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Senior A, Starchuk C, Gaudet-Amigo G, Green J, Patterson S, Perez A. A novel model for curriculum design: Preparation, planning, prototyping, and piloting. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024. [PMID: 38520077 DOI: 10.1111/eje.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
Dental education continuously strives to provide students with positive and meaningful learning experiences. Developing or improving a curriculum usually encompasses three main phases: design, implementation, and evaluation. Most research on curriculum development in dental education has focused on the last two phases. Our commentary addresses this gap by describing a new model for curriculum design that effectively guided the design phase of the complete overhaul of the four-year Doctor of Dental Surgery curriculum at the School of Dentistry, University of Alberta. Built on the strengths of pre-existing curriculum design models, the new model provided enough structure and rigour to support the complexity required during a complete curriculum redesign whilst still allowing sufficient consultation and flexibility to encourage stakeholder engagement. The steps of the new 4P's model (preparation, planning, prototyping, and piloting) and main actions within each step are described. Challenges observed in each step and strategies to address them are reported. Other institutions embarking on renewing or redesigning a curriculum at a program level may benefit from using a curriculum design process similar to the 4P's model. Recommendations are discussed including the inclusion of educational consultants in the curriculum renewal committee, the importance of a leadership that effectively supports curriculum reform, purposeful engagement of stakeholders during each step of the design phase and ensuring that project and change management occur concurrently.
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Affiliation(s)
- Anthea Senior
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen Starchuk
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jacqueline Green
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Patterson
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Haramati A, Bonaminio G, Osheroff N. Professional Identity Formation of Medical Science Educators: An Imperative for Academic Medicine. MEDICAL SCIENCE EDUCATOR 2024; 34:209-214. [PMID: 38510409 PMCID: PMC10948639 DOI: 10.1007/s40670-023-01922-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 03/22/2024]
Abstract
Medical schools increasingly seek the expertise of talented medical science faculty to engage in the educational mission of the school; yet, the professional identity of these individuals is in flux. As courses and departments have become more integrated and less discipline-based, faculty with doctorates in biomedical science disciplines who primarily teach may suffer a loss of connection to their discipline, either in the courses they are teaching or in their home departments. Recent reports suggest that most medical science educators transitioned from the laboratory to the classroom by happenstance-not the most ideal way to build this key segment of the faculty. This article addresses the importance of foundational sciences in medical training, highlights the unique contributions of science educators in medical schools, and makes a case for why the professional identity of medical science educators should be studied. An imperative for academic medicine is to understand the factors that underpin the professional identity formation of medical science educators and to invest in training and nurturing this group of faculty members that are vital to educating the next generation of health professionals.
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Affiliation(s)
- Aviad Haramati
- Department of Biochemistry, Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC 20057 USA
- Center for Innovation and Leadership in Education (CENTILE), Georgetown University School of Medicine, Washington, DC 20057 USA
| | - Giulia Bonaminio
- Department of Family Medicine and Community Health, The University of Kansas School of Medicine, Kansas City, KS USA
| | - Neil Osheroff
- Departments of Biochemistry and Medicine, Vanderbilt University School of Medicine, Nashville, TN USA
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3
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Fulton TB, Nixon LJ, Wilson-Delfosse AL, Harris DM, Ngo KD, Fall LH, O'Brien BC. Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design. MEDICAL TEACHER 2023:1-7. [PMID: 38100767 DOI: 10.1080/0142159x.2023.2289848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them. MATERIALS AND METHODS We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project. RESULTS BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions. CONCLUSIONS BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - L James Nixon
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - David M Harris
- Department of Medical Education, University of Central Florida, Orlando, FL, USA
| | - Khiet D Ngo
- Departments of Medical Education and Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Departments of Pediatrics and Undergraduate Medical Education, University of California, Riverside, CA, USA
| | - Leslie H Fall
- Center for Medical Education, Case Western Reserve University, Cleveland, OH, USA
- Aquifer, Inc, Hanover, NH, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, CA, USA
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Allison S, Mueller C, Lackey-Cornelison W. Structure and function: how to design integrated anatomy and physiology modules for the gross anatomy laboratory. Front Physiol 2023; 14:1250139. [PMID: 37614758 PMCID: PMC10442568 DOI: 10.3389/fphys.2023.1250139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
Physicians must be able to integrate knowledge across disciplines. Therefore, educators need to provide opportunities for students to cognitively integrate information across the medical school curriculum. Literature has shown that specifically pointing out these connections helps students create cause and effect models and ultimately improve their performance. The gross anatomy laboratory provides an excellent environment for students to integrate information by establishing structure and function relationships. This article presents simple steps to create modules which help students cognitively integrate physiology and anatomy at the session level in the gross anatomy laboratory. Driven by backward design, these steps include establishing objectives, creating assessments, and developing activities that can be implemented in a specific learning environment. An example of a flexible module which could be implemented in a number of gross anatomy lab settings (e.g., prosection, dissection, models, virtual) is presented along with a template for the design of future modules. This is followed by a discussion of challenges encountered by educators attempting to integrate structure and function in the gross anatomy lab. Each of these considerations will be addressed with potential solutions for educators seeking to implement these types of integrated activities.
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Affiliation(s)
- Sara Allison
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Caroline Mueller
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, United States
| | - Wendy Lackey-Cornelison
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
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5
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Fulton TB, Collins S, van der Schaaf M, O'Brien BC. Connecting Biochemistry Knowledge to Patient Care in the Clinical Workplace: Senior Medical Students' Perceptions about Facilitators and Barriers. TEACHING AND LEARNING IN MEDICINE 2023; 35:398-410. [PMID: 35796605 DOI: 10.1080/10401334.2022.2084400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students' individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual's cognition, the environment, and their behaviors. This study investigates senior medical students' experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors' behaviors and perceived knowledge, and "patients seen" in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students' perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students' self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and "patients seen" in clerkships. These efforts could strengthen student learning, improve clinical supervisors' self-efficacy, and better inform curriculum design.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sally Collins
- Center for Faculty Educators, University of California, San Francisco, California, USA
| | - Marieke van der Schaaf
- Faculty of Medicine, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Hakim A, Ricketts W, Pfeffer P, Ashworth R. Integration of respiratory physiology and clinical reasoning in the early years of a medical curriculum: engaging with students in a large classroom setting. ADVANCES IN PHYSIOLOGY EDUCATION 2023; 47:237-242. [PMID: 36861766 DOI: 10.1152/advan.00116.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Medical graduates are expected to apply scientific principles and explain the processes underlying common and important diseases. Evidence shows that integrated medical curricula, which deliver biomedical science within the context of clinical cases, facilitate student learning in preparation for practice. However, research has also shown that the student's perception of their knowledge can be lower in integrated compared to traditional courses. Thus the development of teaching methods to support both integrated learning and build student confidence in clinical reasoning is a priority. In this study, we describe the use of an audience response system to support active learning in large classes. Sessions, delivered by medical faculty from both academic and clinical backgrounds, were designed to build on the knowledge of the respiratory system in both health and disease through the interpretation of clinical cases. Results showed that student engagement was high throughout the session and students strongly agreed that the application of knowledge to real-life cases was a better way to understand clinical reasoning. Qualitative free text comments revealed that students liked the link between theory and practice and the active, integrated method of learning. In summary, this study describes a relatively simple but highly effective way of delivering integrated medical science teaching, in this case respiratory medicine, to improve student confidence in clinical reasoning. This educational approach was applied within the early years of the curriculum in preparation for teaching within a hospital setting, but the format could be applied across many different settings.NEW & NOTEWORTHY The development of teaching methods that support integrated learning and build student confidence is a priority. An audience response system was used to engage early year medical students in large classes in preparation for teaching within a hospital setting. Results showed high levels of student engagement and a greater appreciation for the link between theory and practice. This study describes a simple, active, and integrated method of learning that improves student confidence in clinical reasoning.
