• A submitted manuscript is the version of the article upon submission and before peer-review. Th... more • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
A study was undertaken to investigate the validity of a progress test, the Maastricht Progress Te... more A study was undertaken to investigate the validity of a progress test, the Maastricht Progress Test, that was designed to measure knowledge and clinical reasoning growth in a problem-based medical curriculum. Scores and subscores of about 40 students per year (total sample of 195) on the different categories of the progress test were compared with scores on a clinical reasoning test. Both tests revealed the same pattern of increasing scores over the years, and they had a high correlation. Further analyses revealed that the clinical science component, in particular, of the progress test explained the variations in the clinical reasoning test scores. Knowledge of behavioral sciences had a small but independent contribution. Outcomes are discussed from the perspectives of research and theory on the development of medical expertise, and educational consequences are discussed. An appendix contains an example problem. (Contains one table, three figures, and four references.) (Author/SLD)
International Conference of Learning Sciences, Jun 24, 2008
This study investigates success and failure factors related to workplace simulation learning in D... more This study investigates success and failure factors related to workplace simulation learning in Dutch pre-vocational secondary education. Research in other practical settings indicates that self-directed learning, self-regulated learning and deliberate practice are key competencies that positively affect learning outcomes. A focus group study with 20 teachers and 35 students was conducted. Similarities and discrepancies between theory and practice are put forward. For instance, not offering choices interferes with a self-directed learning approach.
or visit the DOI to the publisher's website. • The final author version and the galley proof are ... more or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
Advances in Health Sciences Education, Jul 18, 2018
Visual problem solving is essential to highly visual and knowledge-intensive professional domains... more Visual problem solving is essential to highly visual and knowledge-intensive professional domains such as clinical pathology, which trainees learn by participating in relevant tasks at the workplace (apprenticeship). Proper guidance of the visual problem solving of apprentices by the master is necessary. Interaction and adaptation to the expertise level of the learner are identified as key ingredients of this guidance. This study focuses on the effect of increased participation of the learner in the task on the interaction and adaptation of the guidance by masters. Thirteen unique dyads consisting of a clinical pathologist (master) and a resident (apprentice) discussed and diagnosed six microscope images. Their dialogues were analysed on their content. The dyads were divided in two groups according to the experience of the apprentice. For each dyad, master and apprentice both operated the microscope for half of the cases. Interaction was operationalised as the equal contribution of both master and apprentice to the dialogue. Adaptation was operationalised as the extent to which the content of the dialogues was adapted to the apprentice's level. The main hypothesis stated that the interaction and adaptation increase when apprentices operate the microscope. Most results confirmed this hypothesis: apprentices contributed more content when participating more and the content of these dialogues better reflected expertise differences of apprentices. Based on these results, it is argued that, for learning visual problem solving in a visual and knowledge-intensive domain, it is not only important to externalise master performance, but also that of the apprentice.
