The Development of Visual Expertise in ECG Interpretation: An Eye-Tracking Augmented Re Situ Interview Approach

Phenomenon: Visual expertise in medicine involves a complex interplay between expert visual behavior patterns and higher-level cognitive processes. Previous studies of visual expertise in medicine have centered around traditionally visually intensive disciplines such as radiology and pathology. However, there is limited study of visual expertise in electrocardiogram (ECG) interpretation, a common clinical task that is associated with high error rates. This qualitatively driven multi-methods study aimed to describe differences in cognitive approaches to ECG interpretation between medical students, emergency medicine (EM) residents, and EM attending physicians. Approach: Ten medical students, 10 EM residents, and 10 EM attending physicians were recruited from one tertiary academic center to participate in this study. Participants interpreted 10 ECGs with a screen-based eye-tracking device, then underwent a subjective re situ interview augmented by playback of the participants' own gaze scan-paths via eye-tracking. Interviews were transcribed verbatim and an emergent thematic analysis was performed across participant groups. Diagnostic speed, accuracy, and heat maps of fixation distribution were collected to supplement the qualitative findings. Findings: Qualitative analysis demonstrated differences among the cohorts in three major themes: dual-process reasoning, ability to prioritize, and clinical implications. These qualitative findings were aligned with differences in visual behavior demonstrated by heat maps of fixation distribution across each ECG. More experienced participants completed ECG interpretation significantly faster and more accurately than less experienced participants. Insights: The cognitive processes related to ECG interpretation differed between novices and more experienced providers in EM. Understanding the differences in cognitive approaches to ECG interpretation between these groups may help inform best practices in teaching this ubiquitous diagnostic skill.

Alignment of CanMEDS-based Undergraduate and Postgraduate Pharmacy Curricula in The Netherlands

In this article the design of three master programs (MSc in Pharmacy) and two postgraduate specialization programs for community or hospital pharmacist is described. After a preceding BSc in Pharmacy, these programs cover the full pharmacy education capacity for pharmacists in primary and secondary health care in the Netherlands. All programs use the CanMEDS framework, adapted to pharmacy education and specialization, which facilitates the horizontal integration of pharmacists’ professional development with other health care professions in the country. Moreover, it is illustrated that crossing the boundary from formal (university) education to experiential (workplace) education is eased by a gradual change in time spent in these two educational environments and by the use of comparable monitoring, feedback, and authentic assessment instruments. A reflection on the curricula, based on the principles of the Integrative Pedagogy Model and the Self-determination Theory, suggests that the alignment of these educational programs facilitates the development of professional expertise and professional identity of Dutch pharmacists.

Multicenter randomized trial exploring effects of simulation-based ultrasound training on obstetricians' diagnostic accuracy: value for experienced operators

OBJECTIVE

To explore the effects of simulation-based ultrasound training on the accuracy of fetal weight estimation in the third trimester among obstetricians with different levels of clinical experience.

METHODS

This was a multicenter, randomized pre-post-test practical trial conducted between March 2016 and January 2018. Obstetricians with different levels of clinical experience were randomized to either simulation-based ultrasound training focusing on fetal weight scans or no intervention. Participants completed two scans in pregnant women at term to establish baseline accuracy of fetal weight estimation. Another two scans were performed at follow-up. Accuracy was defined by the percentage difference between estimated fetal weight and actual birth weight. Ultrasound image quality was rated by two expert raters.

RESULTS

Seventy participants with different levels of clinical experience completed the study. Adjusting for clinical experience, the intervention group demonstrated an improvement in measurement accuracy of 31.9% (95% CI, 6.9-50.1%) (P = 0.02), whereas the control group did not improve (relative difference, 13.1% (95% CI, -17.9 to 55.9%); P = 0.45). The change in accuracy was significantly different between the groups (P = 0.02) and independent of clinical experience (P = 0.54). Image-quality scores improved by a mean of 1.2 (95% CI, 0.4-2.1) (P < 0.01) in the intervention group, with no change in the control group (mean difference, 0.1 (95% CI, -0.8 to 1.0); P = 0.78). There was a strong negative correlation between time spent using the simulator and clinical experience (r = -0.70, P = 0.0001).