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Affiliation(s)
- Amir Hakim
- Institute of Health Science Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - William Ricketts
- Institute of Health Science Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, St Bartholomew's Hospital and Royal London Hospital, London, United Kingdom
| | - Paul Pfeffer
- Barts Health NHS Trust, St Bartholomew's Hospital and Royal London Hospital, London, United Kingdom
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rachel Ashworth
- Three Counties Medical School, University of Worcester, Worcester, United Kingdom
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Kercheval JB, Mott NM, Kim EK, Boscardin CK, Klein BA, Hauer KE, Daniel M. Students' Perspectives on Basic and Clinical Science Integration When Step 1 is Administered After the Core Clerkships. TEACHING AND LEARNING IN MEDICINE 2023; 35:117-127. [PMID: 35138966 DOI: 10.1080/10401334.2022.2030235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Phenomenon: According to adult learning theories, effective cognitive integration of basic and clinical science may promote the transfer of knowledge to patient care. The placement of the U.S. Medical Licensing Examination (USMLE) Step 1 after the core clerkships is one strategy intended to facilitate cognitive integration, though learner experiences with this model are unexplored. The purpose of this study is to understand students' perspectives on basic and clinical science integration in a post-clerkship Step 1 curriculum. Approach: Focus groups were conducted between August and September 2020 with senior medical students from the University of California, San Francisco School of Medicine and University of Michigan Medical School. Data were analyzed using a constructivist approach to thematic analysis. Findings: Thirty-three students participated in six focus groups. Participants described multiple barriers to cognitive integration in the clerkship learning environment, though they also identified examples of teaching and learning that facilitated integration. Early in their clerkships, students struggled to integrate because of their tenuous basic science foundation, cognitive overload, and difficulty perceiving the relevance of basic science to patient care. They felt that educators primarily focused on clinical science, and many basic science teaching sessions during clerkships felt irrelevant to patient care. However, students also described experiences that made the connection between basic and clinical science more explicit, including modeling by educators and clerkship learning activities that more overtly encouraged the application of basic science to clinical care. In addition, the return to basic science studying during the post-clerkship dedicated Step 1 study period offered powerful integration opportunities. These facilitators of cognitive integration helped students recognize the value of integration for enduring learning. Insights: There are myriad barriers to cognitive integration of basic and clinical science during clerkships in a post-clerkship Step 1 curriculum. The relevance of basic science to patient care needs to be made more explicit to students through modeling by clinician educators to augment the potential benefits of curricular change. The post-clerkship Step 1 study period appears to offer a unique opportunity for cognitive integration later in a learner's trajectory that may be related to curricular design. When learners recognize the applicability of basic science to patient care, they may more intentionally transfer basic science knowledge to clinical practice.
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Affiliation(s)
- Jacquelyn B Kercheval
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nicole M Mott
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Eric K Kim
- Department of Undergraduate Medical Education, University of California, San Francisco School of Medicine, California, USA
| | - Christy K Boscardin
- Department of Medicine, University of California, San Francisco School of Medicine, California, USA
| | - Barbie A Klein
- Department of Anatomy, University of California, San Francisco School of Medicine, California, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, California, USA
| | - Michelle Daniel
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of California, San Diego School of Medicine, California, USA
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8
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LoGiudice AB, Norman GR, Manzoor S, Monteiro S. Does a deep learning inventory predict knowledge transfer? Linking student perceptions to transfer outcomes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:47-63. [PMID: 35943606 DOI: 10.1007/s10459-022-10141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Students are often encouraged to learn 'deeply' by abstracting generalizable principles from course content rather than memorizing details. So widespread is this perspective that Likert-style inventories are now routinely administered to students to quantify how much a given course or curriculum evokes deep learning. The predictive validity of these inventories, however, has been criticized based on sparse empirical support and ambiguity in what specific outcome measures indicate whether deep learning has occurred. Here we further tested the predictive validity of a prevalent deep learning inventory, the Revised Two-Factor Study Process Questionnaire, by selectively analyzing outcome measures that reflect a major goal of medical education-i.e., knowledge transfer. Students from two undergraduate health sciences courses completed the deep learning inventory before their course's final exam. Shortly after, a random subset of students rated how much each final exam item aligned with three task demands associated with transfer: (1) application of general principles, (2) integration of multiple ideas or examples, and (3) contextual novelty. We then used these ratings from students to examine performance on a subset of exam items that were collectively perceived to demand transfer. Despite good reliability, the resulting transfer outcomes were not substantively predicted by the deep learning inventory. These findings challenge the validity of this tool and others like it.
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Affiliation(s)
- Andrew B LoGiudice
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
- Faculty of Health Sciences Program in Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Canada.
| | - Geoffrey R Norman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Faculty of Health Sciences Program in Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Canada
| | - Saba Manzoor
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Faculty of Health Sciences Program in Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Canada
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Steenhof N. Adaptive Expertise in Undergraduate Pharmacy Education. PHARMACY 2023; 11:pharmacy11010032. [PMID: 36827670 PMCID: PMC9962267 DOI: 10.3390/pharmacy11010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Pharmacy educators are grappling with concerns around curriculum overload and core pharmacist competencies in a rapidly changing and increasingly complex healthcare landscape. Adaptive expertise provides a conceptual framework to guide educators as they design instructional activities that can support students on their journey towards becoming pharmacists who can perform procedural tasks efficiently, as well as creatively handle new and difficult-to-anticipate problems that arise regularly in pharmacy practice. This article explores undergraduate pharmacy education through a cognitive psychology lens and foregrounds three instructional design strategies which support the development of adaptive expertise: (1) cognitive integration, (2) productive failure, and (3) inventing with contrasting cases. These three evidence-based strategies cultivate long-term learning and provide a practical mechanism to combat curriculum overload and backwards-facing assessments. Pharmacy education can encourage the development of procedural and conceptual knowledge and position pharmacy students to excel as they move into more complicated and ambiguous roles in our healthcare system.
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Affiliation(s)
- Naomi Steenhof
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
- The Wilson Centre, University Health Network & University of Toronto, Toronto, ON M5G 2C4, Canada
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Cheung JJH, Kulasegaram KM. Beyond the tensions within transfer theories: implications for adaptive expertise in the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1293-1315. [PMID: 36369374 DOI: 10.1007/s10459-022-10174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Ensuring trainees develop the flexibility with their knowledge to address novel problems, and to efficiently build upon prior knowledge to learn new knowledge is a common goal in health profession education. How trainees come to develop this capacity to transfer and transform knowledge across contexts can be described by adaptive expertise, which focuses on the ability of some experts to innovate upon their existing knowledge to develop novel solutions to novel problems. While adaptive expertise is often presented as an alternative framework to more traditional cognitivist and constructivist expertise models, it is unclear whether the non-routine and routine forms of transfer it describes are distinct from those described by other accounts of transfer. Furthermore, whether what (e.g., knowledge) is transferred and how (e.g., cognitive processes) differs between these views is still debated. In this review, we describe various theories of transfer and present a synthesis clarifying the relationship between transfer and adaptive expertise. Informed by our analysis, we argue that the mechanisms of transfer in adaptive expertise share important commonalities with traditional accounts of transfer, which when understood, can complement efforts by educators and researchers to foster and study adaptive expertise. We present three instructional principles that may better support transfer and adaptive expertise in trainees: i) identifying and incorporating meaningful variability in practice, ii) integrating conceptual knowledge during practice iii) using assessments of trainees' transfer. Taken together, we offer an integrative perspective to how educational systems and experiences can be designed to develop and encourage adaptive expertise and transfer.
