How cognitive psychology changed the face of medical education research

Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar

Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.

Programmatic Assessment of Clinical Reasoning: New Opportunities to Meet an Ongoing Challenge

Issue: Clinical reasoning is essential to physicians' competence, yet assessment of clinical reasoning remains a significant challenge. Clinical reasoning is a complex, evolving, non-linear, context-driven, and content-specific construct which arguably cannot be assessed at one point in time or with a single method. This has posed challenges for educators for many decades, despite significant development of individual assessment methods. Evidence: Programmatic assessment is a systematic assessment approach that is gaining momentum across health professions education. Programmatic assessment, and in particular assessment for learning, is well-suited to address the challenges with clinical reasoning assessment. Several key principles of programmatic assessment are particularly well-aligned with developing a system to assess clinical reasoning: longitudinality, triangulation, use of a mix of assessment methods, proportionality, implementation of intermediate evaluations/reviews with faculty coaches, use of assessment for feedback, and increase in learners' agency. Repeated exposure and measurement are critical to develop a clinical reasoning assessment narrative, thus the assessment approach should optimally be longitudinal, providing multiple opportunities for growth and development. Triangulation provides a lens to assess the multidimensionality and contextuality of clinical reasoning and that of its different, yet related components, using a mix of different assessment methods. Proportionality ensures the richness of information on which to draw conclusions is commensurate with the stakes of the decision. Coaching facilitates the development of a feedback culture and allows to assess growth over time, while enhancing learners' agency. Implications: A programmatic assessment model of clinical reasoning that is developmentally oriented, optimizes learning though feedback and coaching, uses multiple assessment methods, and provides opportunity for meaningful triangulation of data can help address some of the challenges of clinical reasoning assessment.

Redefining the Role of Medical Affairs Professionals as Innovators and Leaders in Industry-Led Medical Education

Medical affairs professionals are pivotal players at the intersection of medical innovation and practice in the pharmaceutical industry. They are uniquely positioned to translate complex medical knowledge into actionable insights for internal and external stakeholders. Industry-led continuing medical education (CME) programs, guided by these professionals, hold the potential to markedly improve clinicians' application of evidence-based medicine (EBM) in clinical settings, thereby elevating patient care outcomes. However, current CME techniques often overlook the integration of diverse disciplines such as educational theories, cognitive psychology, information mastery, and implementation science, which are important for effective real-time decision-making in patient care. This gap in integrating implementation science is vital, as it is key in ensuring that medical innovations are not just developed but also effectively implemented and efficiently utilized in clinical settings. In this opinion article, we aim to highlight the crucial yet often underrecognized role of medical affairs professionals in shaping robust and practical CME programs within the industry. We explore emerging trends and approaches in medical education and CME based on the principles of adult education. Additionally, we explore how medical affairs professionals can effectively drive the adoption of EBM in clinical practice. This exploration aims to provide insights into enhancing CME programs, with medical affairs professionals at the forefront of innovation and leadership in bridging gaps in clinical practice.

A blended approach to developing psychomotor skills in novice learners in a doctor of physical therapy curriculum

PURPOSE

Psychomotor skill performance is central to effective clinical practice across health professions. These complex skills are challenging to teach, particularly in the novice learner. As many health professions programs have increased blended course offerings, educators must establish best practices for teaching psychomotor skills in this evolving learning environment. The purpose of this paper is to describe the innovative application of an evidence-based framework to teaching psychomotor skills to novice learners in a blended learning environment.

MATERIALS AND METHODS

Using a modified 9-step framework, two novice clinical skills courses in a Doctor of Physical Therapy Program were redesigned to teach psychomotor skills in a blended format, using online and in-person class sessions. Online coursework consisted of synchronous and asynchronous learning activities that preceded an immersive lab experience. Formative and summative assessments occurred during lab immersion.

RESULTS AND CONCLUSIONS

The learning framework provided a central evidence-based pillar for novel course design, guiding development of learning activities for teaching psychomotor skills to novice learners in a blended learning environment. Initial student outcomes appear favorable when compared with previous traditional course structures and satisfaction was high. These preliminary findings align with prior research using similar frameworks for learning complex skills and provide an archetype curricular model for a blended learning environment.

Transformation and Articulation of Clinical Data to Understand Students' and Health Professionals' Clinical Reasoning: Protocol for a Scoping Review

BACKGROUND

There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence.

OBJECTIVE

The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals' transformation and articulation of clinical data.

METHODS

This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions.

RESULTS

After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024.

