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Lee JY, Donkers J, Jarodzka H, Sellenraad G, Faber TJE, van Merriënboer JJG. The Effects of Reflective Pauses on Performance in Simulation Training. Simul Healthc 2023:01266021-990000000-00066. [PMID: 37094368 DOI: 10.1097/sih.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION The reflective pause, taking a pause during performance to reflect, is an important practice in simulation-based learning. However, for novice learners, it is a highly complex self-regulatory skill that cannot stand alone without guidance. Using educational theories, we propose how to design cognitive and metacognitive aids to guide learners with the reflective pause and investigate its effects on performance in a simulation training environment. METHODS These effects are examined in four aspects of performance: cognitive load, primary performance, secondary performance, and encapsulation. Medical students ( N = 72) performed tasks in simulation training for emergency medicine, under 2 conditions: reflection condition ( n = 36) where reflection was prompted and guided, and control condition ( n = 36) without such reflection. RESULTS The effects of reflective pauses emerged for 2 aspects of performance: cognitive load decreased and secondary performance improved. However, primary performance and encapsulation did not show significant difference. CONCLUSIONS The results demonstrate that reflective pauses with cognitive and metacognitive aids implemented can enhance some aspects of performance. We suggest that to secure these effects, feedback during reflection and an adaptation period should be provided.
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Affiliation(s)
- Joy Y Lee
- From the Faculty of Governance and Global Affairs (J.Y.L.), Leiden University, The Hague; School of Health Professions Education (J.D., J.J.G.v.M.), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht; Faculty of Education Sciences (H.J.), Open Universiteit, Heerlen; Faculty of Health, Medicine and Life Sciences (G.S.), Maastricht University, Maastricht; and Institute for Medical Education Research Rotterdam (T.J.E.F.), Erasmus University Medical Center, Rotterdam, the Netherlands
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Frerejean J, van Merriënboer JJG, Condron C, Strauch U, Eppich W. Critical design choices in healthcare simulation education: a 4C/ID perspective on design that leads to transfer. Adv Simul (Lond) 2023; 8:5. [PMID: 36823641 PMCID: PMC9951482 DOI: 10.1186/s41077-023-00242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Healthcare simulation education often aims to promote transfer of learning: the application of knowledge, skills, and attitudes acquired during simulations to new situations in the workplace. Although achieving transfer is challenging, existing theories and models can provide guidance. RECOMMENDATIONS This paper provides five general recommendations to design simulations that foster transfer: (1) emphasize whole-task practice, (2) consider a cognitive task analysis, (3) embed simulations within more comprehensive programs, (4) strategically combine and align simulation formats, and (5) optimize cognitive load. We illustrate the application of these five recommendations with a blueprint for an educational program focusing on simulation activities. CONCLUSIONS More evidence-informed approaches to healthcare simulation might require a paradigm shift. We must accept that a limited number of simulations is not enough to develop complex skills. It requires comprehensive programs that combine simulation sessions with workplace learning.
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Affiliation(s)
- Jimmy Frerejean
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Jeroen J. G. van Merriënboer
- grid.5012.60000 0001 0481 6099School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Claire Condron
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ulrich Strauch
- grid.412966.e0000 0004 0480 1382Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands ,grid.412966.e0000 0004 0480 1382Department of Intensive Care, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Walter Eppich
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Smeets HWH, Sluijsmans DMA, Moser A, van Merriënboer JJG. Design guidelines for assessing students' interprofessional competencies in healthcare education: a consensus study. Perspect Med Educ 2022; 11:316-324. [PMID: 36223031 PMCID: PMC9743853 DOI: 10.1007/s40037-022-00728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Healthcare systems require healthcare professionals and students educated in an interprofessional (IP) context. Well-designed assessments are needed to evaluate whether students have developed IP competencies, but we currently lack evidence-informed guidelines to create them. This study aims to provide guidelines for the assessment of IP competencies in healthcare education. METHODS A qualitative consensus study was conducted to establish guidelines for the design of IP assessments using the nominal group technique. First, five expert groups (IP experts, patients, educational scientists, teachers, and students) were asked to discuss design guidelines for IP assessment and reach intra-group consensus. Second, one heterogeneous inter-group meeting was organized to reach a consensus among the expert groups on IP assessment guidelines. RESULTS This study yielded a comprehensive set of 26 guidelines to help design performance assessments for IP education: ten guidelines for both the IP assessment tasks and the IP assessors and six guidelines for the IP assessment procedures. DISCUSSION The results showed that IP assessment is complex and, compared to mono-professional assessment, high-quality IP assessments require additional elements such as multiple IP products and processes to be assessed, an IP pool of assessors, and assessment procedures in which standards are included for the IP collaboration process as well as individual contributions. The guidelines are based on expert knowledge and experience, but an important next step is to test these design guidelines in educational practice.
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Affiliation(s)
- Hester Wilhelmina Henrica Smeets
- Research Centre for Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
| | - Dominique M A Sluijsmans
- Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Albine Moser
- Research Centre for Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Young JQ, Thakker K, John M, Friedman K, Sugarman R, van Merriënboer JJG, Sewell JL, O'Sullivan PS. Exploring the relationship between emotion and cognitive load types during patient handovers. Adv Health Sci Educ Theory Pract 2021; 26:1463-1489. [PMID: 34037906 DOI: 10.1007/s10459-021-10053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Krima Thakker
- Division of Education and Training, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 10543, USA
| | - Majnu John
- Division of Research, Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | | | - Jeroen J G van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Justin L Sewell
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Patricia S O'Sullivan
- Department of Medicine & Office of Research and Development in Medical Education, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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Iqbal MZ, Könings KD, Al-Eraky MM, van Merriënboer JJG. Entrustable Professional Activities for Small-Group Facilitation: A Validation Study Using Modified Delphi Technique. Teach Learn Med 2021; 33:536-545. [PMID: 33588650 DOI: 10.1080/10401334.2021.1877714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
: Entrustable professional activities (EPAs) provide a novel approach to support teachers' structured professionalization and to assess improvement in teaching competence thereafter. Despite their novelty, it is important to assess EPAs as a construct to ensure that they accurately reflect the work of the targeted profession. BACKGROUND: The co-creation of an EPA framework for training and entrustment of small-group facilitators has been discussed in the literature. Although a rigorous design process was used to develop the framework, its content validity has not been established yet.Approach: A modified Delphi technique was used. Three survey rounds were conducted from December 2019 to April 2020. Expert health professions educationalists were recruited using purposive sampling and snowball techniques. In Round 1, a rubric consisting of seven items was used to assess the quality of nine pre-designed EPAs. In Round 2, competencies required to perform the agreed-upon EPAs were selected from 12 competencies provided. In Round 3, consensus was sought on sub-activities recommended for agreed-upon EPAs. Quantitative data were analyzed using multiple statistical analyses, including item-wise and rubric-wise content validity indices, asymmetric confidence interval, mean, standard deviation, and response frequencies. Qualitative data were thematically analyzed using content analysis. FINDINGS: Three of the nine proposed EPAs achieved statistical consensus for retention. These EPAs were: (1) preparing an activity, (2) facilitating a small-group session, and (3) reflecting upon self and the session. Nine of the 12 pre-determined competencies achieved consensus and were then mapped against each agreed-upon EPA based on their relevance. Finally, results indicated consensus on five, six, and four sub-activities for EPA 1, EPA 2, and EPA 3, respectively. CONCLUSIONS: The final framework delineates three EPAs for small-group facilitation and their associated sub-activities. The full description of each EPA provided in this article includes the title, context, task specification, required competencies, and entrustment resources. Program developers, administrative bodies, and teaching staff may find this EPA framework useful to structure faculty development, to entrust teachers, and to support personal development.
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Affiliation(s)
- Muhammad Zafar Iqbal
- Medical Education Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Karen D Könings
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Mohamed M Al-Eraky
- Vice-President office of Academic Initiatives, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Lee JY, Szulewski A, Young JQ, Donkers J, Jarodzka H, van Merriënboer JJG. The medical pause: Importance, processes and training. Med Educ 2021; 55:1152-1160. [PMID: 33772840 PMCID: PMC8518691 DOI: 10.1111/medu.14529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/28/2021] [Accepted: 03/19/2021] [Indexed: 05/10/2023]
Abstract
Research has shown that taking 'timeouts' in medical practice improves performance and patient safety. However, the benefits of taking timeouts, or pausing, are not sufficiently acknowledged in workplaces and training programmes. To promote this acknowledgement, we suggest a systematic conceptualisation of the medical pause, focusing on its importance, processes and implementation in training programmes. By employing insights from educational and cognitive psychology, we first identified pausing as an important skill to interrupt negative momentum and bolster learning. Subsequently, we categorised constituent cognitive processes for pausing skills into two phases: the decision-making phase (determining when and how to take pauses) and the executive phase (applying relaxation or reflection during pauses). We present a model that describes how relaxation and reflection during pauses can optimise cognitive load in performance. Several strategies to implement pause training in medical curricula are proposed: intertwining pause training with training of primary skills, providing second-order scaffolding through shared control and employing auxiliary tools such as computer-based simulations with a pause function.