One of the processes supposed to take place during development toward medical expertise is knowle... more One of the processes supposed to take place during development toward medical expertise is knowledge encapsulation. In this process detailed biomedical concepts are gradually clustered together and reorganized under fewer, clinically relevant terms. A large-scale investigation was made of the process of biomedical knowledge application using subjects of expertise level not too far apart to enable a more detailed analysis of the developmental path. Data indicate that the process of encapsulation is not as smooth as hypothesized. In the first year of the 2-year clerkship period a sharp decrease in the application of biomedical knowledge was observed. Two hypotheses to explain this phenomenon were explored but neither of them could explain the results. However, the finding that the first clerkship year results in a dip in clinical reasoning is a consistent finding and some educational and practical differences that may contribute to this finding are discussed. Three tables and five figures of data are included. (Author/JRH)
Onderzocht is of korte-casusvragen andere denkprocessen teweegbrengen dan feitenkennisvragen. Met... more Onderzocht is of korte-casusvragen andere denkprocessen teweegbrengen dan feitenkennisvragen. Methode: Aan tien huisartsen (experts) en tien studenten (novieten) werden vier casusvragen en zestien inhoudelijk overeenkomende feitenkennisvragen voorgelegd. De vragen werden mondeling beantwoord waarbij het hele denkproces zoveel mogelijk hardop verwoord werd. Op grond van psychometrisch en cognitief psychologisch onderzoek zijn drie indicatoren voor analyse van het denkproces gedefinieerd: 1) de hoeveelheid informatie uit de vraag, die herhaald werd, 2) het aantal direct gegeven antwoorden en 3) het type overwegingen: juist/onjuist-overwegingen of overwegingen met een bepaalde waarde en richting (vectoren). Resultaten: Bij de casusvragen herhaalden de studenten informatie uit de stam en de bijbehorende vraag significant vaker dan de huisartsen en gaven de huisartsen vaker direct antwoord dan de studenten. Deze verschillen werden niet gevonden bij de feitenkennisvragen. Feitenkennisvragen lokten met name juist/onjuist-overwegingen uit, terwijl casusvragen vooral leidden tot vectoroverwegingen.
A study examined the application and availability of clinical and biomedical knowledge in the cli... more A study examined the application and availability of clinical and biomedical knowledge in the clinical reasoning of physicians as well as possible mechanisms responsible for changes in the organization of clinical and biomedical knowledge in the development from novice to expert. Subjects ustre 28 students (10 second year, 8 fourth year, and 10 fifth year) and 10 family physicians with at least 4 years of experience. Subjects were presented with either a typical or atypical case of pancreatitis which they were to diagnose while thinking aloud and then to describe by writing out the pathophysiological processes they believed to underlie the case. Level of expertise correlated with number of case findings subjects responded to with knowledge application propositions. Fourth year students applied the most knowledge propositions and fifth year and experienced physicians the least. Results suggested that the overt role of biomedical knowledge in expert clinical reasoning is virtually absent, though this knowledge has not decreased but increased. Comparison of the overlap between applied and available knowledge suggested that, in approaching the unstructured information of the atypical case, clinical knowledge was preferred over biomedical knowledge. It is concluded that biomedical knowledge becomes increasingly integrated in the clinical knowledge base with increasing expertise. Contains 11 references. (DB)
A study investigated the 'mown phenomenon of "intermediate effect" in which medical students with... more A study investigated the 'mown phenomenon of "intermediate effect" in which medical students with an intermediate amount of knowledge and experience demonstrate higher amounts of recall of the text of a medical case than either experienced clinicians or novices. In this study the amount of activation of prior knowledge was controlled by having subjects--24 fourth-and 24 sixth-year medical students at the University of Limburg (Netherlands) and 6 internists--spend either 30 seconds or 3.5 minutes recalling whatever they knew about endocarditis before being presented with an endocarditis case to comprehend and recall. Findings indicated that the more time subjects had available the more knowledge about the subject they were able to produce; that the amount of prior knowledge produced is a function of level of expertise (physicians produced more information than students); but that "experts" (physicians and sixth-year students) recalled less information but more relevant information about the case than did intermediates (fourth-year students). The results supported the theory that experienced physicians develop cognitive structures or "illness scripts" which they use to automatically represent a case. Contains 14 references. (DB)
Introduction: Students adapt their learning strategies, orientations and conceptions to differenc... more Introduction: Students adapt their learning strategies, orientations and conceptions to differences in the learning environment. The new curriculum of the Faculty of Medicine, University of Peradeniya, Sri Lanka, which commenced in 2005, puts greater emphasis on student-centred learning. The aim of this study was to compare the learning strategies, orientations and conceptions measured by means of a validated Sri Lankan version of the Inventory of Learning Styles (ILS) at the end of the first academic year for a traditional curriculum student group and a new curriculum student group. Materials and Methods: The Adyayana Rata Prakasha Malawa (ARPM) 130-item Sinhala version of the ILS was administered to students of the traditional curriculum and the new curriculum at the end of their first academic year respectively. Mean scale scores of the 2 groups were compared using independent sample t-test. Results: Students of the new curriculum reported the use of critical processing, concrete...
