Blended learning for diagnostic skills: a multicenter cluster randomized non-inferiority trial

Objective: Clinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. Therefore, we developed and evaluated a blended learning course in a multicenter cluster randomized trial. Method: Undergraduate students (N=350) enrolled in eighteen university courses at three universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants’ performance in a clinical diagnostic interview after the courses, secondary outcomes were diagnostic knowledge and participants’ reactions to the courses. All outcomes were analyzed on the individual participant level using non-inferiority testing. Results: Compared to the synchronous course (74.6% pass rate), participation in the blended learning course (89.0% pass rate) increased the likelihood of successfully passing the behavioral test, OR=2.77 (95% CI [1.55, 5.13]), indicating not only non-inferiority, but superiority of the blended learning course. Furthermore, participants in the blended learning course did not perform worse than participants in the synchronous course on the diagnostic knowledge test and several reaction measures. Conclusions: Blended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care.