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Affiliation(s)
- Joy Yeonjoo Lee
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Adam Szulewski
- Departments of Emergency Medicine and PsychologyQueen’s UniversityKingstonONCanada
| | - John Q. Young
- Department of PsychiatryDonald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell HealthGlen OaksNYUSA
| | - Jeroen Donkers
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Halszka Jarodzka
- Faculty of Education SciencesOpen UniversityHeerlenThe Netherlands
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Ayres P, Lee JY, Paas F, van Merriënboer JJG. The Validity of Physiological Measures to Identify Differences in Intrinsic Cognitive Load. Front Psychol 2021; 12:702538. [PMID: 34566780 PMCID: PMC8461231 DOI: 10.3389/fpsyg.2021.702538] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
A sample of 33 experiments was extracted from the Web-of-Science database over a 5-year period (2016-2020) that used physiological measures to measure intrinsic cognitive load. Only studies that required participants to solve tasks of varying complexities using a within-subjects design were included. The sample identified a number of different physiological measures obtained by recording signals from four main body categories (heart and lungs, eyes, skin, and brain), as well as subjective measures. The overall validity of the measures was assessed by examining construct validity and sensitivity. It was found that the vast majority of physiological measures had some level of validity, but varied considerably in sensitivity to detect subtle changes in intrinsic cognitive load. Validity was also influenced by the type of task. Eye-measures were found to be the most sensitive followed by the heart and lungs, skin, and brain. However, subjective measures had the highest levels of validity. It is concluded that a combination of physiological and subjective measures is most effective in detecting changes in intrinsic cognitive load.
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Affiliation(s)
- Paul Ayres
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Joy Yeonjoo Lee
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Fred Paas
- Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, Netherlands
- School of Education/Early Start, University of Wollongong, Wollongong, NSW, Australia
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Kok EM, Sorger B, van Geel K, Gegenfurtner A, van Merriënboer JJG, Robben SGF, de Bruin ABH. Holistic processing only? The role of the right fusiform face area in radiological expertise. PLoS One 2021; 16:e0256849. [PMID: 34469467 PMCID: PMC8409609 DOI: 10.1371/journal.pone.0256849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Radiologists can visually detect abnormalities on radiographs within 2s, a process that resembles holistic visual processing of faces. Interestingly, there is empirical evidence using functional magnetic resonance imaging (fMRI) for the involvement of the right fusiform face area (FFA) in visual-expertise tasks such as radiological image interpretation. The speed by which stimuli (e.g., faces, abnormalities) are recognized is an important characteristic of holistic processing. However, evidence for the involvement of the right FFA in holistic processing in radiology comes mostly from short or artificial tasks in which the quick, ‘holistic’ mode of diagnostic processing is not contrasted with the slower ‘search-to-find’ mode. In our fMRI study, we hypothesized that the right FFA responds selectively to the ‘holistic’ mode of diagnostic processing and less so to the ‘search-to-find’ mode. Eleven laypeople and 17 radiologists in training diagnosed 66 radiographs in 2s each (holistic mode) and subsequently checked their diagnosis in an extended (10-s) period (search-to-find mode). During data analysis, we first identified individual regions of interest (ROIs) for the right FFA using a localizer task. Then we employed ROI-based ANOVAs and obtained tentative support for the hypothesis that the right FFA shows more activation for radiologists in training versus laypeople, in particular in the holistic mode (i.e., during 2s trials), and less so in the search-to-find mode (i.e., during 10-s trials). No significant correlation was found between diagnostic performance (diagnostic accuracy) and brain-activation level within the right FFA for both, short-presentation and long-presentation diagnostic trials. Our results provide tentative evidence from a diagnostic-reasoning task that the FFA supports the holistic processing of visual stimuli in participants’ expertise domain.
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Affiliation(s)
- Ellen M. Kok
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Education, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koos van Geel
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Andreas Gegenfurtner
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Methods in Learning Research, University of Augsburg, Augsburg, Germany
| | | | - Simon G. F. Robben
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anique B. H. de Bruin
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Thi Nguyen VA, Könings KD, Scherpbier AJJA, van Merriënboer JJG. Attracting and retaining physicians in less attractive specialties: the role of continuing medical education. Hum Resour Health 2021; 19:69. [PMID: 34011364 PMCID: PMC8132429 DOI: 10.1186/s12960-021-00613-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/12/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians' intrinsic motivation to work in these specialties. MAIN CONTENT The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians' sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME's long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians' competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory. CONCLUSIONS By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Room 504, B Building, 1 Ton That Tung Street, Dongda, Hanoi, 10000 Vietnam
| | - Karen D. Könings
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen J. G. van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Abstract
AbstractThe testing effect—the power of retrieval practice to enhance long-term knowledge retention more than restudying does—is a well-known phenomenon in learning. However, retrieval practice is hardly appreciated by students and underutilized when studying. One of the reasons is that learners usually do not experience immediate benefits of such practice which often present only after a delay. We therefore conducted 2 experiments to examine whether students choose retrieval practice more often as their learning strategy after having experienced its benefits. In Experiment 1, students received individual feedback about the extent to which their 7-day delayed test scores after retrieval practice differed from their test scores after restudy. Those students who had actually experienced the benefits of retrieval practice appreciated the strategy more and used it more often after receiving feedback. In Experiment 2, we compared the short-term and long-term effects on retrieval practice use of individual performance feedback and general instruction about the testing effect. Although both interventions enhanced its use in the short term, only the individual feedback led to enhanced use in the long term by those who had actually experienced its benefits, demonstrating the superiority of the individual feedback in terms of its ability to promote retrieval practice use.
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Bogomolova K, van Merriënboer JJG, Sluimers JE, Donkers J, Wiggers T, Hovius SER, van der Hage JA. The effect of a three-dimensional instructional video on performance of a spatially complex procedure in surgical residents in relation to their visual-spatial abilities. Am J Surg 2021; 222:739-745. [PMID: 33551116 DOI: 10.1016/j.amjsurg.2021.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of three-dimensional (3D) vs. two-dimensional (2D) video on performance of a spatially complex procedure and perceived cognitive load were examined among residents in relation to their visual-spatial abilities (VSA). METHODS In a randomized controlled trial, 108 surgical residents performed a 5-Flap Z-plasty on a simulation model after watching the instructional video either in a 3D or 2D mode. Outcomes included perceived cognitive load measured by NASA-TLX questionnaire, task performance assessed using Observational Clinical Human Reliability Analysis and the percentage of achieved safe lengthening of the scar. RESULTS No significant differences were found between groups. However, when accounted for VSA, safe lengthening was achieved significantly more often in the 3D group and only among individuals with high VSA (OR = 6.67, 95%CI: 1.23-35.9, p = .027). CONCLUSIONS Overall, 3D instructional videos are as effective as 2D videos. However, they can be effectively used to enhance learning in high VSA residents.
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Affiliation(s)
- Katerina Bogomolova
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Center for Innovation of Medical Education, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands.
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Universiteitssingel 60, UNS60 6229 ER, Maastricht, the Netherlands
| | - Jan E Sluimers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jeroen Donkers
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Universiteitssingel 60, UNS60 6229 ER, Maastricht, the Netherlands
| | - Theo Wiggers
- Incision Academy, Mauritskade 63, 1092 AD, Amsterdam, the Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Center for Innovation of Medical Education, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands
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Szulewski A, Howes D, van Merriënboer JJG, Sweller J. From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine. Acad Med 2021; 96:24-30. [PMID: 32496287 DOI: 10.1097/acm.0000000000003524] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Cognitive load theory has become a leading model in educational psychology and has started to gain traction in the medical education community over the last decade. The theory is rooted in our current understanding of human cognitive architecture in which an individual's limited working memory and unlimited long-term memory interact during the process of learning. Though initially described as primarily a theory of learning, parallels between cognitive load theory and broader aspects of medical education as well as clinical practice are now becoming clear. These parallels are particularly relevant and evident in complex clinical environments, like resuscitation medicine. The authors have built on these connections to develop a recontextualized version of cognitive load theory that applies to complex professional domains and in which the connections between the theory and clinical practice are made explicit, with resuscitation medicine as a case study. Implications of the new model for medical education are also presented along with suggested applications.
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Affiliation(s)
- Adam Szulewski
- A. Szulewski is associate professor, Departments of Emergency Medicine and Psychology, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3076-6221
| | - Daniel Howes
- D. Howes is professor, Departments of Emergency Medicine and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jeroen J G van Merriënboer
- J.J.G. van Merriënboer is professor, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - John Sweller
- J. Sweller is emeritus professor, School of Education, University of New South Wales, Sydney, Australia
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Beulens AJW, Brinkman WM, Umari P, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, van der Poel HG, Bangma C, Wagner C. Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients. Int J Med Robot 2020; 17:e2196. [PMID: 33113236 DOI: 10.1002/rcs.2196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of urethral stump length and width measurements in recorded videos of robot assisted radical prostatectomy procedures using the Kinovea software and to assess if these measurements could be used as predictors of postoperative urinary continence. METHODS Fifty-three patients were selected from an institutional database of 1400 cases and included in the study. All videos were analysed using the computer software 'Kinovea'. All measurements were performed using the inserted bladder catheter as a reference point. RESULTS The reference point (bladder catheter) was available in 33 out of 53 patients. The median surgical urethral length (SUL) was significantly higher in the continent group (1050 vs. 1294 mm, p = 0.018). The urethral width measurements did not show a difference between the groups. In order to validate the Kinovea software as an accurate tool for the measurement of the urethral stump length and width results were correlated with the magnetic resonance imaging measurements of the urethra. CONCLUSIONS The results of this study showed a significantly longer median SUL incontinent patients.