The present study examined the long-term impact of a formative assessment intervention in primary... more The present study examined the long-term impact of a formative assessment intervention in primary education on the development of students’ levels of self-regulation, motivation, and self-efficacy after their transition to secondary education. Participants in the study included 695 Dutch sixth graders from 17 schools. A longitudinal design with measurements on three time points was adopted. The first part of the study, consisting of a pretest, the intervention, and posttest, was conducted during the students’ last 7 months in primary education using two experimental conditions, with peer- and self-assessment, and a control condition. A follow-up took place 10 weeks later, after the summer break and at the commencement of the participants’ secondary education. Longitudinal multilevel analyses showed that the development of self-regulation and motivation is significantly positively associated with the formative self- and peer-assessment interventions and continues after the transition...
Advanced Models of Cognition for Medical Training and Practice, 1992
This contribution concerns the knowledge structures of medical students and physicians. More spec... more This contribution concerns the knowledge structures of medical students and physicians. More specifically, it deals with how these structures change through their application to relevant tasks. We present evidence in favor of a cognitive mechanism that we have labeled "encapsulation". Encapsulation, we believe, plays a key role in the transition from intermediate competence to expert competence in the medical domain. The ideas to be outlined in this paper arose in the context of the clinical case comprehension paradigm developed by Patel and her colleagues at McGill (e.g., Patel & Groen 1986), which is also extensively used in our own lab (Schmidt & Boshuizen 1992a). In addition, corroborating evidence from think-aloud studies is presented. Much is already known about how existing knowledge operates in the understanding of new information, which factors are involved in its activation, and the extent to which it permeates our comprehension of the world. The studies of on contextual activation, those of on schema shifts, the experiments of Spilich, Vesonder, Chiesi and Voss (1979) on recall of information by highand low-knowledge subjects, and, more generally, studies of expert-novice differences in various domains (e.g., Chase & Simon 1973; Chi et al. 1981; Lesgold 1984), all show that the particular knowledge available to subjects determines to a great extent how they perform in relevant domains. Much less, however, is known about the exact nature of the knowledge structures that are employed in real-life tasks such as playing chess, solving physics problems, or understanding clinical cases. Our knowledge of how these structures look is largely theoretical and the subject of ongoing debate. The prevalent point of view, namely, that knowledge is primarily organized in schemata ), scripts (Schank & Abelson 1977) or frames (Minsky 1975) containing variables and slots, has trouble explaining comprehension of non-prototypic situations. In addition, schemata and the accompanying notion of expectation-based processing of new information are found to be far too rigid to account for the complexity of actual learning taking place. If all processing is expectation-based, how can one ever learn something that one didn't already know? More recent proposals emphasize the idea D. A. Evans et al. (eds.