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Affiliation(s)
- Jeffrey J H Cheung
- Department of Medical Education, University of Illinois College of Medicine at Chicago, 808 South Wood Street, 966 CMET MC 591, Chicago, IL, 60612, USA.
| | - Kulamakan M Kulasegaram
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, The Toronto General Hospital, Toronto, ON, Canada
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Malhotra A, Oh S, Jin Z, Feng X. Closing the Integration Gap: A Pilot for Incorporating Foundational Sciences, DEI-Decision Making, Empathy, and Communication for Congestive Heart Failure and Arrhythmia Management by Pharmacy Students. PHARMACY 2022; 10:pharmacy10040077. [PMID: 35893714 PMCID: PMC9326578 DOI: 10.3390/pharmacy10040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Pharmacists must integrate foundational sciences with pharmacy practice for providing optimal patient care. Pharmacy students need to be trained to provide culturally competent, linguistically accessible, and empathetic care while integrating foundational science principles. However, such holistic integration is challenging to achieve and assess. To bridge this gap, we implemented and assessed an “integrated cardiovascular simulation” (ICS) module for P2 students, employing case-based and team-based learning. ICS focused on congestive heart failure with preexisting arrhythmia and incorporated patient counseling relating to diversity factors such as cultural competency, linguistic challenges, and the impact of population diversity on cardiac diseases. Students learned the SBAR communication technique (situation, background, assessment, and recommendation) and recommended therapy while elaborating on drug MOA and adverse effects. ICS was assessed through pre-and post-session quizzes and perception data immediately after the activity, and after two years, when students progressed to the cardiovascular APPE block. Student performance improved on a post-test (80.2%) compared to the pre-test (66.9%), p < 0.01 paired student t-test, with an increase in symptom and arrhythmia pattern recognition (41.2% and 36.7%, respectively). ICS was effective for teaching (1) arrhythmia pathophysiology (85%), (2) EKG interpretation (89%), (3) drug adverse effects (93%), (4) DEI-clinical decision making (92%), and (5) communication skills (85%).
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Affiliation(s)
- Ashim Malhotra
- Department of Pharmaceutical and Biomedical Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USA;
- Correspondence: ; Tel.: +1-916-686-8885
| | - Song Oh
- Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USA; (S.O.); (X.F.)
| | - Zhuqiu Jin
- Department of Pharmaceutical and Biomedical Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USA;
| | - Xiaodong Feng
- Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USA; (S.O.); (X.F.)
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Cheung JJH, Kulasegaram KM, Woods NN, Brydges R. Making Concepts Material: A Randomized Trial Exploring Simulation as a Medium to Enhance Cognitive Integration and Transfer of Learning. Simul Healthc 2021; 16:392-400. [PMID: 34860737 DOI: 10.1097/sih.0000000000000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation affords opportunities to represent functional relationships between conceptual (eg, anatomy) and procedural knowledge (eg, needle insertion technique) in ways that make them accessible to our many senses. Despite deprioritizing realism, such simulations may encourage trainees to create cognitive connections between these knowledge (ie, cognitive integration), which may improve transfer of learning. However, the impact of such "integrated instruction" has not been examined in simulation-based training. We developed integrated video- and simulator-based instructional modules for lumbar puncture training and compared their impacts on participants' retention, transfer, and conceptual knowledge. METHODS During 1 hour of simulation-based training, we randomized 66 medical students to receive either (a) video-based procedural-only instruction, (b) integrated video-based instruction, or (c) integrated simulator-based instruction. One week later, we tested participants' retention and transfer performances and their conceptual knowledge on a written test. RESULTS Simple mediation analyses revealed that compared with participants receiving procedural-only instruction, participants receiving integrated instruction had superior retention and transfer outcomes, mediated by gains in conceptual knowledge (all P < 0.01). We found no significant differences between the integrated groups for retention, transfer, or conceptual knowledge (all P > 0.01). CONCLUSIONS We extended previous findings, showing integrated instruction (video- or simulator-based) improved trainees' conceptual knowledge, which mediated their improved retention and transfer. As an innovation, we demonstrated how simulators can facilitate cognitive integration by making abstract conceptual-procedural relationships material. In suggesting how researchers might capitalize further on simulator-based integration, we offer an alternative framework for designing simulations that emphasizes cognitive processes rather than simulator fidelity.
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Affiliation(s)
- Jeffrey J H Cheung
- From the Department of Medical Education (J.J.H.C.), University of Illinois at Chicago College of Medicine, Chicago, Illinois; Department of Family and Community Medicine (K.M.K., N.N.W.), University of Toronto; The Wilson Centre (K.M.K., N.N.W., R.B.), Toronto General Hospital; The Institute for Education Research at the University Health Network (N.N.W.); Department Medicine (R.B.), University of Toronto; and Allan Waters Family Simulation Centre (R.B.), St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Grap SM, Vaida SJ, Mets B, Eckert JM. Successful Implementation of a Robust Medical Student Curriculum in Anesthesiology. A A Pract 2021; 15:e01536. [PMID: 34673666 DOI: 10.1213/xaa.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increasing medical student enrollment creates challenges for clinical course directors to accommodate students and to provide consistency in clinical experiences. We discuss curricular modifications addressing these challenges specific to anesthesiology electives through the creation of 2-week anesthesiology electives to provide scheduling flexibility in the clinical years. We also incorporated curricular enhancements as a consistent didactic framework congruent with the clinical experience. Since initiating these electives in 2017, annual student enrollment increased >33%. More fourth-year students have enrolled in these courses. The annual number of students matching anesthesiology has maintained ≥8% graduating class. Our highest has been 15% in 2020.
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Affiliation(s)
- Shannon M Grap
- From the Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Malhotra A, Reddy IK, Fulford M, Khasawneh FT, Tiwari AK, Feng X. Strategies for the integration of foundational and clinical sciences in doctor of pharmacy programs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ashim Malhotra
- College of Pharmacy California Northstate University Elk Grove California USA
| | - Indra K. Reddy
- Irma Lerma Rangel College of Pharmacy Texas A&M University Kingsville Texas USA
| | - Michael Fulford
- College of Pharmacy University of Georgia Athens Georgia USA
| | - Fadi T. Khasawneh
- Irma Lerma Rangel College of Pharmacy Texas A&M University Kingsville Texas USA
| | - Amit K. Tiwari
- The College of Pharmacy and Pharmaceutical Sciences The University of Toledo Toledo Ohio USA
| | - Xiaodong Feng
- College of Pharmacy California Northstate University Elk Grove California USA
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Zivanov C, Li X, Shah KP, Estrada L, Cutrer WB, Hooks M, Keedy V, Dahlman KB. Precision Cancer Medicine: Dynamic Learning of Cancer Biology in a Clinically Meaningful Context. MEDICAL SCIENCE EDUCATOR 2021; 31:1029-1042. [PMID: 34457947 PMCID: PMC8368858 DOI: 10.1007/s40670-021-01267-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Precision medicine is revolutionizing healthcare practices, most notably in oncology. With cancer being the second leading cause of death in the USA, it is important to integrate precision oncology content in undergraduate medical education. METHODS In 2015, we launched a Clinical Cancer Medicine Integrated Science Course (ISC) for post-clerkship medical students at Vanderbilt University School of Medicine (VUSM). In this ISC, students learned cancer biology and clinical oncology concepts through a combination of classroom and patient care activities. Student feedback from mid- and end-of-course surveys and student match data were analyzed and used to develop ongoing course improvements. RESULTS To date, 72 medical students have taken the Clinical Cancer Medicine ISC. Over 90% of students who completed end-of-course surveys agreed or strongly agreed that this course advanced their foundational science knowledge in clinical cancer medicine, that clinical relevance was provided during non-clinical foundational science learning activities, and that foundational science learning was embedded in course clinical experiences. Students who took this course most commonly matched in Internal Medicine, Pathology, Pediatrics, and Radiation Oncology. VUSM students who matched into Pathology and Radiation Oncology were more likely to take this ISC than students who matched in other specialties. CONCLUSION The Clinical Cancer Medicine ISC serves as a model for incorporating precision oncology, cancer biology foundational science, and oncology patient care activities in undergraduate medical education. The course prepares students to care for oncology patients in their fields of interests during their future career in medicine.