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Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paolo Umari
- University of Eastern Piedmont, Novara, Italy
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ad J M Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Urologist, Not Practicing
| | - Jean Paul van Basten
- Prosper Prostate Cancer Center, Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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14
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Abstract
Cognitive-load researchers attempt to engineer the instructional control of cognitive load by designing methods that substitute productive for unproductive cognitive load. This article highlights proven and new methods to achieve this instructional control by focusing on the cognitive architecture used by cognitive-load theory and aspects of the learning task, the learner, and the learning environment.
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Affiliation(s)
- Fred Paas
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam
- School of Education, University of Wollongong
- Early Start, University of Wollongong
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15
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Beulens AJW, Brinkman WM, Koldewijn EL, Hendrikx AJM, van Basten JPA, van Merriënboer JJG, Van der Poel HG, Bangma CH, Wagner C. A Prospective, Observational, Multicentre Study Concerning Nontechnical Skills in Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy. EUR UROL SUPPL 2020; 19:37-44. [PMID: 34337453 PMCID: PMC8317860 DOI: 10.1016/j.euros.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/20/2020] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction and hypotheses valuation of surgical skills, both technical and nontechnical, is possible through observations and video analysis. Besides technical failures, adverse outcomes in surgery can also be related to hampered communication, moderate teamwork, lack of leadership, and loss of situational awareness. Even though some surgeons are convinced about nontechnical skills being an important part of their professionalisation, there is paucity of data about a possible relationship between nontechnical skills and surgical outcome. In robot-assisted surgery, the surgeon sits behind the console and is at a remote position from the surgical field and team, making communication more important than in open surgery and conventional laparoscopy. A lack of structured research makes it difficult to assess the value of the different analysis methods for nontechnical skills, particularly in robot-assisted surgery. Our hypothesis includes the following: (1) introduction of robot-assisted surgery leads to an initial decay in nontechnical skills behaviour during the learning curve of the team, (2) nontechnical skills behaviour is more explicitly expressed in experienced robot-assisted surgery teams than in experienced open surgery teams, and (3) introduction of robot-assisted surgery leads to the development of different forms of nontechnical skills behaviour compared with open surgery. Design This study is a prospective, observational, multicentre, nonrandomised, case-control study including bladder cancer patients undergoing either an open radical cystectomy or a robot-assisted radical cystectomy at the Catharina Hospital Eindhoven, the Netherlands, or at the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam. All patients are eligible for inclusion; there are no exclusion criteria. The Catharina Hospital Eindhoven, the Netherlands, performs on average 35 radical cystectomies a year. The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam, performs on average 100 radical cystectomies a year. Protocol overview The choice of treatment is at the discretion of the patient and the surgeon. Patient results will be obtained prospectively. Pathology results as well as complications occurring within 90 d following surgery will be registered. Surgical complications will be registered according to the Clavien-Dindo system. Measurements Nontechnical skills will be observed using five different methods: (1) NOTSS: Nontechnical Skills for Surgeons; (2) Oxford NOTECHS II: a modified theatre team nontechnical skills scoring system; (3) OTAS: Observational Teamwork Assessment for Surgery; (4) Interpersonal and Cognitive Assessment for Robotic Surgery (ICARS): evaluation of nontechnical skills in robotic surgery; and (5) analysis of human factors. Technical skills in robot-assisted radical cystectomy will be analysed using two different methods: (1) GEARS: Global Evaluative Assessment of Robotic Skill and (2) GERT: Generic Error Rating Tool. Safety criteria and reporting Formal ethical approval has been provided by Medical research Ethics Committees United (MEC-U), The Netherlands (reference number W19.048). We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals. Statistical analysis Frequency statistics will be calculated for patient demographical data, and a Shapiro-Wilk test with p > 0.05 will be used to define normal distribution. Univariate analysis will be conducted to test for statistically significant differences in observation scores between open radical cystectomy and robot-assisted radical cystectomy cohorts across all variables, using independent sample t tests and Mann-Whitney U testing, as appropriate. A variable-selection strategy will be used to create multivariate models. Binary logistic regression will be conducted to calculate odds ratios and 95% confidence intervals for significant predictors on univariate analysis and clinically relevant covariates. Statistical significance is set at p < 0.05 based on a two-tailed comparison. Summary This study uses a structured approach to the analysis of nontechnical skills using extracorporeal videos of both open radical cystectomy and robot-assisted radical cystectomy surgeries, in order to obtain detailed data on nontechnical skills during open and minimally invasive surgeries. The results of this study could possibly be used to develop team-training programmes, specifically for the introduction of the surgical robot in relation to changes in nontechnical skills. Additional analysis of technical skills using the intracorporeal footage of the surgical robot will be used to elucidate the role of surgical skills and surgical events in nontechnical skills.
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Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ad J M Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Henk G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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16
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Nazari T, van de Graaf FW, Dankbaar MEW, Lange JF, van Merriënboer JJG, Wiggers T. One Step at a Time: Step by Step Versus Continuous Video-Based Learning to Prepare Medical Students for Performing Surgical Procedures. J Surg Educ 2020; 77:779-787. [PMID: 32171749 DOI: 10.1016/j.jsurg.2020.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study was to compare the effects of cognitive load and surgical performance in medical students that performed the open inguinal hernia repair after preparation with step-by-step video-demonstration versus continuous video-demonstration. Hypothetically, the step-by-step group will perceive lower extraneous load during the preparation of the surgical procedure compared to the continuous group. Subsequently, fewer errors will be made in the surgical performance assessment by the step-by-step group, resulting in better surgical performance. DESIGN In this prospective study, participants were randomly assigned to the step-by-step or continuous video-demonstration. They completed questionnaires regarding perceived cognitive load during preparation (10-point Likert scale). Their surgical performance was assessed on a simulation hernia model using the Observational Clinical Human Reliability Assessment. SETTING Erasmus University Medical Center, Rotterdam, the Netherlands. PARTICIPANTS Participants included medical students who were enrolled in extracurricular anatomy courses. RESULTS Forty-three students participated; 23 students in the step-by-step group and 20 in the continuous group. As expected, the step-by-step group perceived a lower extraneous cognitive load (2.92 ± 1.21) compared to the continuous group (3.91 ± 1.67, p = 0.030). The surgical performance was not statistically significantly different between both groups; however, in subanalyses on a selection of students that prepared for 1 to 2 hours, the step-by-step group made less procedural errors, 1.67 ± 1.11, compared to the continuous group, 3.06 ± 1.91, p = 0.018. CONCLUSIONS Our results suggest that preparation using step-by-step video-based learning results in lower extraneous cognitive load and subsequently fewer procedural errors during the surgical performance. For learning purposes, demonstration videos of surgical procedures should be presented in a segmented format.
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Affiliation(s)
- Tahmina Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Incision Academy, Amsterdam, the Netherlands.
| | - Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mary E W Dankbaar
- The institute of Medical Education Research Rotterdam (iMERR), the Netherlands; Department of Education, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
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17
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Nguyen VAT, Könings KD, Wright EP, Kim GB, Luu HN, Scherpbier AJJA, van Merriënboer JJG. Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations. Hum Resour Health 2020; 18:32. [PMID: 32366327 PMCID: PMC7197171 DOI: 10.1186/s12960-020-00474-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/22/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty. METHODS A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice). RESULTS Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice. CONCLUSIONS The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Room 504, B4 Building, 1 Ton That Tung Street, Dongda, Hanoi, 10000 Vietnam
| | - Karen D. Könings
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - E. Pamela Wright
- Guelph International Health Consulting, Frederik Hendrikstraat 18, 1052 HT Amsterdam, the Netherlands
| | - Giang Bao Kim
- Center of Student Assessment and Quality Assurance, Hanoi Medical University, 1 Ton That Tung Street, Dongda, Hanoi, Vietnam
| | - Hoat Ngoc Luu
- Biostatistics and Medical Informatics Department, Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Dongda, Hanoi, Vietnam
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Jeroen J. G. van Merriënboer
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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18
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Rovers SFE, Stalmeijer RE, van Merriënboer JJG, Savelberg HHCM, de Bruin ABH. Corrigendum: How and Why Do Students Use Learning Strategies? A Mixed Methods Study on Learning Strategies and Desirable Difficulties With Effective Strategy Users. Front Psychol 2020; 11:261. [PMID: 32153471 PMCID: PMC7044668 DOI: 10.3389/fpsyg.2020.00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2018.02501.].
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Affiliation(s)
- Sanne F E Rovers
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | | | - Hans H C M Savelberg
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Anique B H de Bruin
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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19
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Beulens AJW, Namba HF, Brinkman WM, Meijer RP, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, Van der Poel HG, Bangma C, Wagner C. Analysis of the video motion tracking system "Kinovea" to assess surgical movements during robot-assisted radical prostatectomy. Int J Med Robot 2020; 16:e2090. [PMID: 32034977 DOI: 10.1002/rcs.2090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUNDS Robot-assisted surgery facilitated the possibility to evaluate the surgeon's skills by recording and evaluating the robot surgical images. The aim of this study was to investigate the possibility of using a computer programme (Kinovea) for objective assessment of surgical movements in previously recorded in existing robot-assisted radical prostatectomy (RARP) videos. METHODS Twelve entire RARP procedures were analysed by a trained researcher using the computer programme "Kinovea" to perform semi-automated assessment of surgical movements. RESULTS Data analysis showed Kinovea was on average able to automatically assess only 22% of the total surgical duration per video of the robot-assisted surgery. On average, it lasted 4 hours of continued monitoring by the researcher to assess one RARP using Kinovea. CONCLUSION Although we proved it is technically possible to use the Kinovea system in retrospective analysis of surgical movement in robot-assisted surgery, the acquired data do not give a comprehensive enough analysis of the video to be used in skills assessment.