Safe and effective patient handovers remain a global organizational and training challenge. The W... more Safe and effective patient handovers remain a global organizational and training challenge. The World Health Organization (WHO) lists effective handovers as one of its High 5 patient safety initiatives. Training for handover competencies is a promising approach to improve the quality of handovers. We present the Handover toolbox that aims to support different stakeholders (e.g. general practitioners, nurses, medical trainer, experts in patient handover, and medical students) to provide customized handover training for specific demands. The Handover toolbox was designed in the context of the FP7 HANDOVER project from April 2009 until October 2011 by using the Technology Enhanced Learning Design Process (TEL-DP). TEL-DP consisted of six different methods: 1). User requirements analysis; 2). Writing personas; 3). Group Concept Mapping 4). Analysis of suitable software; 5). Plus-Minus-Interesting rating; and 6). Usability testing. TEL-DP is aligned to participatory design approaches and guaranteed a development process in close collaboration with the stakeholders. From method (1) it appeared that different kinds of trainings are needed that allow to train professionals on the job as well as medical students in their studies. Methods (2) and (3) made clear that training experts from different countries differed in their views on the desired content and delivery of handover training. This means that a onesize-fits-all training was not applicable rather a customisable learning approach, a toolbox, that allow trainers to design their own training for various target groups with specific handover information needs was a far better solution. Method (4) identified the most suitable ready-to-use software systems that provided the required functionalities and could be further customized to the needs of the users. Method ( ) and ( ) resulted in several points for improvement of the Handover toolbox, mainly related to improved usability and navigation. Until the end of the development process in October 2011, 165 training experts were attracted by the toolbox and signed up for the system. Conclusions We developed a Handover toolbox for different stakeholders who are interested in improving handovers through customized training and learning. Its design is based on a carefully stakeholder investigation, using the TEL-DP approach which is a systematic and comprehensive design approach. It provides state of the art content about 40 handover tools with practical guidelines, a generic training design that can be customized to specific handover training needs, and enables community members to contribute own experiences and best practice examples. Next to this content, it offers an easy to use e-learning environment to support trainers in their handover classes. The developments can only be seen as a first supportive step to achieve a better patient safety. The final implementation phase of the toolbox has only partly been achieved within the FP7 HANDOVER project. Europe's medical schools need additional support to implement the toolbox into their medical education system. Therefore, a follow-up implementation project was designed that will apply the toolbox in three University Hospitals in Germany, Spain, and Ireland.
• A submitted manuscript is the version of the article upon submission and before peer-review. Th... more • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
or visit the DOI to the publisher's website. • The final author version and the galley proof are ... more or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
The aim of this study was to compare student learning patterns in higher education across differe... more The aim of this study was to compare student learning patterns in higher education across different cultures. A meta-analysis was performed on three large-scale studies that had used the same research instrument: the Inventory of learning Styles (ILS). The studies were conducted in the two Asian countries Sri Lanka and Indonesia and the European country The Netherlands. Students reported use of learning strategies, metacognitive strategies, conceptions of learning and learning orientations were compared in two ways: by analyses of variance of students' mean scale scores on ILS scales, as well as by comparing the factor structures of the ILS-scales between the three studies. Results showed most differences in student learning patterns between Asian and European students. However, many differences were identified between students from the two Asian countries as well. The Asian learner turned out to be a myth. Moreover, Sri Lankan students made the least use of memorising strategies of all groups. That Asian learners would have a propensity for rote learning turned out to be a myth as well. Some patterns of learning turned out to be universal and occurred in all groups, other patterns were found only among the Asian or the European students. The findings are discussed in terms of learning environment and culture as explanatory factors. Practical implications for student mobility in an international context are derived.
Education for Health: Change in Learning & Practice, 2002
Introduction: There are few published studies that address the problem of dysfunctional tutorial ... more Introduction: There are few published studies that address the problem of dysfunctional tutorial groups. Most studies are restricted to student or faculty opinions separately and to speci c aspects affecting the tutorial group function. This study examined teacher and student perceptions of frequency and importance of problems observed in tutorial groups in a new PBL program. Methods: Tutors (n=30) and students in the second (n=75) and third (n=53) year completed a questionnaire at the beginning of the 1999 academic year. The questionnaire had 33 items grouped as seven ''factors'' related to tutor performance, feedback, assessment, educational resources, student performance, educational problems and external factors Results: The most important problems identi ed were related to tutors (mainly in training aspects) and students (mainly in problem discussion). Students and feedback (quality) were the most frequent. There were statistically signi cant differences between tutors' and students ' (higher) and between second and third year (higher) students' perceptions of different factors. Conclusions: (1) Marilia Medical School (FAMEMA) has problems in the tutorial group function mainly related to contributions of students and tutors. (2) Students' and tutors' opinions, as well as those of second and third year students, differ and therefore all need to be consulted to solve tutorial group problems. ( There is a need for continued evaluation of problem-based learning at FAMEMA. We must look at perceptions of students from all years.