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Affiliation(s)
- Catherine Zivanov
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
| | - Xuanyi Li
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
| | - Kaustav P. Shah
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
| | - Lourdes Estrada
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
- Department of Biochemistry, Vanderbilt University, Nashville, TN USA
| | - William B. Cutrer
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
- Departments of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Mary Hooks
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
- Department of Surgery, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Vicki Keedy
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kimberly Brown Dahlman
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN USA
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN USA
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Fall LH, English R, Fulton TB, Harris DM, Ngo K, Nixon J, Hembrook-Short J, Wilson-Delfosse A. Thinking Slow More Quickly: Development of Integrated Illness Scripts to Support Cognitively Integrated Learning and Improve Clinical Decision-Making. MEDICAL SCIENCE EDUCATOR 2021; 31:1005-1007. [PMID: 34457943 PMCID: PMC8368410 DOI: 10.1007/s40670-021-01293-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
Illness scripts describe the mental model used by experienced clinicians to store and recall condition-specific knowledge when making clinical decisions. Studies demonstrate that novice clinicians struggle to develop and apply strong illness scripts. We developed the Integrated Illness Script and Mechanism of Disease (IIS-MOD) map framework to address this challenge.
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Affiliation(s)
- Leslie H. Fall
- Aquifer, Inc., 21 Lafayette Street, Suite 230, Lebanon, NH 03755 USA
| | - Robin English
- Louisiana State University School of Medicine, Baton Rouge, USA
| | - Tracy B. Fulton
- University of California San Francisco School of Medicine, San Francisco, USA
| | - David M. Harris
- University of Central Florida School of Medicine, Orlando, USA
| | - Khiet Ngo
- Loma Linda University School of Medicine, Loma Linda, USA
| | - James Nixon
- University of Minnesota School of Medicine, Minneapolis, USA
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Khalil MK, Giannaris EL, Lee V, Baatar D, Richter S, Johansen KS, Mishall PL. Integration of clinical anatomical sciences in medical education: Design, development and implementation strategies. Clin Anat 2021; 34:785-793. [PMID: 33905130 DOI: 10.1002/ca.23736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/09/2022]
Abstract
For the last 20 years, undergraduate medical education has seen a major curricular reform movement toward integration of basic and clinical sciences. The rationale for integrated medical school curricula focuses on the application of knowledge in a clinical context and the early ability to practice key skills such as critical thinking and clinical problem-solving. The method and extent of discipline integration can vary widely from single sessions to entire programs. A challenge for integrated curricula is the design of appropriate assessments. The goal of this review is to provide a framework for clinical anatomy educators with definitions of integration, examples of existing integration models, strategies, and instructional methods that promote integration of basic and clinical sciences.
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Affiliation(s)
- Mohammed K Khalil
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | | | - Vaughan Lee
- College of Medicine, University of South Alabama, Mobile, Alabama, USA
| | - Dolgor Baatar
- Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Saskia Richter
- University of Delaware, Department of Kinesiology and Applied Physiology, Newark, Delaware, USA
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Quesnelle KM, Zaveri NT, Schneid SD, Blumer JB, Szarek JL, Kruidering M, Lee MW. Design of a foundational sciences curriculum: Applying the ICAP framework to pharmacology education in integrated medical curricula. Pharmacol Res Perspect 2021; 9:e00762. [PMID: 33974344 PMCID: PMC8112301 DOI: 10.1002/prp2.762] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
Expectations for physicians are rapidly changing, as is the environment in which they will practice. In response, preclerkship medical education curricula are adapting to meet these demands, often by reducing the time for foundational sciences. This descriptive study compares preclerkship pharmacology education curricular practices from seven allopathic medical schools across the United States. We compare factors and practices that affect how pharmacology is integrated into the undergraduate medical education curriculum, including teaching techniques, resources, time allocated to pharmacology teaching, and assessment strategies. We use data from seven medical schools in the United States, along with results from a literature survey, to inform the strengths and weaknesses of various approaches and to raise important questions that can guide future research regarding integration of foundational sciences in medical school and health professions' curricula. In this comparative study, we found that there is significant heterogeneity in the number of hours dedicated to pharmacology in the preclerkship curriculum, whereas there was concordance in the use of active learning pedagogies for content delivery. Applying the ICAP (Interactive, Constructive, Active, Passive) Framework for cognitive engagement, our data showed that pharmacology was presented using more highly engaging pedagogies during sessions that are integrated with other foundational sciences. These findings can serve as a model that can be applied beyond pharmacology to other foundational sciences such as genetics, pathology, microbiology, biochemistry, etc.
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Affiliation(s)
- Kelly M. Quesnelle
- Department of Biomedical SciencesWestern Michigan University Homer Stryker M.D. School of MedicineKalamazooMIUSA
| | - Naunihal T. Zaveri
- Department of Integrated Medical SciencesCollege of MedicineFlorida Atlantic UniversityBoca RatonFLUSA
- Present address:
Arkansas College of Osteopathic MedicineFort SmithARUSA
| | - Stephen D. Schneid
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of California San DiegoLa JollaCAUSA
| | - Joe B. Blumer
- Department of Cell and Molecular Pharmacology and Experimental TherapeuticsMedical University of South CarolinaCharlestonSCUSA
| | - John L. Szarek
- Department of Medical EducationGeisinger Commonwealth School of MedicineScrantonPAUSA
| | - Marieke Kruidering
- Department of PharmacologyCollege of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Michael W. Lee
- Department of Medical EducationDepartment of OncologyLive Strong Cancer InstitutesUniversity of Texas at AustinAustinTXUSA
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Mylopoulos M. Preparing Future Adaptive Experts: Why It Matters and How It Can Be Done. MEDICAL SCIENCE EDUCATOR 2020; 30:11-12. [PMID: 34457848 PMCID: PMC8368930 DOI: 10.1007/s40670-020-01089-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 06/01/2023]
Affiliation(s)
- Maria Mylopoulos
- Faculty of Medicine, The Wilson Centre, University of Toronto, Toronto, Ontario Canada
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Mema B, Mylopoulos M, Tekian A, Park YS. Using Learning Curves to Identify and Explain Growth Patterns of Learners in Bronchoscopy Simulation: A Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1921-1928. [PMID: 32675795 DOI: 10.1097/acm.0000000000003595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Learning curves can illustrate how trainees acquire skills and the path to competence. This study examined the growth trajectories of novice trainees while practicing on a bronchoscopy virtual reality (VR) simulator compared with those of experts. METHOD This was a sequential explanatory mixed-methods design. Twenty pediatric subspecialty trainees and 7 faculty practiced with the VR simulator (October 2017 to March 2018) at the Hospital for Sick Children, Toronto, Canada. The authors examined the relationship between number of repetitions and VR outcomes and patterns of growth using a growth mixture modeling. Using an instrumental case study design, field notes and semistructured interviews with trainees and simulation instructor were examined to explain the patterns of growth. The authors used a constant comparative approach to identify themes iteratively. Team analysis continued until a stable thematic structure was developed and applied to the entire data. RESULTS The growth mixture model identified 2 patterns of growth. A slower growth included learners that had inherent difficulty with the skill, did not integrate the knowledge of anatomy in simulation practice, and used the simulator for simple repetitive practice with no strategy for improvement in between trials. The faster growth included learners who used an adaptive expertise approach: integrating knowledge of anatomy, finding flexible solutions, and creating a deeper conceptual understanding. CONCLUSIONS The authors provide validity evidence for use of growth models in education and explain patterns of growth such as a "slow growth" with a mechanistic repetitive practice and a "fast growth" with adaptive expertise.