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Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Hanae F Namba
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | - Henk G Van der Poel
- Department of Urology, Dutch Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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20
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Wagner-Menghin M, de Bruin ABH, van Merriënboer JJG. Communication skills supervisors' monitoring of history-taking performance: an observational study on how doctors and non-doctors use cues to prepare feedback. BMC Med Educ 2020; 20:36. [PMID: 32028941 PMCID: PMC7006145 DOI: 10.1186/s12909-019-1920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Medical students need feedback to improve their patient-interviewing skills because self-monitoring is often inaccurate. Effective feedback should reveal any discrepancies between desired and observed performance (cognitive feedback) and indicate metacognitive cues which are diagnostic of performance (metacognitive feedback). We adapted a cue-utilization model to studying supervisors' cue-usage when preparing feedback and compared doctors' and non-doctors' cue usage. METHOD Twenty-one supervisors watched a video of a patient interview, choose scenes for feedback, and explained their selection. We applied content analysis to categorize and count cue-use frequency per communication pattern (structuring/facilitating) and scene performance rating (positive/negative) for both doctors and non-doctors. RESULTS Both groups used cognitive cues more often than metacognitive cues to explain their scene selection. Both groups also used metacognitive cues such as subjective feelings and mentalizing cues, but mainly the doctors mentioned 'missing information' as a cue. Compared to non-doctors, the doctors described more scenes showing negative performance and fewer scenes showing positive narrative-facilitating performance. CONCLUSIONS Both groups are well able to communicate their observations and provide cognitive feedback on undergraduates' interviewing skills. To improve their feedback, supervisors should be trained to also recognize metacognitive cues, such as subjective feelings and mentalizing cues, and learn how to convert both into metacognitive feedback.
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Affiliation(s)
| | - Anique B. H. de Bruin
- Maastricht University, School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen J. G. van Merriënboer
- Maastricht University, School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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21
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Hung W, Dolmans DHJM, van Merriënboer JJG. A review to identify key perspectives in PBL meta-analyses and reviews: trends, gaps and future research directions. Adv Health Sci Educ Theory Pract 2019; 24:943-957. [PMID: 31768786 DOI: 10.1007/s10459-019-09945-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
In the past 50 years, the original McMaster PBL model has been implemented, experimented, revised, and modified, and is still evolving. Yet, the development of PBL is not a series of success stories, but rather a journey of experiments, failures and lessons learned. In this paper, we analyzed the meta-analyses and systematic reviews on PBL from 1992 to present as they provide a focused lens on the PBL research in the past 5 decades. We identified three major waves in the PBL research development, analyzed their impact on PBL research and practice, and offered suggestions of research gaps and future directions for the field. The first wave of PBL research (polarization: 1990-mid 2000) focused on answering the question "Does PBL work?" and the outcomes. The results were conflicting. The researchers took polarizing positions and debated over the merits of PBL throughout this wave. However, the contradictory results and the debates in fact pushed the researchers to look harder for new directions to solve the puzzle. These efforts resulted in the second wave (from outcomes to process: mid 2000-mid 2010) that focused on the question "How does PBL work?" The second wave of PBL research targeted at investigating the effects of implementation constituents, such as assessment formats or single versus curriculum wide implementations. The third wave (specialization: mid 2010 and onward) of PBL research focused on "How does PBL work in different specific contexts?" These research widened our perspectives by expanding our understanding of how PBL manifests itself in different contexts. Given the diversification of PBL and more hybrid PBL models, we suggest "Why does PBL with particular implementation characteristics for specific outcomes work or not work in the condition where it is implemented?" to be the question to answer in the next wave of PBL research.
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Affiliation(s)
- Woei Hung
- Instructional Design and Technology Program, Department of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, USA.
| | - Diana H J M Dolmans
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jeroen J G van Merriënboer
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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22
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Mohtady HA, Könings KD, Al-Eraky MM, Muijtjens AMM, van Merriënboer JJG. High enthusiasm about long lasting mentoring relationships and older mentors. BMC Med Educ 2019; 19:364. [PMID: 31547807 PMCID: PMC6757421 DOI: 10.1186/s12909-019-1791-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mentoring plays a pivotal role in workplace-based learning, especially in the medical realm. Organising a formal mentoring programme can be labor and time intensive and generally impractical in resource constrained medical schools with limited numbers of mentors. Hence, informal mentoring offers a valuable alternative, but will be more likely to be effective when mentors and protégés share similar views. It is therefore important to gain more insight into factors influencing perceptions of informal mentoring. This study aims to explore mentors and protégés' perceptions of informal mentoring and how these vary (or not) with gender, age and the duration of the relationship. METHOD We administered an Informal Mentor Role Instrument (IMRI) to medical practitioners and academics from Egypt, Pakistan and Saudi Arabia. The questionnaire was developed for the study from other validated instruments. It contained 39 items grouped into 7 domains: acceptance, counselling, friendship, parenting, psychological support, role modelling and sociability. RESULTS A total of 103 mentors and 91 protégés completed the IMRI. Mentors had a better appreciation for the interpersonal aspects of informal mentoring than protégés, especially regarding acceptance, counselling and friendship. Moreover, being older and engaged in a longer mentoring relationship contributed to more positive perceptions of interpersonal aspects of mentoring, regardless of one's role (mentor or protégé). CONCLUSION It can be concluded that the expectations of mentors and protégés differed regarding the content and aim of the interpersonal characteristics of their mentoring relationship. We recommend mentors and protégés to more explicitly exchange their expectations of the informal mentoring relationship, as typically practiced in formal mentoring. Additionally, in our study, seniority and lasting relationships seem crucial for good informal mentoring. It appears beneficial to foster lasting informal mentoring relationships and to give more guidance to younger mentors.
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Affiliation(s)
- Heba A. Mohtady
- Medical Education Department, Fakeeh College for Medical Sciences, P.O 2537, Jeddah, 21461 Kingdom of Saudi Arabia
- Maastricht University, Maastricht, the Netherlands
- Microbiology &Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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23
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van Geel K, Kok EM, Krol JP, Houben IPL, Thibault FE, Pijnappel RM, van Merriënboer JJG, Lobbes MBI. Reversal of the hanging protocol of Contrast Enhanced Mammography leads to similar diagnostic performance yet decreased reading times. Eur J Radiol 2019; 117:62-68. [PMID: 31307654 DOI: 10.1016/j.ejrad.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Contrast-enhanced mammography (CEM) was found superior to Full-Field Digital Mammography (FFDM) for breast cancer detection. Current hanging protocols show low-energy (LE, similar to FFDM) images first, followed by recombined (RC) images. However, evidence regarding which hanging protocol leads to the most efficient reading process and highest diagnostic performance is lacking. This study investigates the effects of hanging-protocol ordering on the reading process and diagnostic performance of breast radiologists using eye-tracking methodology. Furthermore, it investigates differences in reading processes and diagnostic performance between LE, RC and FFDM images. MATERIALS AND METHODS Twenty-seven breast radiologists were randomized into three reading groups: LE-RC (commonly used hangings), RC-LE (reversed hangings) and FFDM. Thirty cases (nine malignant) were used. Fixation count, net dwell time and time-to-first fixation on malignancies as visual search measures were registered by the eye-tracker. Reading time per image was measured. Participants clicked on suspicious lesions to determine sensitivity and specificity. Area-under-the-ROC-curve (AUC) values were calculated. RESULTS RC-LE scored identical on visual search measures, t(16)= -1.45, p = .17 or higher-p values, decreased reading time with 31%, t(16)= -2.20, p = .04, while scoring similar diagnostic performance compared to LE-RC, t(13.2) = -1.39, p - .20 or higher p-values. The reading process was more efficient on RC compared to LE. Diagnostic performance of CEM was superior to FFDM; F (2,26) = 16.1, p < .001. Average reading time did not differ between the three groups, F (2,25) = 3.15, p = .06. CONCLUSION The reversed CEM hanging protocol (RC-LE) scored similar on diagnostic performance compared to LE-RC, while reading time was a third faster. Abnormalities were interpreted quicker on RC images. A RC-LE hanging protocol is therefore recommended for clinical practice and training. Diagnostic performance of CEM was (again) superior to FFDM.
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Affiliation(s)
- Koos van Geel
- Department of Radiology, Maastricht University Medical Center, PO box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - Ellen M Kok
- Department of Education, Utrecht University, Heidelberglaan 1, Room E3.34, 3584, CS, Utrecht, the Netherlands
| | - Jorian P Krol
- Department of Radiology, Maastricht University Medical Center, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Ivo P L Houben
- Department of Radiology, Maastricht University Medical Center, PO box 5800, 6202, AZ, Maastricht, the Netherlands; Maastricht University, School for Oncology and Developmental Biology (GROW), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Fabienne E Thibault
- Department of Radiology, Institut Curie, 26 rue d'Ulm, 75248, Paris Cedex 05, France
| | - Ruud M Pijnappel
- Department of Radiology, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jeroen J G van Merriënboer
- Maastricht University, School of Health Professions Education, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands
| | - Marc B I Lobbes
- Department of Radiology, Maastricht University Medical Center, PO box 5800, 6202, AZ, Maastricht, the Netherlands; Maastricht University, School for Oncology and Developmental Biology (GROW), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
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Darras KE, G van Merriënboer JJ, Toom M, Roberson ND, H de Bruin AB, Nicolaou S, Forster BB. Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps. Can Assoc Radiol J 2019; 70:320-326. [PMID: 31300315 DOI: 10.1016/j.carj.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE There is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning). METHODS An online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05. RESULTS The response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important (P < .01) and quizzes as less important (P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable. CONCLUSION This study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.