CONCLUSION

Simulation-based ultrasound training improved accuracy and image quality when performing fetal weight estimation in women at term, independent of obstetricians' clinical experience. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Emergence of Skilled Behaviors in Professional, Amateur and Junior Cricket Batsmen During a Representative Training Scenario

The aim of this study was to explore the emergence of skilled behaviors, in the form of actions, cognitions and emotions, between professional state level cricket batters and their lesser skilled counterparts. Twenty-two male cricket batsmen (n = 6 state level; n = 8 amateur grade club level, n = 8 junior state representative level) participated in a game scenario training session against right arm pace bowlers (n = 6 amateur senior club). The batsmen were tasked with scoring as many runs as possible during a simulated limited-overs game. The actions, cognitions, and emotions of each batsmen were recorded in situ with findings showing differences between state level players and those lesser skilled. State level batsmen played more scoring shots and scored more runs, underpinned by superior bat-ball contact and technical efficiency. Furthermore, the state player's cognitive evaluations of their own performance differed from junior batters, with more reported strategies based on an external outcome focus, such as where to score runs, rather than a focus on internal processes, such as making technical changes. State level batsmen also reported lower levels of nervousness compared with junior level batsmen. These results highlight the importance of viewing the emergence of skilled behavior as multi-faceted, rather than simply the acquisition of superior execution and technical proficiency.

Geographical Variations in the Interaction of Relative Age Effects in Youth and Adult Elite Soccer

Selection biases based on the use of cut-off dates and the timing of athletes’ birthdates have been termed relative age effects. These effects have been shown to differentially affect individuals involved in sport. For example, young male soccer players born early in their age group are overrepresented in elite teams while studies in adult soccer indicated potential carry-over effects from talent development systems. This two-study approach focuses on the processes within multi-year age groups in youth and adult elite soccer and on the role of players’ age position within the age band with regard to players’ birth year and birth month. Study 1 tests for an interaction of two different types of relative age effects among data from participants in the last five Under-17 FIFA World Cups (2007–2015). Analyses revealed a significant global within-year effect and varying birthdate distributions were found between confederations. Even stronger effects were found for constituent year effects. For the total sample, a multi-way frequency analysis (MFA) revealed an interaction with a pattern of a stronger within-year effect for the younger year group. This study highlights the need to consider interactions between different types of age effects. The main aim of Study 2 was to test for carry-over effects from previously found constituent year effects among players participating in the 2014 soccer World Cup and, therefore, to test for long-term effects of age grouping structures used during earlier stages of talent development. A secondary purpose of this study was to replicate findings on the existence of within-year effects and to test whether effects vary between continental confederations. No significant interaction between constituent year and within-year effects was shown by the MFA among the World Cup sample and previous findings on varying within-year effects were replicated. Results indicate that long-term effects of age grouping structures in earlier high-level talent development structures exist.

Developing expertise in gynecologic surgery: reflective perspectives of international experts on learning environments and processes

Research in medical education does not provide a clear understanding of how professional expertise develops among surgeons and what experiential factors contribute to that development. To address this gap, the researchers interviewed 16 international experts in female pelvic medicine and reconstructive surgery to assess their reflective perceptions of what specific opportunities and experiences initiated and supported their development toward expertise in their field. Characteristics and influences explaining the speed and quality of expertise development were sorted into the following themes: the dynamic process of expertise development, internal and personal characteristics, general aptitudes and preparatory skills, role modeling and interpersonal influences, opportunities to learn and practice, and roles and reference points. Across the narratives and perspectives of these expert surgeons, both individual characteristics and choices, and contextual activities and opportunities were necessary and important. Experiences with greatest impact on quality of expertise development included those provided by the environment and mentors, as well as those sought out by learners themselves, to elaborate and supplement existing opportunities. The ideal combination across experts was interaction and integration of individual characteristics with experiential opportunities. Grounded in theory and research in expertise development, these findings can support improvement of medical education, both for individual mentors and strategic program development. As surgery evolves at a continuously increasing pace, effective mentoring of promising surgical trainees will be critical to ensure that future generations of gynecologic surgeons will remain excellent. Effective, efficient surgical expertise development requires identifying trainees with the appropriate characteristics and providing them with the best development opportunities.