CONCLUSIONS

By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners' developing competencies and educational progress.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50797.

Using instructor-developed study resources to increase evidence-based learning strategies among medical students: A mixed-methods study

PURPOSE

Applying effective learning strategies to address knowledge gaps is a critical skill for lifelong learning, yet prior studies demonstrate that medical students use ineffective study habits.

METHODS

To address this issue, the authors created and integrated study resources aligned with evidence-based learning strategies into a medical school course. Pre-/post-course surveys measured changes in students' knowledge and use of evidence-based learning strategies. Eleven in-depth interviews subsequently explored the impact of the learning resources on students' study habits.

RESULTS

Of 139 students, 43 and 66 completed the pre- and post-course surveys, respectively. Students' knowledge of evidence-based learning strategies was unchanged; however, median time spent using flashcards (15% to 50%, p < .001) and questions (10% to 20%, p = .0067) increased while time spent creating lecture notes (20% to 0%, p = .003) and re-reading notes (10% to 0%, p = .009) decreased. In interviews, students described four ways their habits changed: increased use of active learning techniques, decreased time spent creating learning resources, reviewing content multiple times throughout the course, and increased use of study techniques synthesizing course content.

CONCLUSION

Incorporating evidence-based study resources into the course increased students' use of effective learning techniques, suggesting this may be more effective than simply teaching about evidence-based learning.

Perceptions and Experiences of Undergraduate Students Regarding Social Media as a Tool for Government COVID-19-Related Messages: A Qualitative Study in Nottingham, UK

The rise of social media has given way to its use as a form of public health communication. Previous research has shown social media-based interventions to be effective, particularly for university students. Social media was used as a tool for public health messaging during the COVID-19 pandemic; however, there is a lack of information regarding the experiences and perceptions of such messaging and its effectiveness among UK university students. A qualitative study was conducted to explore the perceptions and experiences of public health messaging on social media during the pandemic, as well as the effects of such messaging. Fourteen semi-structured interviews with undergraduate students at the University of Nottingham, UK, were conducted. Five main themes were identified: effects of COVID-19 on university students, use of social media by university students, COVID-19 messaging on social media, effects of public health messaging on social media in compliance with COVID-19 guidelines, and improving public health messaging for the future. This study provides a novel insight into the experiences and perceptions of undergraduate students at a UK university regarding public health messaging on social media during the COVID-19 pandemic.

Framework and Schema are False Synonyms: Defining Terms to Improve Learning

Clinical reasoning is an essential expertise of health care professionals that includes the complex cognitive processes that lead to diagnosis and management decisions. In order to optimally teach, learn, and assess clinical reasoning, it is imperative for teachers and learners to have a shared understanding of the language. Currently, educators use the terms schema and framework interchangeably but they are distinct concepts. In this paper, we offer definitions for schema and framework and use the high-stakes field of aviation to demonstrate the interplay of these concepts. We offer examples of framework and schema in the medical education field and discuss how a clear understanding of these concepts allows for greater intentionality when teaching and assessing clinical reasoning.

Using Evidence-Based Learning Strategies to Improve Medical Education

Medical education research has been adopting principles from psychology to improve student learning. Here is an overview and illustrative examples of six evidence-based learning strategies that have been thoroughly researched and validated in the psychology literature: spacing, interleaving, retrieval practice, elaboration, dual coding, and concrete examples. For each of these, their use within medical education and considerations that may influence efficacy are discussed. Medical education researchers should collaborate more with psychology researchers in transdisciplinary teams to better implement these strategies and more directly benefit from advances made in the psychology literature.

Longitudinal Interleaved Residency Training: A Consensus Definition

BACKGROUND AND OBJECTIVES

Cognitive benefits of longitudinal curricula and interleaving have been demonstrated in several disciplines. However, most residency curricula are structured in a block format. There is no consensus definition as to what constitutes a longitudinal program, making comparative research on curricular efficacy a challenge. The objective of our study was to arrive at a consensus definition of Longitudinal Interleaved Residency Training (LIRT) in family medicine.

METHODS

A national workgroup was convened and utilized a Delphi method between October 2021 and March 2022 to arrive at a consensus definition.

RESULTS

Twenty-four invitations were sent, and 18 participants initially accepted. The final workgroup (n=13) was representative of the nationwide diversity of family medicine residency programs in terms of geographic location (P=.977) and population density (P=.123). The following definition was approved: "LIRT is a curricular design and program structure that offers graduated, concurrent clinical experiences in the core competencies of the specialty. LIRT models the comprehensive scope of practice and continuity that defines the specialty; applies training methods that enhance long-term retention of knowledge, skills, and attitudes across all dimensions and locations of care delivery; and accomplishes program objectives through employment of longitudinal curricular scheduling and interleaving with spaced repetition." Additional technical criteria and definitions of terms are elucidated in the body of this article.