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Affiliation(s)
- Kathryn E Darras
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - Matthew Toom
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan D Roberson
- Centre for Teaching, Learning, and Technology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anique B H de Bruin
- School of Health Professions Education, Maastricht University, The Netherlands
| | - Savvas Nicolaou
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce B Forster
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Nguyen VAT, Könings KD, Wright EP, Luu HN, Scherpbier AJJA, van Merriënboer JJG. Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession. Hum Resour Health 2019; 17:31. [PMID: 31092249 PMCID: PMC6521520 DOI: 10.1186/s12960-019-0368-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/30/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND Recruiting and retaining students in preventive medical (PM) specialties has never been easy; one main challenge is how to select appropriate students with proper motivation. Understanding how students perceive PM practice differently from practicing doctors is necessary to guide students, especially for those for whom PM is only a substitute for medicine as their first study preference, properly during their study and, later, the practice of PM. METHODS One thousand three hundred eighty-six PM students in four Vietnamese medical schools and 101 PM doctors filled out a questionnaire about the relevance of 44 characteristics of working in PM. ANOVAs were conducted to define the relationship between students' interest, year of study, willingness to work in PM, and the degree to which students had realistic perceptions of PM practice, compared to doctors' perceptions. RESULTS Overall, compared to doctors' perceptions, students overestimated the importance of most of the investigated PM practice's characteristics. Moreover, students' perception related to their preference and willing to pursue a career in PM after graduation. In particular, students for whom PM was their first choice had more realistic perceptions of community practice than those who chose PM as their second choice. And, second-choice students had more realistic perceptions than first-choice students in their final years of study, but expected higher work stress in PM practice. Students who were willing to pursue a career in PM rated the importance of community practice higher than those who were not. We also found that students' perception changed during training as senior students had more realistic perceptions of clinical aspects and working stress than junior students, even though they overemphasized the importance of the community aspects of PM practice. CONCLUSIONS To increase the number of students actually entering the PM field after graduation, the flawed perceptions of students about the real working environment of PM doctors should be addressed through vocation-oriented activities in the curriculum targeted on groups of students who are most likely to have unrealistic perceptions. Our findings also have implications for other less attractive primary health care specialties that experience problems with recruiting and retaining students.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, 1 Ton That Tung street, Dongda, Hanoi, Vietnam
| | - Karen D. Könings
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - E. Pamela Wright
- Guelph International Health Consulting, Frederik Hendrikstraat 18, 1052 HT Amsterdam, the Netherlands
| | - Hoat Ngoc Luu
- Biostatistics and Medical Informatics Department, Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung street, Dongda, Hanoi, Vietnam
| | - Albert J. J. A. Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Jeroen J. G. van Merriënboer
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Geel KV, Kok EM, Aldekhayel AD, Robben SGF, van Merriënboer JJG. Chest X-ray evaluation training: impact of normal and abnormal image ratio and instructional sequence. Med Educ 2019; 53:153-164. [PMID: 30474292 PMCID: PMC6587445 DOI: 10.1111/medu.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Medical image perception training generally focuses on abnormalities, whereas normal images are more prevalent in medical practice. Furthermore, instructional sequences that let students practice prior to expert instruction (inductive) may lead to improved performance compared with methods that give students expert instruction before practice (deductive). This study investigates the effects of the proportion of normal images and practice-instruction order on learning to interpret medical images. It is hypothesised that manipulation of the proportion of normal images will lead to a sensitivity-specificity trade-off and that students in practice-first (inductive) conditons need more time per practice case but will correctly identify more test cases. METHODS Third-year medical students (n = 103) learned radiograph interpretation by practising cases with, respectively, 30% or 70% normal radiographs prior to expert instruction (practice-first order) or after expert instruction (instruction-first order). After training, students performed a test (60% normal) and sensitivity (% of correctly identified abnormal radiographs), specificity (% of correctly identified normal radiographs), diagnostic performance (% of correct diagnoses) and case duration were measured. RESULTS The conditions with 30% of normal images scored higher on sensitivity but the conditions with 70% of normal images scored higher on specificity, indicating a sensitivity and specificity trade-off. Those who participated in inductive conditions took less time per practice case but more per test case. They had similar test sensitivity, but scored lower on test specificity. CONCLUSIONS The proportion of normal images impacted the sensitivity-specificity trade-off. This trade-off should be an important consideration for the alignment of training with future practice. Furthermore, the deductive conditions unexpectedly scored higher on specificity when participants took less time per case. An inductive approach did not lead to higher diagnostic performance, possibly because participants might already have relevant prior knowledge. Deductive approaches are therefore advised for the training of advanced learners.
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Affiliation(s)
- Koos van Geel
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen M Kok
- Department of Education, Utrecht University, Utrecht, the Netherlands
| | - Abdullah D Aldekhayel
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeroen J G van Merriënboer
- School of Health Professions Education, Department of Educational Research and Development, Maastricht University, Maastricht, the Netherlands
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Rovers SFE, Stalmeijer RE, van Merriënboer JJG, Savelberg HHCM, de Bruin ABH. How and Why Do Students Use Learning Strategies? A Mixed Methods Study on Learning Strategies and Desirable Difficulties With Effective Strategy Users. Front Psychol 2018; 9:2501. [PMID: 30618932 PMCID: PMC6302009 DOI: 10.3389/fpsyg.2018.02501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/23/2018] [Indexed: 11/30/2022] Open
Abstract
In order to ensure long-term retention of information students must move from relying on surface-level approaches that are seemingly effective in the short-term to “building in” so called “desirable difficulties,” with the aim of achieving understanding and long-term retention of the subject matter. But how can this level of self-regulation be achieved by students when learning? Traditionally, research on learning strategy use is performed using self-report questionnaires. As this method is accompanied by several drawbacks, we chose a qualitative, in-depth approach to inquire about students' strategies and to investigate how students successfully self-regulate their learning. In order to paint a picture of effective learning strategy use, focus groups were organized in which previously identified, effectively self-regulating students (N = 26) were asked to explain how they approach their learning. Using a constructivist grounded theory methodology, a model was constructed describing how effective strategy users manage their learning. In this model, students are driven by a personal learning goal, adopting a predominantly qualitative, or quantitative approach to learning. While learning, students are continually engaged in active processing and self-monitoring. This process is guided by a constant balancing between adhering to established study habits, while maintaining a sufficient degree of flexibility to adapt to changes in the learning environment, assessment demands, and time limitations. Indeed, students reported using several strategies, some of which are traditionally regarded as “ineffective” (highlighting, rereading etc.). However, they used them in a way that fit their learning situation. Implications are discussed for the incorporation of desirable difficulties in higher education.
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Affiliation(s)
- Sanne F E Rovers
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | | | - Hans H C M Savelberg
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Anique B H de Bruin
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Jaarsma T, Boshuizen HPA, Jarodzka H, van Merriënboer JJG. To guide or to follow? Teaching visual problem solving at the workplace. Adv Health Sci Educ Theory Pract 2018; 23:961-976. [PMID: 30022266 PMCID: PMC6245035 DOI: 10.1007/s10459-018-9842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
Visual problem solving is essential to highly visual and knowledge-intensive professional domains such as clinical pathology, which trainees learn by participating in relevant tasks at the workplace (apprenticeship). Proper guidance of the visual problem solving of apprentices by the master is necessary. Interaction and adaptation to the expertise level of the learner are identified as key ingredients of this guidance. This study focuses on the effect of increased participation of the learner in the task on the interaction and adaptation of the guidance by masters. Thirteen unique dyads consisting of a clinical pathologist (master) and a resident (apprentice) discussed and diagnosed six microscope images. Their dialogues were analysed on their content. The dyads were divided in two groups according to the experience of the apprentice. For each dyad, master and apprentice both operated the microscope for half of the cases. Interaction was operationalised as the equal contribution of both master and apprentice to the dialogue. Adaptation was operationalised as the extent to which the content of the dialogues was adapted to the apprentice's level. The main hypothesis stated that the interaction and adaptation increase when apprentices operate the microscope. Most results confirmed this hypothesis: apprentices contributed more content when participating more and the content of these dialogues better reflected expertise differences of apprentices. Based on these results, it is argued that, for learning visual problem solving in a visual and knowledge-intensive domain, it is not only important to externalise master performance, but also that of the apprentice.