The Grounded Expertise Components Approach in the Novel Area of Cryptic Crossword Solving

This paper presents a relatively unexplored area of expertise research which focuses on the solving of British-style cryptic crossword puzzles. Unlike its American "straight-definition" counterparts, which are primarily semantically-cued retrieval tasks, the British cryptic crossword is an exercise in code-cracking detection work. Solvers learn to ignore the superficial "surface reading" of the clue, which is phrased to be deliberately misleading, and look instead for a grammatical set of coded instructions which, if executed precisely, will lead to the correct (and only) answer. Sample clues are set out to illustrate the task requirements and demands. Hypothesized aptitudes for the field might include high fluid intelligence, skill at quasi-algebraic puzzles, pattern matching, visuospatial manipulation, divergent thinking and breaking frame abilities. These skills are additional to the crystallized knowledge and word-retrieval demands which are also a feature of American crossword puzzles. The authors present results from an exploratory survey intended to identify the characteristics of the cryptic crossword solving population, and outline the impact of these results on the direction of their subsequent research. Survey results were strongly supportive of a number of hypothesized skill-sets and guided the selection of appropriate test content and research paradigms which formed the basis of an extensive research program to be reported elsewhere. The paper concludes by arguing the case for a more grounded approach to expertise studies, termed the Grounded Expertise Components Approach. In this, the design and scope of the empirical program flows from a detailed and objectively-based characterization of the research population at the very onset of the program.

Expertise Development With Different Types of Automation: A Function of Different Cognitive Abilities

OBJECTIVE

I explored whether different cognitive abilities (information-processing ability, working-memory capacity) are needed for expertise development when different types of automation (information vs. decision automation) are employed.

BACKGROUND

It is well documented that expertise development and the employment of automation lead to improved performance. Here, it is argued that a learner's ability to reason about an activity may be hindered by the employment of information automation. Additional feedback needs to be processed, thus increasing the load on working memory and decelerating expertise development. By contrast, the employment of decision automation may stimulate reasoning, increase the initial load on information-processing ability, and accelerate expertise development. Authors of past research have not investigated the interrelations between automation assistance, individual differences, and expertise development.

METHOD

Sixty-one naive learners controlled simulated air traffic with two types of automation: information automation and decision automation. Their performance was captured across 16 trials. Well-established tests were used to assess information-processing ability and working-memory capacity.

RESULTS

As expected, learners' performance benefited from expertise development and decision automation. Furthermore, individual differences moderated the effect of the type of automation on expertise development: The employment of only information automation increased the load on working memory during later expertise development. The employment of decision automation initially increased the need to process information.

CONCLUSION

These findings highlight the importance of considering individual differences and expertise development when investigating human-automation interaction.

APPLICATION

The results are relevant for selecting automation configurations for expertise development.

Expertise in performance assessment: assessors' perspectives

The recent rise of interest among the medical education community in individual faculty making subjective judgments about medical trainee performance appears to be directly related to the introduction of notions of integrated competency-based education and assessment for learning. Although it is known that assessor expertise plays an important role in performance assessment, the roles played by different factors remain to be unraveled. We therefore conducted an exploratory study with the aim of building a preliminary model to gain a better understanding of assessor expertise. Using a grounded theory approach, we conducted seventeen semi-structured interviews with individual faculty members who differed in professional background and assessment experience. The interviews focused on participants' perceptions of how they arrived at judgments about student performance. The analysis resulted in three categories and three recurring themes within these categories: the categories assessor characteristics, assessors' perceptions of the assessment tasks, and the assessment context, and the themes perceived challenges, coping strategies, and personal development. Central to understanding the key processes in performance assessment appear to be the dynamic interrelatedness of the different factors and the developmental nature of the processes. The results are supported by literature from the field of expertise development and in line with findings from social cognition research. The conceptual framework has implications for faculty development and the design of programs of assessment.