• A submitted manuscript is the version of the article upon submission and before peer-review. Th... more • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
A study was undertaken to investigate the validity of a progress test, the Maastricht Progress Te... more A study was undertaken to investigate the validity of a progress test, the Maastricht Progress Test, that was designed to measure knowledge and clinical reasoning growth in a problem-based medical curriculum. Scores and subscores of about 40 students per year (total sample of 195) on the different categories of the progress test were compared with scores on a clinical reasoning test. Both tests revealed the same pattern of increasing scores over the years, and they had a high correlation. Further analyses revealed that the clinical science component, in particular, of the progress test explained the variations in the clinical reasoning test scores. Knowledge of behavioral sciences had a small but independent contribution. Outcomes are discussed from the perspectives of research and theory on the development of medical expertise, and educational consequences are discussed. An appendix contains an example problem. (Contains one table, three figures, and four references.) (Author/SLD)
International Conference of Learning Sciences, Jun 24, 2008
This study investigates success and failure factors related to workplace simulation learning in D... more This study investigates success and failure factors related to workplace simulation learning in Dutch pre-vocational secondary education. Research in other practical settings indicates that self-directed learning, self-regulated learning and deliberate practice are key competencies that positively affect learning outcomes. A focus group study with 20 teachers and 35 students was conducted. Similarities and discrepancies between theory and practice are put forward. For instance, not offering choices interferes with a self-directed learning approach.
or visit the DOI to the publisher's website. • The final author version and the galley proof are ... more or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
Advances in Health Sciences Education, Jul 18, 2018
Visual problem solving is essential to highly visual and knowledge-intensive professional domains... more Visual problem solving is essential to highly visual and knowledge-intensive professional domains such as clinical pathology, which trainees learn by participating in relevant tasks at the workplace (apprenticeship). Proper guidance of the visual problem solving of apprentices by the master is necessary. Interaction and adaptation to the expertise level of the learner are identified as key ingredients of this guidance. This study focuses on the effect of increased participation of the learner in the task on the interaction and adaptation of the guidance by masters. Thirteen unique dyads consisting of a clinical pathologist (master) and a resident (apprentice) discussed and diagnosed six microscope images. Their dialogues were analysed on their content. The dyads were divided in two groups according to the experience of the apprentice. For each dyad, master and apprentice both operated the microscope for half of the cases. Interaction was operationalised as the equal contribution of both master and apprentice to the dialogue. Adaptation was operationalised as the extent to which the content of the dialogues was adapted to the apprentice's level. The main hypothesis stated that the interaction and adaptation increase when apprentices operate the microscope. Most results confirmed this hypothesis: apprentices contributed more content when participating more and the content of these dialogues better reflected expertise differences of apprentices. Based on these results, it is argued that, for learning visual problem solving in a visual and knowledge-intensive domain, it is not only important to externalise master performance, but also that of the apprentice.
One of the processes supposed to take place during development toward medical expertise is knowle... more One of the processes supposed to take place during development toward medical expertise is knowledge encapsulation. In this process detailed biomedical concepts are gradually clustered together and reorganized under fewer, clinically relevant terms. A large-scale investigation was made of the process of biomedical knowledge application using subjects of expertise level not too far apart to enable a more detailed analysis of the developmental path. Data indicate that the process of encapsulation is not as smooth as hypothesized. In the first year of the 2-year clerkship period a sharp decrease in the application of biomedical knowledge was observed. Two hypotheses to explain this phenomenon were explored but neither of them could explain the results. However, the finding that the first clerkship year results in a dip in clinical reasoning is a consistent finding and some educational and practical differences that may contribute to this finding are discussed. Three tables and five figures of data are included. (Author/JRH)
Onderzocht is of korte-casusvragen andere denkprocessen teweegbrengen dan feitenkennisvragen. Met... more Onderzocht is of korte-casusvragen andere denkprocessen teweegbrengen dan feitenkennisvragen. Methode: Aan tien huisartsen (experts) en tien studenten (novieten) werden vier casusvragen en zestien inhoudelijk overeenkomende feitenkennisvragen voorgelegd. De vragen werden mondeling beantwoord waarbij het hele denkproces zoveel mogelijk hardop verwoord werd. Op grond van psychometrisch en cognitief psychologisch onderzoek zijn drie indicatoren voor analyse van het denkproces gedefinieerd: 1) de hoeveelheid informatie uit de vraag, die herhaald werd, 2) het aantal direct gegeven antwoorden en 3) het type overwegingen: juist/onjuist-overwegingen of overwegingen met een bepaalde waarde en richting (vectoren). Resultaten: Bij de casusvragen herhaalden de studenten informatie uit de stam en de bijbehorende vraag significant vaker dan de huisartsen en gaven de huisartsen vaker direct antwoord dan de studenten. Deze verschillen werden niet gevonden bij de feitenkennisvragen. Feitenkennisvragen lokten met name juist/onjuist-overwegingen uit, terwijl casusvragen vooral leidden tot vectoroverwegingen.