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Affiliation(s)
- Thomas Jaarsma
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands.
| | - Henny P A Boshuizen
- Centre for Learning Sciences and Technologies, Open University of The Netherlands, Heerlen, The Netherlands
| | - Halszka Jarodzka
- Centre for Learning Sciences and Technologies, Open University of The Netherlands, Heerlen, The Netherlands
| | - Jeroen J G van Merriënboer
- Centre for Learning Sciences and Technologies, Open University of The Netherlands, Heerlen, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Beulens AJW, Brinkman WM, Porte PJ, Meijer RP, van Merriënboer JJG, Van der Poel HG, Wagner C. The value of a 1-day multidisciplinary robot surgery training for novice robot surgeons. J Robot Surg 2018; 13:435-447. [PMID: 30467702 DOI: 10.1007/s11701-018-0894-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION To fulfil the need for a basic level of competence in robotic surgery (Brinkman et al., Surg Endosc Other Interv Tech 31(1):281-287, 2017; Dutch Health inspectorate (Inspectie voor de gezondheidszorg), Insufficient carefulness at the introduction of surgical robots (in Dutch: Onvoldoende zorgvuldigheid bij introductie van operatierobots), Igz, Utrecht, 2010), the NIVEL (Netherlands Institute for Healthcare Research) developed the 'Basic proficiency requirements for the safe use of robotic surgery' (BPR). Based on the BPR a 1-day robotic surgery training was organised to answer the following research questions: (1) Are novice robot surgeons able to accurately self-assess their knowledge and dexterity skills? (2) Is it possible to include the teaching of all BPRs in a 1-day training? MATERIALS AND METHODS Based on the BPR, a robot surgery course was developed for residents and specialists (surgery, gynaecology and urology). In preparation, the participants completed an online e-module. The 1-day training consisted of a practical part on robot set-up, a theoretical section, and hands-on exercises on virtual reality robot simulators. Multiple online questionnaire was filled out by the participants at the end of the training to evaluate the perceived educational value of the course and to self-assess the degree to which BPRs were reached. RESULTS 20 participants completed the training during the conference of the Dutch Association for Endoscopic Surgery (NVEC) in 2017. Participants indicated nearly all competency requirements were mastered at the end of the training. The competency requirements not mastered were, however, critical requirements for the safe use of the surgical robot. Skill simulation results show a majority of participants are unable to reach a proficient simulation score in basic skill simulation exercises. CONCLUSION Results show novice robot surgeons are too positive in the self-assessment of their own dexterity skills after a 1-day training. Self-assessment revealed uncertainty of the obtained knowledge level on requirements for the safe use of the surgical robot. Basic courses on robotic training should inform trainees about their results to enhance learning and inform them of their competence levels.
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Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. .,Department of Urology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
| | - Willem M Brinkman
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Petra J Porte
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Henk G Van der Poel
- Department of Urology, Dutch Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands
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30
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de Vries AH, Muijtjens AMM, van Genugten HGJ, Hendrikx AJM, Koldewijn EL, Schout BMA, van der Vleuten CPM, Wagner C, Tjiam IM, van Merriënboer JJG. Development and validation of the TOCO–TURBT tool: a summative assessment tool that measures surgical competency in transurethral resection of bladder tumour. Surg Endosc 2018; 32:4923-4931. [DOI: 10.1007/s00464-018-6251-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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Raaijmakers SF, Baars M, Paas F, van Merriënboer JJG, van Gog T. Training self-assessment and task-selection skills to foster self-regulated learning: Do trained skills transfer across domains? Appl Cogn Psychol 2018; 32:270-277. [PMID: 29610547 PMCID: PMC5873380 DOI: 10.1002/acp.3392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022]
Abstract
Students' ability to accurately self-assess their performance and select a suitable subsequent learning task in response is imperative for effective self-regulated learning. Video modeling examples have proven effective for training self-assessment and task-selection skills, and-importantly-such training fostered self-regulated learning outcomes. It is unclear, however, whether trained skills would transfer across domains. We investigated whether skills acquired from training with either a specific, algorithmic task-selection rule or a more general heuristic task-selection rule in biology would transfer to self-regulated learning in math. A manipulation check performed after the training confirmed that both algorithmic and heuristic training improved task-selection skills on the biology problems compared with the control condition. However, we found no evidence that students subsequently applied the acquired skills during self-regulated learning in math. Future research should investigate how to support transfer of task-selection skills across domains.
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Affiliation(s)
| | - Martine Baars
- Department of Psychology, Education and Child Studies Erasmus University Rotterdam Rotterdam The Netherlands
| | - Fred Paas
- Department of Psychology, Education and Child Studies Erasmus University Rotterdam Rotterdam The Netherlands.,Early Start Research Institute University of Wollongong Wollongong Australia
| | | | - Tamara van Gog
- Department of Education Utrecht University Utrecht The Netherlands
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de Melo BCP, Rodrigues Falbo A, Sorensen JL, van Merriënboer JJG, van der Vleuten C. Self-perceived long-term transfer of learning after postpartum hemorrhage simulation training. Int J Gynaecol Obstet 2018; 141:261-267. [PMID: 29330842 DOI: 10.1002/ijgo.12442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/26/2017] [Accepted: 01/11/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore long-term transfer (application of acquired knowledge and skills on the job) after postpartum hemorrhage simulation training based on either instructional design (ID) principles or conventional best practice. METHODS In this qualitative study, semi-structured interviews with obstetrics and gynecology healthcare practitioners were conducted between August 7 and September 26, 2015, in Recife, Brazil. The participants were randomly selected from each of two postpartum hemorrhage simulations attended 2 years earlier (one ID and one conventional best practice). Thematic analysis was used to explore (1) residents' perceptions of long-term transfer of learning, (2) ID elements influencing the perceived long-term transfer, and (3) differences in the participants' perceptions according to the type of simulation attended. RESULTS There were 12 interview participants. After either simulation format, residents perceived long-term transfer effects. Training design factors influencing transfer were, in their opinion, related to trainees' characteristics, simulation design, and workplace environment. Trainees who participated in the ID-based simulation perceived better communication skills and better overall situational awareness: "I didn't do that before." CONCLUSION All residents perceived long-term transfer after simulation training for postpartum hemorrhage. Those who attended the ID format additionally perceived improvements in communication skills and situational awareness, which are fundamental factors in the management of postpartum hemorrhage.
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Affiliation(s)
- Brena Carvalho Pinto de Melo
- Curso de Medicina, Faculdade Pernambucana de Saúde, Recife, Brazil.,Centro de Atenção à Mulher, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ana Rodrigues Falbo
- Faculty Development Coordination, Faculdade Pernambucana de Saúde, Recife, Brazil.,Diretoria de Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jeroen J G van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Cees van der Vleuten
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Szulewski A, Gegenfurtner A, Howes DW, Sivilotti MLA, van Merriënboer JJG. Measuring physician cognitive load: validity evidence for a physiologic and a psychometric tool. Adv Health Sci Educ Theory Pract 2017; 22:951-968. [PMID: 27787677 DOI: 10.1007/s10459-016-9725-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/19/2016] [Indexed: 05/14/2023]
Abstract
In general, researchers attempt to quantify cognitive load using physiologic and psychometric measures. Although the construct measured by both of these metrics is thought to represent overall cognitive load, there is a paucity of studies that compares these techniques to one another. The authors compared data obtained from one physiologic tool (pupillometry) to one psychometric tool (Paas scale) to explore whether they actually measured the construct of cognitive load as purported. Thirty-two participants with a range of resuscitation medicine experience and expertise completed resuscitation-medicine based multiple-choice-questions as well as arithmetic questions. Cognitive load, as measured by both tools, was found to be higher for the more difficult questions as well as for questions that were answered incorrectly (p < 0.001). The group with the least medical experience had higher cognitive load than both the intermediate and experienced groups when answering domain-specific questions (p = 0.023 and p = 0.003 respectively for the physiologic tool; p = 0.006 and p < 0.001 respectively for the psychometric tool). There was a strong positive correlation (Spearman's ρ = 0.827, p < 0.001 for arithmetic questions; Spearman's ρ = 0.606, p < 0.001 for medical questions) between the two cognitive load measurement tools. These findings support the validity argument that both physiologic and psychometric metrics measure the construct of cognitive load.
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Affiliation(s)
- Adam Szulewski
- Department of Emergency Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Andreas Gegenfurtner
- Institut für Qualität und Weiterbildung, Technische Hochschule Deggendorf, Edlmairstraße 9, 94469, Deggendorf, Germany
| | - Daniel W Howes
- Departments of Emergency Medicine and Critical Care, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Marco L A Sivilotti
- Departments of Emergency Medicine and Biomedical and Molecular Sciences, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, Room N.5.06, 6200 MD, Maastricht, The Netherlands
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Nguyen VAT, Könings KD, Scherpbier AJJA, Wright P, Luu HN, van Merriënboer JJG. Preventive medicine as a first- or second-choice course: a cross-sectional survey into students' motivational differences and implications for information provision. BMC Res Notes 2017; 10:383. [PMID: 28797276 PMCID: PMC5553608 DOI: 10.1186/s13104-017-2706-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/29/2017] [Indexed: 11/26/2022] Open
Abstract
Background Challenges in recruiting and retaining medical staff in preventive medical specialties have recently been the subject of numerous studies. To improve selection procedures, it is important to understand the career preferences and incentives of students in preventive medicine (PM), who initially marked the program as either their first choice or second choice. 1386 PM students in four Vietnamese medical schools participated in a survey using a structured, written questionnaire. Students were asked about their reasons for entering medical school and studying PM, their perceptions of PM during the academic course, and their expected career path following graduation. Results First-choice PM students (group 1) more often had siblings working as a preventive doctor, while second-choice PM students’ siblings (group 2) were more often medical students or clinical doctors. Group 1 had gathered more information about PM by consulting their high-school teachers and the national career guide. They were mainly drawn to the PM program by the newness of the profession, the prospect of a high-income job, its low entry criteria and low study burden compared to general medicine, their desire to uphold their family tradition, and to fulfill their family’s wish of having a doctor in the family. Group 2 chose to study PM because they wanted to pursue their dream of becoming a doctor. Compared to the first group, their perception of PM more frequently changed during the later years of the curriculum and they more frequently envisioned becoming a clinical doctor following graduation. Conclusions Interest in and motivation for PM may be cultivated among prospective or current students by improving information provision, diffusing knowledge, and otherwise acquainting students better with the PM specialty before and during the program. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2706-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, 1 Tonthattung, Dongda, Hanoi, Vietnam.