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Affiliation(s)
- Briseida Mema
- B. Mema is a staff physician in the Department of Critical Care Medicine, Hospital for Sick Children and Associate Professor in the Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria Mylopoulos
- M. Mylopoulos is a scientist at the Wilson Center and Associate Professor in the Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ara Tekian
- A. Tekian is a Professor and Director of International Programs in the Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois
| | - Yoon Soo Park
- Y.S. Park is director of health professions education research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Ferguson KJ, Kreiter CD, Franklin E, Haugen TH, Dee FR. Investigating the validity of web-enabled mechanistic case diagramming scores to assess students' integration of foundational and clinical sciences. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:629-639. [PMID: 31720878 DOI: 10.1007/s10459-019-09944-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning. The data were from the medical school graduating class of 2018 (N = 136 students). In 2014-2015 we implemented a total of 16 case diagrams in case analysis groups within the Mechanisms of Health and Disease (MOHD) strand of the pre-clinical curriculum. These cases were based on topics being taught during the lectures and small group sessions for MOHD. We created an overall score across all 16 cases for each student. We then correlated these scores with performance in the preclinical curriculum [as assessed by overall performance in MOHD integrated foundational basic science courses and overall performance in the Clinical and Professional Skills (CAPS) courses], and standardized licensing exam scores [United States Medical Licensing Exam (USMLE)] Step 1 (following core clerkships) and Step 2 Clinical Knowledge (at the beginning of the fourth year of medical school). MCD scores correlated with students' overall basic science scores (r = .46, p = .0002) and their overall performance in Clinical and Professional Skills courses (r = .49, p < .0001). In addition, they correlated significantly with standardized exam measures, including USMLE Step 1 (r = .33, p ≤ .0001), and USMLE Step 2 CK (r = .39, p < .0001). These results provide preliminary validity evidence that MCDs may be useful in identifying students who have difficulty in integrating foundational and clinical sciences.
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Affiliation(s)
- Kristi J Ferguson
- General Internal Medicine (Emeritus), Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Clarence D Kreiter
- Department of Family Medicine, and Consultant, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ellen Franklin
- Office of Student Affairs and Curriculum, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Thomas H Haugen
- Department of Pathology, Pathology and Laboratory Service, Veterans Administration Medical Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Fred R Dee
- Department of Pathology (Emeritus), University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Spicer DB, Thompson KH, Kilgallen SM. Making the Connection: Using Concept Mapping to Bring the Basic Sciences to the Diagnosis. J Osteopath Med 2020; 120:e11-e13. [DOI: 10.7556/jaoa.2020.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Although medical education has historically emphasized the role and importance of basic science in clinical reasoning, educators have struggled to teach basic science to optimize its use for students. Concept mapping helps students develop relationships between basic and clinical science, which can enhance understanding of the material. Educators at the University of New England College of Osteopathic Medicine developed a weekly concept-mapping activity connecting biomedical principles with clinical signs, symptoms, and laboratory values from a comprehensive clinical case. This activity elicits cross-disciplinary discussion, illustrates content integration by the students, and enhances faculty collaboration across disciplines.
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Jackson JM, Skelton JA, Peters TR. Medical Students' Clinical Reasoning During a Simulated Viral Pandemic: Evidence of Cognitive Integration and Insights on Novices' Approach to Diagnostic Reasoning. MEDICAL SCIENCE EDUCATOR 2020; 30:767-774. [PMID: 32382451 PMCID: PMC7202796 DOI: 10.1007/s40670-020-00946-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Cognitive integration from multiple disciplines is essential to clinical problem-solving. Because it is not directly observable, demonstrating evidence of learners' cognitive integration remains a challenge. In addition, little is known about preclinical medical students' approach to diagnostic reasoning despite widespread implementation of clinical reasoning curricula for these early learners. The objectives of this study were to characterize how first-year medical students integrated knowledge to problem-solve during a simulated viral pandemic and to characterize students' diagnostic reasoning approach to this clinical scenario. MATERIALS AND METHODS Student teams analyzed clinical data to formulate hypotheses for the pandemic's source and submitted reports justifying their hypotheses and treatment recommendations. A content analysis on students' reports identified codes and themes characterizing the learning content integrated and students' approaches to diagnostic reasoning tasks. RESULTS Sixteen problem-solving codes were identified, demonstrating integration of new and previously encountered content from multiple disciplines. A compare-contrast analytical approach was the most commonly employed diagnostic reasoning approach (100%), with a smaller subset of teams also using a causal approach (20%). DISCUSSION Content analysis of preclinical students' diagnostic justification tasks provided insights into their approach to diagnostic reasoning, which was most consistent with the search-inference framework rather than a causal approach, likely due to limited pathophysiological knowledge at that point in training. CONCLUSIONS Evidence of cognitive integration can be made explicit through learners' narrative justification of diagnostic reasoning tasks. Preclinical students' diagnostic reasoning development has implications for curricular design and implementation for this learner group.
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Affiliation(s)
- Jennifer M. Jackson
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA
| | - Joseph A. Skelton
- Department of Pediatrics; Department of Epidemiology & Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA
| | - Timothy R. Peters
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA
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Chaudhary ZK, Mylopoulos M, Barnett R, Sockalingam S, Hawkins M, O'Brien JD, Woods NN. Reconsidering Basic: Integrating Social and Behavioral Sciences to Support Learning. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:S73-S78. [PMID: 31365405 DOI: 10.1097/acm.0000000000002907] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The integration of basic science mechanistic knowledge (pathophysiology and etiology) with clinical features (signs and symptoms) during learning leads to robust cognitive representations in novices and supports the development of clinical reasoning, including better diagnostic accuracy and later learning of related concepts. However, previous studies have used a limited scope of traditional biomedical sciences, including biochemistry, anatomy, and physiology. The use of extended forms of foundational knowledge, including behavioral and sociological sciences, that have been proposed to support learning and performance in complex health systems remains unexplored. METHOD Thirty-three first-year medical students from the University of Toronto MD Program participated in the study. The effect of integrated extended basic science (EBS) learning was compared with that of clinically focused instruction on an initial assessment of diagnosis using clinical vignettes and a "preparation for future learning" assessment (PFLA) to assess learning of new related content in medical psychiatry (co-occurring physical and mental health conditions). RESULTS Both forms of instruction supported the development of diagnostic ability on initial assessment (t[30] = 1.20, P = .24). On the PFLA, integrated instruction of extended forms of basic science led to superior performance on assessing complex patients' health care needs (t[30] = 2.70, P < .05). CONCLUSIONS Similar to previous studies using integration of biomedical sciences, the integration of EBS can enhance later learning of new related concepts. These results have implications for curriculum design to support development of expert clinical reasoning.
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Affiliation(s)
- Zarah K Chaudhary
- Z.K. Chaudhary is research associate, The Wilson Centre, University Health Network, and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. M. Mylopoulos is associate professor, Department of Pediatrics, and scientist and associate director, The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. R. Barnett is a medical student, MD Program, University of Toronto, Toronto, Ontario, Canada. S. Sockalingam is professor, Department of Psychiatry, centre researcher, The Wilson Centre, University of Toronto, and vice president of education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. M. Hawkins is clinical fellow, Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada. J.D. O'Brien is lecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. N.N. Woods is associate professor, Department of Family and Community Medicine, and scientist, Wilson Centre and Centre of Ambulatory Care Education at Women's College Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Boon M, van Baalen S, Groenier M. Interdisciplinary expertise in medical practice: Challenges of using and producing knowledge in complex problem-solving. MEDICAL TEACHER 2019; 41:668-677. [PMID: 30661424 DOI: 10.1080/0142159x.2018.1544417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Purpose: Clarification of interdisciplinary expertise as the ability to deal with the cognitive and epistemological challenges of multi- and interdisciplinary problem-solving-such as in developing and implementing medical technology for diagnoses and treatment of patients in collaborations between clinicians, technicians, and engineers-and of the higher-order cognitive skills needed as part of this expertise. Method: Clarify the epistemological difficulties of combining scientific knowledge, methodologies and technologies from different disciplines in problem-solving, by drawing on recent developments in the philosophy of science. Conclusion: We argue that interdisciplinary expertise involves the cognitive ability to connect, translate and establish links between disciplinary knowledge, as well as the metacognitive ability to understand and explain the role of the disciplinary perspective-consisting of, e.g. basic concepts, theories, models, methodologies, technologies, and specific ways of measuring, reasoning and modeling in a discipline-in how knowledge is used and produced.