A study examined the application and availability of clinical and biomedical knowledge in the cli... more A study examined the application and availability of clinical and biomedical knowledge in the clinical reasoning of physicians as well as possible mechanisms responsible for changes in the organization of clinical and biomedical knowledge in the development from novice to expert. Subjects ustre 28 students (10 second year, 8 fourth year, and 10 fifth year) and 10 family physicians with at least 4 years of experience. Subjects were presented with either a typical or atypical case of pancreatitis which they were to diagnose while thinking aloud and then to describe by writing out the pathophysiological processes they believed to underlie the case. Level of expertise correlated with number of case findings subjects responded to with knowledge application propositions. Fourth year students applied the most knowledge propositions and fifth year and experienced physicians the least. Results suggested that the overt role of biomedical knowledge in expert clinical reasoning is virtually absent, though this knowledge has not decreased but increased. Comparison of the overlap between applied and available knowledge suggested that, in approaching the unstructured information of the atypical case, clinical knowledge was preferred over biomedical knowledge. It is concluded that biomedical knowledge becomes increasingly integrated in the clinical knowledge base with increasing expertise. Contains 11 references. (DB)
A study investigated the 'mown phenomenon of "intermediate effect" in which medical students with... more A study investigated the 'mown phenomenon of "intermediate effect" in which medical students with an intermediate amount of knowledge and experience demonstrate higher amounts of recall of the text of a medical case than either experienced clinicians or novices. In this study the amount of activation of prior knowledge was controlled by having subjects--24 fourth-and 24 sixth-year medical students at the University of Limburg (Netherlands) and 6 internists--spend either 30 seconds or 3.5 minutes recalling whatever they knew about endocarditis before being presented with an endocarditis case to comprehend and recall. Findings indicated that the more time subjects had available the more knowledge about the subject they were able to produce; that the amount of prior knowledge produced is a function of level of expertise (physicians produced more information than students); but that "experts" (physicians and sixth-year students) recalled less information but more relevant information about the case than did intermediates (fourth-year students). The results supported the theory that experienced physicians develop cognitive structures or "illness scripts" which they use to automatically represent a case. Contains 14 references. (DB)
Introduction: Students adapt their learning strategies, orientations and conceptions to differenc... more Introduction: Students adapt their learning strategies, orientations and conceptions to differences in the learning environment. The new curriculum of the Faculty of Medicine, University of Peradeniya, Sri Lanka, which commenced in 2005, puts greater emphasis on student-centred learning. The aim of this study was to compare the learning strategies, orientations and conceptions measured by means of a validated Sri Lankan version of the Inventory of Learning Styles (ILS) at the end of the first academic year for a traditional curriculum student group and a new curriculum student group. Materials and Methods: The Adyayana Rata Prakasha Malawa (ARPM) 130-item Sinhala version of the ILS was administered to students of the traditional curriculum and the new curriculum at the end of their first academic year respectively. Mean scale scores of the 2 groups were compared using independent sample t-test. Results: Students of the new curriculum reported the use of critical processing, concrete...