| | - Karen D Könings
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Albert J J A Scherpbier
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Pamela Wright
- General Director of Medical Committee Netherlands Vietnam, Weteringschans 32, 1017 SH, Amsterdam, The Netherlands
| | - Hoat Ngoc Luu
- Biostatistics and Medical Informatics Department, Institute of Training for Preventive Medicine and Public Health, Hanoi Medical University, 1 Tongthattung, Dongda, Hanoi, Vietnam
| | - Jeroen J G van Merriënboer
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Kok EM, van Geel K, van Merriënboer JJG, Robben SGF. What We Do and Do Not Know about Teaching Medical Image Interpretation. Front Psychol 2017; 8:309. [PMID: 28316582 PMCID: PMC5334326 DOI: 10.3389/fpsyg.2017.00309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.
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Affiliation(s)
- Ellen M Kok
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Koos van Geel
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Centre Maastricht, Netherlands
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de Melo BCP, Falbo AR, Muijtjens AMM, van der Vleuten CPM, van Merriënboer JJG. The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training. Int J Gynaecol Obstet 2017; 137:99-105. [PMID: 28090643 DOI: 10.1002/ijgo.12084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare learning outcomes of postpartum hemorrhage simulation training based on either instructional design guidelines or best practice. METHODS A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013. The instructional design group included 13 teams, whereas the best practice group included seven teams. A standardized task checklist was used for scenario analysis and the proportion of correctly executed tasks compared (post-test minus pretest). RESULTS The instructional design group scored higher than the best practice group for total number of tasks completed (median difference 0.46 vs 0.17; P<0.001; effect size [r]=0.72). Similar results were observed for communication (median difference 0.56 vs 0.22; P=0.004; r=0.58), laboratory evaluation (median difference 0.83 vs 0.00; P<0.001; r=0.76), and mechanical management (median difference 0.25 vs -0.15; P=0.048; r=0.39). Speed of learning was also increased. The median differences were 0.20 for the instructional design group compared with 0.05 for the best practice group at 60 seconds (P=0.015; r=0.49), and 0.49 versus 0.26 (P=0.001; r=0.65) at 360 seconds. CONCLUSION The use of simulation training for postpartum hemorrhage that was based on instructional design guidelines yielded better learning outcomes than did training based on best practice.
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Affiliation(s)
- Brena C P de Melo
- Faculdade Pernambucana de Saúde and Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Centro de Atenção à Mulher, Recife, Brazil.,School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ana R Falbo
- Faculdade Pernambucana de Saúde and Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Centro de Atenção à Mulher, Recife, Brazil
| | - Arno M M Muijtjens
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Cees P M van der Vleuten
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jeroen J G van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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van Merriënboer JJG, de Croock MBM, Jelsma O. The Transfer Paradox: Effects of Contextual Interference on Retention and Transfer Performance of a Complex Cognitive Skill. Percept Mot Skills 2016. [DOI: 10.2466/pms.1997.84.3.784] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In an exploratory study, the effects of contextual interference on retention and transfer performance were studied for learning a complex cognitive skill, namely, troubleshooting a computer-based simulation of a chemical process plant. Support was found for the “transfer paradox”: high contextual interference had negative effects on performance during practice and none on number of retention problems solved after the training but positive effects on number of new problems solved (transfer). Implications for the design of training are discussed.
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Abstract
In the present study, interactions of contextual interference and the cognitive style reflection-impulsivity were examined for training and retention performance. 64 subjects were randomly assigned to either a random or blocked practice schedule in learning a cursor-movement task. Reflectivity indices were determined by means of our computerized version of the Matching Familiar Figures Test. Analysis showed that the generally positive effect of practicing under a random practice schedule decreased for more reflective subjects. Further, training under a random practice schedule forced impulsive subjects to behave more like reflective ones, which improved their performance at retention. It was concluded that reflection-impulsivity is an important factor to be incorporated into the design of effective training programs.
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Wagner-Menghin M, de Bruin A, van Merriënboer JJG. Monitoring communication with patients: analyzing judgments of satisfaction (JOS). Adv Health Sci Educ Theory Pract 2016; 21:523-40. [PMID: 26443084 DOI: 10.1007/s10459-015-9642-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 09/26/2015] [Indexed: 05/17/2023]
Abstract
Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.
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Affiliation(s)
- Michaela Wagner-Menghin
- Department of Medical Education (DEMAW), Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Anique de Bruin
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Jeroen J G van Merriënboer
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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40
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Stoof A, Martens RL, van Merriënboer JJG, Bastiaens TJ. The Boundary Approach of Competence: A Constructivist Aid for Understanding and Using the Concept of Competence. Human Resource Development Review 2016. [DOI: 10.1177/1534484302013005] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although competence is an important concept in human resource development and education, there is no theoretical framework for competence. This article focuses on the development of such a theoretical framework. It proposes the boundary approach ofcompetence, an aid to support human resource managers and educationalists in thinking about the concept of competence and in defining it properly. Here, the concept of competence is being explored by focusing on its dimensions and by identifying differences with related terms. The boundary approach of competence heavily depends on a constructivist point ofview. This holds that the quest for one absolute meaning of competence is being abandoned and that instead competence definitions are being valued against their degree of viability. This article proposes three variables for enhancing viability: people, goal and context.
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de Vries AH, Schout BMA, van Merriënboer JJG, Pelger RCM, Koldewijn EL, Muijtjens AMM, Wagner C. High educational impact of a national simulation-based urological curriculum including technical and non-technical skills. Surg Endosc 2016; 31:928-936. [PMID: 27387182 DOI: 10.1007/s00464-016-5060-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although simulation training is increasingly used to meet modern technology and patient safety demands, its successful integration within surgical curricula is still rare. The Dutch Urological Practical Skills (D-UPS) curriculum provides modular simulation-based training of technical and non-technical basic urological skills in the local hospital setting. This study aims to assess the educational impact of implementing the D-UPS curriculum in the Netherlands and to provide focus points for improvement of the D-UPS curriculum according to the participants. METHODS Educational impact was assessed by means of qualitative individual module-specific feedback and a quantitative cross-sectional survey among residents and supervisors. Twenty out of 26 Dutch teaching hospitals participated. The survey focussed on practical aspects, the D-UPS curriculum in general, and the impact of the D-UPS curriculum on the development of technical and non-technical skills. RESULTS A considerable survey response of 95 % for residents and 76 % for supervisors was obtained. Modules were attended by junior and senior residents, supervised by a urologist, and peer teaching was used. Ninety percent of supervisors versus 67 % of residents judged the D-UPS curriculum as an important addition to current residency training (p = 0.007). Participants' aggregated general judgement of the modules showed a substantial percentage favorable score (M ± SE: 57 ± 4 %). The impact of training on, e.g., knowledge of materials/equipment and ability to anticipate on complications was high, especially for junior residents (77 ± 5 and 71 ± 7 %, respectively). Focus points for improvement of the D-UPS curriculum according to the participants include adaptation of the training level to residents' level of experience and focus on logistics. CONCLUSION The simulation-based D-UPS curriculum has a high educational impact. Residents and supervisors consider the curriculum to be an important addition to current residency training. Focus points for improvement of the D-UPS curriculum according to the participants include increased attention to logistics and integration of a spiral learning approach.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Barbara M A Schout
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Rob C M Pelger
- Department of Urology, University Medical Center Leiden, Leiden, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Kok EM, Jarodzka H, de Bruin ABH, BinAmir HAN, Robben SGF, van Merriënboer JJG. Systematic viewing in radiology: seeing more, missing less? Adv Health Sci Educ Theory Pract 2016; 21:189-205. [PMID: 26228704 PMCID: PMC4749649 DOI: 10.1007/s10459-015-9624-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/16/2015] [Indexed: 05/26/2023]
Abstract
To prevent radiologists from overlooking lesions, radiology textbooks recommend "systematic viewing," a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = -.10, p = .62, and coverage and performance, r = -.06, p = .74. Experts were significantly more systematic than students F2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = -.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.