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Affiliation(s)
- Mieke Boon
- a Department of Philosophy , University of Twente , Enschede , The Netherlands
| | - Sophie van Baalen
- a Department of Philosophy , University of Twente , Enschede , The Netherlands
| | - Marleen Groenier
- b Department of Technical Medicine , University of Twente , Enschede , The Netherlands
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Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer. J Gen Intern Med 2019; 34:969-977. [PMID: 30937667 PMCID: PMC6544739 DOI: 10.1007/s11606-019-04959-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Curricular constraints require being selective about the type of content trainees practice in their formal training. Teaching trainees procedural knowledge about "how" to perform steps of a skill along with conceptual knowledge about "why" each step is performed can support skill retention and transfer (i.e., the ability to adapt knowledge to novel problems). However, how best to organize how and why content for procedural skills training is unknown. OBJECTIVES We examined the impact of different approaches to integrating why and how content on trainees' skill retention and transfer of simulation-based lumbar puncture (LP). DESIGN AND PARTICIPANTS We randomized medical students (N = 66) to practice LP for 1 h using one of three videos. One video presented only the how content for LP (Procedural Only). Two other videos presented how and why content (e.g., anatomy) in two ways: Integrated in Sequence, with why content followed by how content, or Integrated for Causation, with how and why content integrated throughout. MAIN MEASURES Pairs of blinded raters scored participants' retention and transfer LP performances on a global rating scale (GRS), and written tests assessed participants' procedural and conceptual knowledge. KEY RESULTS Simple mediation regression analyses showed that participants receiving an integrated instructional video performed significantly better on transfer through their intervention's positive impact on conceptual knowledge (all p < 0.01). Further, the Integrated for Causation group performed significantly better on transfer than the Integrated in Sequence group (p < 0.01), again mediated by improved conceptual knowledge. We observed no mediation of participants' skill retention (all p > 0.01). CONCLUSIONS When teaching supports cognitive integration of how and why content, trainees are able to transfer learning to new problems because of their improved conceptual understanding. Instructional designs for procedural skills that integrate how and why content can help educators optimize what trainees learn from each repetition of practice.
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Steinel N, Palmer GC, Nowicki E, Lee E, Nelson E, Whiteley M, Lee MW. Integration of Microbiology, Pharmacology, Immunology, and Infectious Disease Using Active Teaching and Self-Directed Learning. MEDICAL SCIENCE EDUCATOR 2019; 29:315-324. [PMID: 34457482 PMCID: PMC8368113 DOI: 10.1007/s40670-018-00689-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In an era of decreasing basic science curriculum at medical schools, we sought to re-imagine how to optimally deliver three core basic science disciplines (microbiology, pharmacology, and immunology) together with infectious disease in a 5-week course. This course, developed as part of a new 1-year pre-clinical basic science curriculum at the recently established Dell Medical School (DMS) at the University of Texas at Austin, featured a fully integrated curriculum in which the majority of the sessions were team-taught. This course, in line with the goals and missions of DMS, presented material using primarily self-directed and active learning approaches. Here, we describe the format and content of the course. We present our strategy and rationale for selecting these particular learning modalities and topics for pre-class and in-class coverage, using educational and cognitive psychology literature as a guide. We also discuss how, based on feedback from both student evaluations and performance data, the course evolved over the first two iterations.
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Affiliation(s)
- Natalie Steinel
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA USA
| | - Gregory C. Palmer
- Institute of Environmental Sustainability, Loyola University, Chicago, IL USA
| | - Emily Nowicki
- Department of Science and Math, Curry College, Milton, MA USA
| | - Ernestine Lee
- Department of Population Health, Division of Family Medicine, Dell Medical School, University of Texas at Austin, Austin, TX USA
| | - Elizabeth Nelson
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, TX USA
| | - Marvin Whiteley
- College of Sciences, Georgia Tech University, Atlanta, GA USA
| | - Michael W. Lee
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, TX USA
- Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, TX USA
- Live Strong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, TX USA
- Department of Medical Education and Live Strong Cancer Institutes, The University of Texas at Austin, Health Learning Building, 1501 Red River Street, MC: 0100, Austin, TX 78712 USA
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Abstract
This article was migrated. The article was marked as recommended. Teaching basic science in the medical school remains a challenge, and the lack of appropriate resources is one of important limitation. Building up such resources is difficult, time-costly and does not always result in effective, solid and student-centered instruction. This "personal view" aims to stimulate scientists and scientific journals to engage with new ideas and innovative resources for biomedical education. The time has now come to plan research and education as mutually beneficial activities, supporting each other rather than competing with each other. Scientific research should be converted into digital learning resources hosted by scientific journals on a regular basis, and subjected to peer-review to ensure quality and integration of contents, appropriate cognitive approach and rigorous criteria of selection. Turning science into teaching represents an investment with mutual benefits, for students and educators. Academic educators can produce resources to face the teaching burden, and gather the opportunity to increase personal productivity. Students can take advantage from being engaged in innovative learning environments where educators act as catalysts for learning, instead of just transmitters of knowledge.
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Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences - University of Padua - Viale G. Colombo
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Abraham RR, Alele F, Kamath U, Kurien A, Rai KS, Bairy I, Rao MKG, Rao G, Devi V, Rao YK, Sen Gupta T, Malau-Aduli BS. Assessment for learning: a needs analysis study using formative assessment to evaluate the need for curriculum reform in basic sciences. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:482-486. [PMID: 30035629 DOI: 10.1152/advan.00093.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A needs analysis study for curriculum reform in basic sciences was conducted at Melaka Manipal Medical College, India, by means of a formative assessment method, namely Basic Science Retention Examination (BSRE). Students participated in a BSRE, which comprised recall and clinical multiple-choice questions in six discipline areas. They also rated the clinical relevance of each question and provided responses to three open-text questions about the exam. Pass rates were determined; clinical relevance ratings and performance scores were compared between recall type and clinical questions to test students' level of clinical application of basic science knowledge. Text comments were thematically analyzed to identify recurring themes. Only one-third of students passed the BSRE (32.2%). Students performed better in recall questions compared with clinical questions in anatomy (51.0 vs. 40.2%), pathology (45.1 vs. 38.1%), pharmacology (41.8 vs. 31.7%), and biochemistry (43.5 vs. 26.9%). In physiology, students performed better in clinical questions compared with the recall type (56.2 vs. 45.8%). Students' response to BSRE was positive. The findings imply that transfer of basic science knowledge was poor, and that assessment methods should emphasize clinical application of basic science knowledge.