The present study examined the long-term impact of a formative assessment intervention in primary... more The present study examined the long-term impact of a formative assessment intervention in primary education on the development of students’ levels of self-regulation, motivation, and self-efficacy after their transition to secondary education. Participants in the study included 695 Dutch sixth graders from 17 schools. A longitudinal design with measurements on three time points was adopted. The first part of the study, consisting of a pretest, the intervention, and posttest, was conducted during the students’ last 7 months in primary education using two experimental conditions, with peer- and self-assessment, and a control condition. A follow-up took place 10 weeks later, after the summer break and at the commencement of the participants’ secondary education. Longitudinal multilevel analyses showed that the development of self-regulation and motivation is significantly positively associated with the formative self- and peer-assessment interventions and continues after the transition...
Advanced Models of Cognition for Medical Training and Practice, 1992
This contribution concerns the knowledge structures of medical students and physicians. More spec... more This contribution concerns the knowledge structures of medical students and physicians. More specifically, it deals with how these structures change through their application to relevant tasks. We present evidence in favor of a cognitive mechanism that we have labeled "encapsulation". Encapsulation, we believe, plays a key role in the transition from intermediate competence to expert competence in the medical domain. The ideas to be outlined in this paper arose in the context of the clinical case comprehension paradigm developed by Patel and her colleagues at McGill (e.g., Patel & Groen 1986), which is also extensively used in our own lab (Schmidt & Boshuizen 1992a). In addition, corroborating evidence from think-aloud studies is presented. Much is already known about how existing knowledge operates in the understanding of new information, which factors are involved in its activation, and the extent to which it permeates our comprehension of the world. The studies of on contextual activation, those of on schema shifts, the experiments of Spilich, Vesonder, Chiesi and Voss (1979) on recall of information by highand low-knowledge subjects, and, more generally, studies of expert-novice differences in various domains (e.g., Chase & Simon 1973; Chi et al. 1981; Lesgold 1984), all show that the particular knowledge available to subjects determines to a great extent how they perform in relevant domains. Much less, however, is known about the exact nature of the knowledge structures that are employed in real-life tasks such as playing chess, solving physics problems, or understanding clinical cases. Our knowledge of how these structures look is largely theoretical and the subject of ongoing debate. The prevalent point of view, namely, that knowledge is primarily organized in schemata ), scripts (Schank & Abelson 1977) or frames (Minsky 1975) containing variables and slots, has trouble explaining comprehension of non-prototypic situations. In addition, schemata and the accompanying notion of expectation-based processing of new information are found to be far too rigid to account for the complexity of actual learning taking place. If all processing is expectation-based, how can one ever learn something that one didn't already know? More recent proposals emphasize the idea D. A. Evans et al. (eds.