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Affiliation(s)
- Ellen M Kok
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Halszka Jarodzka
- Welten Institute, Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands
- Humanities Laboratory, Lund University, Lund, Sweden
| | - Anique B H de Bruin
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hussain A N BinAmir
- International Master in Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Könings KD, van Berlo J, Koopmans R, Hoogland H, Spanjers IAE, ten Haaf JA, van der Vleuten CPM, van Merriënboer JJG. Using a Smartphone App and Coaching Group Sessions to Promote Residents' Reflection in the Workplace. Acad Med 2016; 91:365-70. [PMID: 26556297 DOI: 10.1097/acm.0000000000000989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PROBLEM Reflecting on workplace-based experiences is necessary for professional development. However, residents need support to raise their awareness of valuable moments for learning and to thoughtfully analyze those learning moments afterwards. APPROACH From October to December 2012, the authors held a multidisciplinary six-week postgraduate training module focused on general competencies. Residents were randomly assigned to one of four conditions with varying degrees of reflection support; they were offered (1) a smartphone app, (2) coaching group sessions, (3) a combination of both, or (4) neither type of support. The app allowed participants to capture in real time learning moments as a text note, audio recording, picture, or video. Coaching sessions held every two weeks aimed to deepen participants' reflection on captured learning moments. Questionnaire responses and reflection data were compared between conditions to assess the effects of the app and coaching sessions on intensity and frequency of reflection. OUTCOMES Sixty-four residents participated. App users reflected more often, captured more learning moments, and reported greater learning progress than nonapp users. Participants who attended coaching sessions were more alert to learning moments and pursued more follow-up learning activities to improve on the general competencies. Those who received both types of support were most alert to these learning moments. NEXT STEPS A simple mobile app for capturing learning moments shows promise as a tool to support workplace-based learning, especially when combined with coaching sessions. Future research should evaluate these tools on a broader scale and in conjunction with residents' and students' personal digital portfolios.
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Affiliation(s)
- Karen D Könings
- K.D. Könings is assistant professor, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. J. van Berlo is senior ICT developer, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. R. Koopmans is professor of general internal medicine, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. H. Hoogland was associate professor, Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands, at the time this work was completed. He is now retired. I.A.E. Spanjers is researcher, ResearchNed, Nijmegen, the Netherlands. J.A. ten Haaf is project manager, E-learning, University Library, Maastricht University, Maastricht, the Netherlands. C.P.M. van der Vleuten is professor of education, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. J.J.G. van Merriënboer is professor of learning and instruction, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Jaarsma T, Boshuizen HPA, Jarodzka H, Nap M, Verboon P, van Merriënboer JJG. Tracks to a Medical Diagnosis: Expertise Differences in Visual Problem Solving. Appl Cognit Psychol 2016. [DOI: 10.1002/acp.3201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas Jaarsma
- Welten Institute; Open University of The Netherlands; Heerlen The Netherlands
| | - Henny P. A. Boshuizen
- Welten Institute; Open University of The Netherlands; Heerlen The Netherlands
- University of Turku; Turku Finland
| | - Halszka Jarodzka
- Welten Institute; Open University of The Netherlands; Heerlen The Netherlands
- Humanities Laboratory; Lund University; Lund Sweden
| | - Marius Nap
- Pathology Department; Atrium Medical Center; Heerlen The Netherlands
| | - Peter Verboon
- Welten Institute; Open University of The Netherlands; Heerlen The Netherlands
- Faculty of Psychology and Educational Sciences; Open University of The Netherlands; Heerlen The Netherlands
| | - Jeroen J. G. van Merriënboer
- Welten Institute; Open University of The Netherlands; Heerlen The Netherlands
- Faculty of Health, Medicine and Life Sciences; Maastricht University; Maastricht The Netherlands
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Jaarsma T, Jarodzka H, Nap M, van Merriënboer JJG, Boshuizen HPA. Expertise in clinical pathology: combining the visual and cognitive perspective. Adv Health Sci Educ Theory Pract 2015; 20:1089-106. [PMID: 25677013 PMCID: PMC4564442 DOI: 10.1007/s10459-015-9589-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/30/2015] [Indexed: 05/10/2023]
Abstract
Expertise studies in the medical domain often focus on either visual or cognitive aspects of expertise. As a result, characteristics of expert behaviour are often described as either cognitive or visual abilities. This study focuses on both aspects of expertise and analyses them along three overarching constructs: (1) encapsulations, (2) efficiency, and (3) hypothesis testing. This study was carried out among clinical pathologists performing an authentic task: diagnosing microscopic slides. Participants were 13 clinical pathologists (experts), 12 residents in pathology (intermediates), and 13 medical students (novices). They all diagnosed seven cases in a virtual microscope and gave post hoc explanations for their diagnoses. The collected data included eye movements, microscope navigation, and verbal protocols. Results showed that experts used lower magnifications and verbalized their findings as diagnoses. Also, their diagnostic paths were more efficient, including fewer microscope movements and shorter reasoning chains. Experts entered relevant areas later in their diagnostic process, and visited fewer of them. Intermediates used relatively high magnifications and based their diagnoses on specific abnormalities. Also, they took longer to reach their diagnosis and checked more relevant areas. Novices searched in detail, described findings by their appearances, and uttered long reasoning chains. These results indicate that overarching constructs can justly be identified: encapsulations and efficiency are apparent in both visual and cognitive aspects of expertise.
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Affiliation(s)
- Thomas Jaarsma
- Welten Institute, Open University of The Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Halszka Jarodzka
- Welten Institute, Open University of The Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands
| | - Marius Nap
- Pathology Department, Atrium Medical Center, Heerlen, The Netherlands
| | - Jeroen J G van Merriënboer
- Welten Institute, Open University of The Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Henny P A Boshuizen
- Welten Institute, Open University of The Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands
- University of Turku, Turku, Finland
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de Vries AH, Boute MC, Kuppen MCP, van Merriënboer JJG, Koldewijn EL, Pelger RCM, Schout BMA, Wagner C. Patient Safety Risks of Basic Urological Procedures Performed by Junior and Senior Residents. J Surg Educ 2015; 72:918-926. [PMID: 26117078 DOI: 10.1016/j.jsurg.2015.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/18/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs. DESIGN Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method. SETTING This study was performed in 5 teaching hospitals in the Netherlands. PARTICIPANTS We included 11 junior residents and 5 senior residents in urology in the final study cohort. RESULTS Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues. CONCLUSION Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Maaike C Boute
- Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands
| | - Malou C P Kuppen
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jeroen J G van Merriënboer
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob C M Pelger
- Department of Urology, University Medical Center Leiden, Leiden, The Netherlands
| | - Barbara M A Schout
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Swager R, Klarus R, van Merriënboer JJG, Nieuwenhuis LF. Constituent aspects of workplace guidance in secondary VET. European Journal of Training and Development 2015. [DOI: 10.1108/ejtd-01-2015-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– This paper aims to present an integrated model of workplace guidance to enhance awareness of what constitutes good guidance, to improve workplace guidance practices in vocational education and training.
Design/methodology/approach
– To identify constituent aspects of workplace guidance, a systematic search of Web of Science was conducted, focussing on mentoring literature, research on institutional socialization tactics and research on didactical interventions and their effects.
Findings
– The model interprets workplace learning as a relational and integrated process of participation, acquisition, guidance and social interaction. Psychosocial support, structure-providing interventions and didactical interventions are discussed as essential components of guidance. How these components are enacted is influenced by the characteristics of training firms and their employees’ readiness to provide guidance. This makes guidance an intrapersonal process. Workplace guidance is also an interpersonal process in which the agencies of employees mediate the relationship between guidance and interaction, and the agencies of trainees mediate the relationship between, on the one hand, participation and acquisition and, on the other hand, social interaction.
Originality/value
– Integrated models of what constitutes good workplace guidance are rare. To fill this gap, this paper highlights constituent aspects of workplace guidance and brings them together in an integrated model. The model can help mentors/employees choose effective interventions to improve workplace learning.
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Bohle Carbonell K, Könings KD, Segers M, van Merriënboer JJG. Measuring adaptive expertise: development and validation of an instrument. European Journal of Work and Organizational Psychology 2015. [DOI: 10.1080/1359432x.2015.1036858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van Loon MH, de Bruin ABH, van Gog T, van Merriënboer JJG, Dunlosky J. Can students evaluate their understanding of cause-and-effect relations? The effects of diagram completion on monitoring accuracy. Acta Psychol (Amst) 2014; 151:143-54. [PMID: 24977937 DOI: 10.1016/j.actpsy.2014.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/03/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022] Open
Abstract
For effective self-regulated study of expository texts, it is crucial that learners can accurately monitor their understanding of cause-and-effect relations. This study aimed to improve adolescents' monitoring accuracy using a diagram completion task. Participants read six texts, predicted performance, selected texts for restudy, and were tested for comprehension. Three groups were compared, in which learners either completed causal diagrams immediately after reading, completed them after a delay, or received no-diagram control instructions. Accuracy of predictions of performance was highest for learning of causal relations following delayed diagram completion. Completing delayed diagrams focused learners specifically on their learning of causal relations, so this task did not improve monitoring of learning of factual information. When selecting texts for restudy, the participants followed their predictions of performance to the same degree, regardless of monitoring accuracy. Fine-grained analyses also showed that, when completing delayed diagrams, learners based judgments on diagnostic cues that indicated actual understanding of connections between events in the text. Most important, delayed diagram completion can improve adolescents' ability to monitor their learning of cause-and-effect relations.
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Affiliation(s)
- Mariëtte H van Loon
- Maastricht University, Department of Educational Development & Research and Graduate School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Anique B H de Bruin
- Maastricht University, Department of Educational Development & Research and Graduate School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Tamara van Gog
- Erasmus University Rotterdam, Department of Psychology, P.O. Box 1783, 3000 DR Rotterdam, The Netherlands
| | - Jeroen J G van Merriënboer
- Maastricht University, Department of Educational Development & Research and Graduate School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - John Dunlosky
- Kent State University, Department of Psychology, P.O. Box 5190, Kent, OH 44242-0001, USA
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