CONCLUSIONS

A representative national workgroup crafted a consensus definition of Longitudinal Interleaved Residency Training (LIRT) in family medicine, a program structure with a basis in emerging evidence-based cognitive science.

Twelve tips for physicians’ mastering expertise in diagnostic excellence

Diagnostic errors, which account for a large proportion of medical errors, are a global medical challenge. The slogan of reducing diagnostic errors has recently shifted to a new strategy of diagnostic excellence, the core of which is the importance of improving the multidisciplinary diagnostic process. Many of the elements and strategies necessary for diagnostic excellence have been presented. In the context of this diagnostic improvement, some reports have been structured to improve the quality of performance of individual physicians as players. Still, surprisingly, only a few reports have focused on specific day-to-day training strategies for the diagnostic thinking process as expertise. This paper focuses on this point and proposes strategies for refining the diagnostic thinking expertise of frontline physicians in the new era, based on the following four elements: knowledge and experience, diagnostic thinking strategies, information management skills, and calibration and reflection.

Study smart - impact of a learning strategy training on students' study behavior and academic performance

Recent research shows the importance to teach students the self-regulated use of effective learning strategies at university. However, the effects of such training programs on students' metacognitive knowledge, use of learning strategies, and academic performance in the longer term are unknown. In the present study, all first-year pharmacology students from one university attended a learning strategy training program, i.e., the 'Study Smart program', in their first weeks. The 20% (n = 25) lowest scoring students on the first midterm received further support regarding their learning strategies. Results showed that all students gained accurate metacognitive knowledge about (in)effective learning strategies in the short- and long-term and reported to use less highlighting, less rereading, but more interleaving, elaboration, and distributed practice after the training program. Academic performance was compared to the prior cohort, which had not received the Study Smart program. While in the previous cohort, students in the top, middle, and bottom rank of midterm 1 stayed in these ranks and still differed significantly in the final exam, students in the Study Smart cohort that received the training program improved throughout the year and differences between ranks were significantly reduced. A learning strategy training program including a remediation track for lower performing students can thus support students to study more effectively and enhance equal chances for all students at university.

How Medical Students Apply Their Biomedical Science Knowledge to Patient Care in the Family Medicine Clerkship

Medical students enter clerkships with the requisite biomedical science knowledge to engage in supervised patient care. While poised to apply this knowledge, students face the cognitive challenge of transfer: applying knowledge learned in one context (i.e., preclinical classroom) to solve problems in a different context (i.e., patients in the clinic). To help students navigate this challenge, a structured reflection exercise was developed using Kolb's experiential learning cycle as an organizing framework. Students selected a patient encounter (concrete experience), wrote and addressed biomedical science learning objectives related to the care of the patient (reflective observation), reflected on how addressing the learning objectives influenced patient care (abstract conceptualization), and described their attending engaging in a similar process (active experimentation). A directed content analysis of students' written reflections revealed that most students wrote clinical science learning objectives in addition to biomedical science learning objectives. When viewed through the lenses of knowledge encapsulation theory and illness script theory, some students recognized knowledge encapsulation as a process beginning to occur in their own approach and their attendings' approach to clinical reasoning. Students readily applied their biomedical science knowledge to explain the pathophysiologic basis of disease (fault illness script domain) and signs and symptoms (consequence illness script domain), with fewer addressing predisposing conditions (enabling conditions illness script domain). Instances in which students observed their attending applying biomedical science knowledge were rare. Implications for using structured reflective writing as a tool to facilitate student application of their biomedical science knowledge in clerkships are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01697-5.

Diagnostic Schemas: Form and Function

Diagnostic schemas are frameworks that depict organized clinical knowledge and serve as a bridge between problem representation and differential diagnosis generation. Schema-based problem solving is increasingly used among clinician educators and is widely featured in digital media. We examine the origins of schemas and their theoretical background, review existing literature on their applications in medicine, and explore their utility for learners and teachers.