Safe and effective patient handovers remain a global organizational and training challenge. The W... more Safe and effective patient handovers remain a global organizational and training challenge. The World Health Organization (WHO) lists effective handovers as one of its High 5 patient safety initiatives. Training for handover competencies is a promising approach to improve the quality of handovers. We present the Handover toolbox that aims to support different stakeholders (e.g. general practitioners, nurses, medical trainer, experts in patient handover, and medical students) to provide customized handover training for specific demands. The Handover toolbox was designed in the context of the FP7 HANDOVER project from April 2009 until October 2011 by using the Technology Enhanced Learning Design Process (TEL-DP). TEL-DP consisted of six different methods: 1). User requirements analysis; 2). Writing personas; 3). Group Concept Mapping 4). Analysis of suitable software; 5). Plus-Minus-Interesting rating; and 6). Usability testing. TEL-DP is aligned to participatory design approaches and guaranteed a development process in close collaboration with the stakeholders. From method (1) it appeared that different kinds of trainings are needed that allow to train professionals on the job as well as medical students in their studies. Methods (2) and (3) made clear that training experts from different countries differed in their views on the desired content and delivery of handover training. This means that a onesize-fits-all training was not applicable rather a customisable learning approach, a toolbox, that allow trainers to design their own training for various target groups with specific handover information needs was a far better solution. Method (4) identified the most suitable ready-to-use software systems that provided the required functionalities and could be further customized to the needs of the users. Method ( ) and ( ) resulted in several points for improvement of the Handover toolbox, mainly related to improved usability and navigation. Until the end of the development process in October 2011, 165 training experts were attracted by the toolbox and signed up for the system. Conclusions We developed a Handover toolbox for different stakeholders who are interested in improving handovers through customized training and learning. Its design is based on a carefully stakeholder investigation, using the TEL-DP approach which is a systematic and comprehensive design approach. It provides state of the art content about 40 handover tools with practical guidelines, a generic training design that can be customized to specific handover training needs, and enables community members to contribute own experiences and best practice examples. Next to this content, it offers an easy to use e-learning environment to support trainers in their handover classes. The developments can only be seen as a first supportive step to achieve a better patient safety. The final implementation phase of the toolbox has only partly been achieved within the FP7 HANDOVER project. Europe's medical schools need additional support to implement the toolbox into their medical education system. Therefore, a follow-up implementation project was designed that will apply the toolbox in three University Hospitals in Germany, Spain, and Ireland.
• A submitted manuscript is the version of the article upon submission and before peer-review. Th... more • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
or visit the DOI to the publisher's website. • The final author version and the galley proof are ... more or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User
The aim of this study was to compare student learning patterns in higher education across differe... more The aim of this study was to compare student learning patterns in higher education across different cultures. A meta-analysis was performed on three large-scale studies that had used the same research instrument: the Inventory of learning Styles (ILS). The studies were conducted in the two Asian countries Sri Lanka and Indonesia and the European country The Netherlands. Students reported use of learning strategies, metacognitive strategies, conceptions of learning and learning orientations were compared in two ways: by analyses of variance of students' mean scale scores on ILS scales, as well as by comparing the factor structures of the ILS-scales between the three studies. Results showed most differences in student learning patterns between Asian and European students. However, many differences were identified between students from the two Asian countries as well. The Asian learner turned out to be a myth. Moreover, Sri Lankan students made the least use of memorising strategies of all groups. That Asian learners would have a propensity for rote learning turned out to be a myth as well. Some patterns of learning turned out to be universal and occurred in all groups, other patterns were found only among the Asian or the European students. The findings are discussed in terms of learning environment and culture as explanatory factors. Practical implications for student mobility in an international context are derived.
Education for Health: Change in Learning & Practice, 2002
Introduction: There are few published studies that address the problem of dysfunctional tutorial ... more Introduction: There are few published studies that address the problem of dysfunctional tutorial groups. Most studies are restricted to student or faculty opinions separately and to speci c aspects affecting the tutorial group function. This study examined teacher and student perceptions of frequency and importance of problems observed in tutorial groups in a new PBL program. Methods: Tutors (n=30) and students in the second (n=75) and third (n=53) year completed a questionnaire at the beginning of the 1999 academic year. The questionnaire had 33 items grouped as seven ''factors'' related to tutor performance, feedback, assessment, educational resources, student performance, educational problems and external factors Results: The most important problems identi ed were related to tutors (mainly in training aspects) and students (mainly in problem discussion). Students and feedback (quality) were the most frequent. There were statistically signi cant differences between tutors' and students ' (higher) and between second and third year (higher) students' perceptions of different factors. Conclusions: (1) Marilia Medical School (FAMEMA) has problems in the tutorial group function mainly related to contributions of students and tutors. (2) Students' and tutors' opinions, as well as those of second and third year students, differ and therefore all need to be consulted to solve tutorial group problems. ( There is a need for continued evaluation of problem-based learning at FAMEMA. We must look at perceptions of students from all years.
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