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Affiliation(s)
- Reem Rachel Abraham
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Faith Alele
- Division of Tropical Medicine, James Cook University , Townsville, Queensland , Australia
| | - Ullas Kamath
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Annamma Kurien
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Kiranmai S Rai
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Indira Bairy
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Mohandas K G Rao
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Guruprasad Rao
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Vasudha Devi
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Yeshwant K Rao
- Melaka Manipal Medical College, Manipal Academy of Higher Education , Manipal, Karnataka , India
| | - Tarun Sen Gupta
- Division of Tropical Medicine, James Cook University , Townsville, Queensland , Australia
| | - Bunmi S Malau-Aduli
- Division of Tropical Medicine, James Cook University , Townsville, Queensland , Australia
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Mylopoulos M, Steenhof N, Kaushal A, Woods NN. Twelve tips for designing curricula that support the development of adaptive expertise. MEDICAL TEACHER 2018; 40:850-854. [PMID: 30009648 DOI: 10.1080/0142159x.2018.1484082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
An essential component of expertise is a clinician's ability to adapt to uncertain, complex, or novel situations while maintaining their competence in routine situations. Adaptive expertise provides a framework for understanding and developing experts who have the skills to effectively balance and support these dimensions of work using both procedural and conceptual knowledge. It is important for educators to understand that often the training which fosters adaptive expertise does not require new tools or approaches, but rather a reconceptualization of training using many of the same instruction and assessment formats already available. The twelve tips discussed in this paper showcase ways in which education can be transformed to support the development of adaptive expertise including the significance of instruction that combines various forms for knowledge, the value of productive struggle, and shifting the design of assessments to support learning and performance beyond retention and direct application.
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Affiliation(s)
- Maria Mylopoulos
- a The Wilson Centre, University of Toronto , Toronto , ON , Canada
| | | | - Amit Kaushal
- b University Health Network , Toronto , ON , Canada
| | - Nicole N Woods
- a The Wilson Centre, University of Toronto , Toronto , ON , Canada
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Castillo JM, Park YS, Harris I, Cheung JJH, Sood L, Clark MD, Kulasegaram K, Brydges R, Norman G, Woods N. A critical narrative review of transfer of basic science knowledge in health professions education. MEDICAL EDUCATION 2018; 52:592-604. [PMID: 29417600 DOI: 10.1111/medu.13519] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/16/2017] [Accepted: 11/28/2017] [Indexed: 06/08/2023]
Abstract
CONTEXT 'Transfer' is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies. METHODS A systematic search of the literature was conducted. Articles related to basic science teaching at the undergraduate level in HPE were analysed using a 'transfer out'/'transfer in' conceptual framework. 'Transfer out' refers to the application of knowledge developed in one learning situation to the solving of a new problem. 'Transfer in' refers to the use of previously acquired knowledge to learn from new problems or learning situations. RESULTS Of 9803 articles initially identified, 627 studies were retrieved for full text evaluation; 15 were included in the literature review. A total of 93% explored 'transfer out' to clinical reasoning and 7% (one article) explored 'transfer in'. Measures of 'transfer out' fostered by basic science knowledge included diagnostic accuracy over time and in new clinical cases. Basic science knowledge supported learning - 'transfer in' - of new related content and ultimately the 'transfer out' to diagnostic reasoning. Successful teaching strategies included the making of connections between basic and clinical sciences, the use of commonsense analogies, and the study of multiple clinical problems in multiple contexts. Performance on recall tests did not reflect the transfer of basic science knowledge to clinical reasoning. CONCLUSIONS Transfer of basic science knowledge to clinical reasoning is an essential component of HPE that requires further development for implementation and scholarship.
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Affiliation(s)
- Jean-Marie Castillo
- Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Centre for Ambulatory Care Education, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Family and Community Medicine, Nantes University, Nantes, France
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ilene Harris
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey J H Cheung
- Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lonika Sood
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health in Madison, Madison, Wisconsin, USA
- Aurora Health Care, Green Bay, Wisconsin, USA
| | - Maureen D Clark
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
- Library of the Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kulamakan Kulasegaram
- Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Brydges
- Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Norman
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Woods
- Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Centre for Ambulatory Care Education, University of Toronto, Toronto, Ontario, Canada
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Greene JM, Fuller KA, Persky AM. Practical Tips for Integrating Clinical Relevance into Foundational Science Courses. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6603. [PMID: 30013247 PMCID: PMC6041486 DOI: 10.5688/ajpe6603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/10/2017] [Indexed: 05/10/2023]
Abstract
The integration of foundational science and clinical science education is a hallmark of educational reform within the health professions, and an increasing number of pharmacy schools are implementing integrated curricula in professional pharmacy programs. Although the foundational sciences serve as an essential framework for understanding clinical knowledge, instructors may face challenges when integrating clinical science into foundational science courses. Here we present practical learner-centered teaching tips to address these challenges.
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Affiliation(s)
- Jessica M. Greene
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina
| | - Kathryn A. Fuller
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina
| | - Adam M. Persky
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina
- Associate Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
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Violato C, Gao H, O'Brien MC, Grier D, Shen E. How do physicians become medical experts? A test of three competing theories: distinct domains, independent influence and encapsulation models. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:249-263. [PMID: 28702788 DOI: 10.1007/s10459-017-9784-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/03/2017] [Indexed: 05/13/2023]
Abstract
The distinction between basic sciences and clinical knowledge which has led to a theoretical debate on how medical expertise is developed has implications for medical school and lifelong medical education. This longitudinal, population based observational study was conducted to test the fit of three theories-knowledge encapsulation, independent influence, distinct domains-of the development of medical expertise employing structural equation modelling. Data were collected from 548 physicians (292 men-53.3%; 256 women-46.7%; mean age = 24.2 years on admission) who had graduated from medical school 2009-2014. They included (1) Admissions data of undergraduate grade point average and Medical College Admission Test sub-test scores, (2) Course performance data from years 1, 2, and 3 of medical school, and (3) Performance on the NBME exams (i.e., Step 1, Step 2 CK, and Step 3). Statistical fit indices (Goodness of Fit Index-GFI; standardized root mean squared residual-SRMR; root mean squared error of approximation-RSMEA) and comparative fit [Formula: see text] of three theories of cognitive development of medical expertise were used to assess model fit. There is support for the knowledge encapsulation three factor model of clinical competency (GFI = 0.973, SRMR = 0.043, RSMEA = 0.063) which had superior fit indices to both the independent influence and distinct domains theories ([Formula: see text] vs [Formula: see text] [[Formula: see text]] vs [Formula: see text] [[Formula: see text]], respectively). The findings support a theory where basic sciences and medical aptitude are direct, correlated influences on clinical competency that encapsulates basic knowledge.
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Affiliation(s)
- Claudio Violato
- Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- School of Medicine, University of Minnesota Twin Cities, Minneapolis, MN, 55455, USA.
| | - Hong Gao
- Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Mary Claire O'Brien
- Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - David Grier
- Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - E Shen
- Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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van der Hoeven D, van der Hoeven R, Zhu L, Busaidy K, Quock RL. Integration of Basic and Clinical Sciences: Faculty Perspectives at a U.S. Dental School. J Dent Educ 2018; 82:349-355. [PMID: 29606651 DOI: 10.21815/jde.018.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022]
Abstract
Although dental education has traditionally been organized into basic sciences education (first and second years) and clinical education (third and fourth years), there has been growing interest in ways to better integrate the two to more effectively educate students and prepare them for practice. Since 2012, The University of Texas School of Dentistry at Houston (UTSD) has made it a priority to improve integration of basic and clinical sciences, with a focus to this point on integrating the basic sciences. The aim of this study was to determine the perspectives of basic and clinical science faculty members regarding basic and clinical sciences integration and the degree of integration currently occurring. In October 2016, all 227 faculty members (15 basic scientists and 212 clinicians) were invited to participate in an online survey. Of the 212 clinicians, 84 completed the clinician educator survey (response rate 40%). All 15 basic scientists completed the basic science educator survey (response rate 100%). The majority of basic and clinical respondents affirmed the value of integration (93.3%, 97.6%, respectively) and reported regular integration in their teaching (80%, 86.9%). There were no significant differences between basic scientists and clinicians on perceived importance (p=0.457) and comfort with integration (p=0.240), but the basic scientists were more likely to integrate (p=0.039) and collaborate (p=0.021) than the clinicians. There were no significant differences between generalist and specialist clinicians on importance (p=0.474) and degree (p=0.972) of integration in teaching and intent to collaborate (p=0.864), but the specialists reported feeling more comfortable presenting basic science information (p=0.033). Protected faculty time for collaborative efforts and a repository of integrated basic science and clinical examples for use in teaching and faculty development were recommended to improve integration. Although questions might be raised about the respondents' definition of "integration," this study provides a baseline assessment of perceptions at a dental school that is placing a priority on integration.