Clinical Practicum Assessment for Biomedical Science Program from Graduates' Perspective

The clinical practicum for biomedical science students aims to provide graduates with the knowledge and skills required to work in diagnostic laboratory settings. This study examines graduates' perspectives on content, teachers and clinical training and their satisfaction rates based on the skills gained during training. The study was conducted on females who graduated from Qatar University between 2015 and 2020. We used a previously validated questionnaire called CPAT-QU. Telephonic interviews were conducted and were analyzed using SPSS. The results showed a high satisfaction rate, of 80%, for the content and organization of the clinical training. The participants' main concerns included the evaluation criteria, as 8.7% were not satisfied. The students suggested increasing the length of the training in order to obtain experience that was more practical. The students' satisfaction with the teachers was 70% in terms of their attitude, command of knowledge and ability to convey knowledge. In total, 69.5% of the graduates claimed that their instructors were interested in teaching and 4.4% claimed their instructors conveyed disinterest in teaching. The Qatar University graduates were satisfied with the content of their clinical training. However, they reported some gaps in this training. Identifying these gaps will help in restructuring clinical training to improve student experience.

A Novel Deep Framework for English Communication Based on Educational Psychology Perspective

The impact of verbal reading practices on learning is examined from the perspective of educational psychology, using the motivation theory and the schema theory. This research intends to enhance learner's English communication abilities in response to the needs for national economic growth and scientific and technological development. To motivate students to improve their English, the research may address the issue of inadequate opportunities by adding an artificial intelligence (AI) conversation mechanism to the students speaking English exercise. First, cognitive psychology is analyzed in detail, and a model based on cognitive psychology is implemented to solve the problems existing in student's English communication. In addition, various measures are presented and used to increase student's oral English communication abilities. We used sixty students from North China University of Water Resources and Electric Power are separated into two classes: Class A and Class B. The experimental group is called Class A, while the control group is called Class B. Following a comparison of the outcomes obtained before and after training. The experimental group's reading comprehension, responding to questions, situational conversation, and subject description scores rose by 13.33, 15.19, 17.39, and 28.3 %, respectively. The overall average score of the class climbed by 17.75 %, whereas the scores of pupils in Class B improved just an undersized. The results reveal that following the vocalized reading exercise, the student's English grades, self-efficacy, and topic knowledge increased considerably in the experimental group. Moreover, the proposed model, employs computer simulation in the English communication teaching system and AI, which can aid in the creation of an interactive learning environment for students to improve their spoken English and English communication abilities.

The "Neurospeed" game: a fun tool to learn the neurological semiology

BACKGROUND

Neurological semiology is often considered by medical students as particularly difficult to learn. Finding alternative teaching methods may improve students' motivation and understanding of this field.

METHODS

We developed the "Neurospeed", a game to learn neurological syndromes. We assessed its efficiency on short-term learning of neurological syndromes in third-year medical students, through Multiple Choice Questions (MCQs) before and after the game session. Students' satisfaction was evaluated by a satisfaction survey.

RESULTS

Out of the 199 third-year medical students of the Faculty of Medicine Sorbonne Paris Nord, 180 attended the Neurospeed in December 2020, and 148 answered 20 Multiple Choice Questions before and after the game, with significant improvement of their score (p < 0.001). Most of the participants agreed that the game was playful, stimulating, and helpful to learn neurological semiology.

CONCLUSIONS

Overall, our results show that the Neurospeed game is an interesting tool as a complement to traditional lectures. Further studies are necessary to compare the efficacy of different types of serious games on short-term and long-term learning of neurological semiology.

Health professions education scholarship: The emergence, current status, and future of a discipline in its own right

Medical education, as a domain of scholarly pursuit, has enjoyed a remarkably rapid development in the past 70 years and is now more commonly known as health professions education (HPE) scholarship. Evidenced by a solid increase of publications, numbers of specialized journals, professional associations, national and international conferences, academies for medical educators, masters and doctoral courses, and the establishment of many units of HPE scholarship, the domain of HPE education scholarship has matured into a scholarly discipline in its own right. In this contribution, the author reviews the developments of the field from Boyer's four criteria that determine scholarship: discovery, integration, application, and teaching. Born mid-20th century, and in the first decades developed in the predominant area of physician education, HPE scholarship has matured, with increasing breadth, depth, and volume of scholars, publications, conferences, and dedicated centers for research and development. The author concludes that, given the infrastructure that has emerged, HPE can arguably be considered a discipline in its own right. This academic question may not matter hugely for practices of scholarly work in this domain, and any stance in this academic debate inevitably reflects a personal view, but the author would support the view of health professions scholarship as being a unique niche, with inherent dependence on both medical and other health professional sciences, on the one hand, and social sciences, including educational sciences, on the other hand.