision-making biases, and decision science concepts that would be covered in the workshop. Results : Of the 120 students who participated in the workshop, 41 students completed the pre course and post course evaluation. The overall pre-quiz scores, and post-quiz scores were evaluated. Results of a paired sample t-test indicated a statistically significant improvement in scores [t(40) = 7.64, p <0 .001]. The Mean Pre-Quiz Score was 51.83% ± 18.40, the Mean Post-Quiz Score was 74.09 ± 18.40. This represents a 22.26% (95% CI : 16.37-28.14) score increase from pre-quiz to post-quiz (p<0.001). Conclusions : Our data suggests that this novel outdoor experiential learning workshop was an effective method of teaching decision-making biases and general decision science concepts to first year medical students. Future iterations of this work can investigate long-term retention of these concepts, and changes in clinical practice and decision-making behavior following completion of the course.