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Affiliation(s)
- Dharini van der Hoeven
- Dr. Dharini van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Ransome van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston; Dr. Busaidy is Professor, Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston.
| | - Ransome van der Hoeven
- Dr. Dharini van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Ransome van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston; Dr. Busaidy is Professor, Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston
| | - Liang Zhu
- Dr. Dharini van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Ransome van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston; Dr. Busaidy is Professor, Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston
| | - Kamal Busaidy
- Dr. Dharini van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Ransome van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston; Dr. Busaidy is Professor, Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston
| | - Ryan L Quock
- Dr. Dharini van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Ransome van der Hoeven is Assistant Professor, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston; Dr. Busaidy is Professor, Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston
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Dahlman KB, Weinger MB, Lomis KD, Nanney L, Osheroff N, Moore DE, Estrada L, Cutrer WB. Integrating Foundational Sciences in a Clinical Context in the Post-Clerkship Curriculum. MEDICAL SCIENCE EDUCATOR 2018; 28:145-154. [PMID: 29632705 PMCID: PMC5889049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To design, implement, and launch courses that integrate foundational science learning and clinical application in a post-clerkship undergraduate medical school curriculum. METHOD In Academic Year (AY) 15-16, as part of a comprehensive curricular revision, Vanderbilt University School of Medicine (VUSM) formally implemented "Integrated Science Courses" (ISCs) that combined rigorous training in the foundational sciences with meaningful clinical experiences. These courses integrated foundational sciences that could be leveraged in the clinical environment, utilized a variety of instructional modalities, and included quantitative and qualitative (competency-based milestones) student assessments. Each ISC underwent a rigorous quality improvement process that required input on foundational science content, student experience, and student performance assessment. RESULTS Eleven ISCs were delivered to 173 students in AY15-16, with some students taking more than one ISC. Immediately after completing each course, 93% (n=222) of ISC enrollees completed a course evaluation. Students (91%; n=201) 'agreed' or 'strongly agreed' that foundational science learning informed and enriched the clinical experiences. Furthermore, 94% (n=209) of students thought that the clinical experiences informed and enriched the foundational science learning. Ninety-four percent of the students anticipated using the foundational science knowledge acquired in future clinical training and practice. CONCLUSION The teaching of foundational sciences in the clinical workplace in the post-clerkship medical curriculum is challenging and resource-intensive, yet feasible. Additional experience with the model will inform the mix of courses as well as the breadth and depth of foundational science instruction that is necessary to foster scientifically-based clinical reasoning skills in each student.
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Affiliation(s)
- Kimberly Brown Dahlman
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Matthew B. Weinger
- Department of Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Geriatric Research Education and Clinical Center, Nashville, TN 37232 USA
- Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Kimberly D. Lomis
- Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Lillian Nanney
- Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Neil Osheroff
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN 37232 USA
| | - Donald E. Moore
- Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Lourdes Estrada
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - William B. Cutrer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232 USA
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Cheung JJH, Kulasegaram KM, Woods NN, Moulton CA, Ringsted CV, Brydges R. Knowing How and Knowing Why: testing the effect of instruction designed for cognitive integration on procedural skills transfer. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:61-74. [PMID: 28434131 DOI: 10.1007/s10459-017-9774-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/14/2017] [Indexed: 06/07/2023]
Abstract
Transfer is a desired outcome of simulation-based training, yet evidence for how instructional design features promote transfer is lacking. In clinical reasoning, transfer is improved when trainees experience instruction integrating basic science explanations with clinical signs and symptoms. To test whether integrated instruction has similar effects in procedural skills (i.e., psychomotor skills) training, we studied the impact of instruction that integrates conceptual (why) and procedural (how) knowledge on the retention and transfer of simulation-based lumbar puncture (LP) skill. Medical students (N = 30) were randomized into two groups that accessed different instructional videos during a 60-min self-regulated training session. An unintegrated video provided procedural How instruction via step-by-step demonstrations of LP, and an integrated video provided the same How instruction with integrated conceptual Why explanations (e.g., anatomy) for key steps. Two blinded raters scored post-test, retention, and transfer performances using a global rating scale. Participants also completed written procedural and conceptual knowledge tests. We used simple mediation regression analyses to assess the total and indirect effects (mediated by conceptual knowledge) of integrated instruction on retention and transfer. Integrated instruction was associated with improved conceptual (p < .001) but not procedural knowledge test scores (p = .11). We found no total effect of group (p > .05). We did find a positive indirect group effect on skill retention (B ab = .93, p < .05) and transfer (B ab = .59, p < .05), mediated through participants improved conceptual knowledge. Integrated instruction may improve trainees' skill retention and transfer through gains in conceptual knowledge. Such integrated instruction may be an instructional design feature for simulation-based training aimed at improving transfer outcomes.
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Affiliation(s)
- Jeffrey J H Cheung
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada.
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Canada.
| | - Kulamakan M Kulasegaram
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Nicole N Woods
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Carol-Anne Moulton
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Charlotte V Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Århus, Denmark
| | - Ryan Brydges
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Canada
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Bandiera G, Kuper A, Mylopoulos M, Whitehead C, Ruetalo M, Kulasegaram K, Woods NN. Back from basics: integration of science and practice in medical education. MEDICAL EDUCATION 2018; 52:78-85. [PMID: 28994457 DOI: 10.1111/medu.13386] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success. SCOPE OF REVIEW In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula. CONCLUSIONS Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of 'basic science' relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science.
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Affiliation(s)
- Glen Bandiera
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Mariela Ruetalo
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kulamakan Kulasegaram
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole N Woods
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Lisk K, Agur AMR, Woods NN. Examining the effect of self-explanation on cognitive integration of basic and clinical sciences in novices. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1071-1083. [PMID: 28013426 DOI: 10.1007/s10459-016-9743-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of self-explanation during learning has the potential to promote and support the development of integrated knowledge by encouraging novices to elaborate on the causal relationship between clinical features and basic science mechanisms. To explore the effect of this strategy, we compared diagnostic efficacy of teaching students (n = 71) the clinical features of four musculoskeletal pathologies using either (1) integrated causal basic science descriptions (BaSci group); (2) integrated causal basic science descriptions combined with self-explanation prompts (SE group); (3) basic science mechanisms segregated from the clinical features (SG group). All participants completed a diagnostic accuracy test immediately after learning and 1-week later. The results showed that the BaSci group performed significantly better compared to the SE (p = 0.019) and SG groups (p = 0.004); however, no difference was observed between the SE and SG groups (p = 0.91). We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic conceptual understanding of each disease. These findings suggest that integration strategies need to be carefully structured and applied in ways that support the holistic story created by integrated basic science instruction in order to foster conceptual coherence and to capitalize on the benefits of cognition integration.
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Affiliation(s)
- Kristina Lisk
- Rehabilitation Sciences Institute, Division of Anatomy, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 1158, Toronto, ON, M5S 1A8, Canada.
- The Wilson Centre, University Health Network, Toronto, ON, Canada.
| | - Anne M R Agur
- Rehabilitation Sciences Institute, Division of Anatomy, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 1158, Toronto, ON, M5S 1A8, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole N Woods
- Rehabilitation Sciences Institute, Division of Anatomy, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 1158, Toronto, ON, M5S 1A8, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University Health Network, Toronto, ON, Canada
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Sivapragasam M. Basic science in integrated curricula : A medical student experience. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:257-8. [PMID: 27492323 PMCID: PMC4978642 DOI: 10.1007/s40037-016-0290-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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