Workshops med patient videocases

 Når medicinstuderende begynder at møde patienter, starter de en langvarig proces med dannelse af kognitive mønstre kaldet illness scripts. Hvert enkelt nyt møde med en patient bidrager med nye detaljer. Imidlertid mindsker ændringer i arbejdstilrettelæggelse eller naturlige årstidsvariationer de studerendes chance for at møde virkelige patienter. Patient videocases er en værdifuld hjælp til at skabe interaktive, autentiske, virtuelle læringsmiljøer som kan fremme nødvendig script dannelse.Vi ville identificere en række vigtige tilstande, som de medicinstuderende ofte ikke møder dem under deres 16 dage i klinikophold på en børneafdeling. Vi fremstillede 8 digitale patient videocases med passende hyppighed, relevans og teknisk kvalitet. De studerende beskrev og fortolkede dem før de blev gennemgået med en underviser. Efterfølgende udfyldte de studerende et spørgeskema.Alle 65 medicin studerende deltog i de to workshops. Andelen, som udelukkende har mødt patienter med de 8 tilstande via patient videocases var 36,8-87,5 %, afhængigt af tilstanden. 

Conveying clinical reasoning based on visual observation via eye-movement modelling examples

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2012). Conveying clinical reasoning based on visual observation via eye-movement modelling examples. Instructional Science, 40(5), 813-827. doi:10.1007/s11251-012-9218-5Complex perceptual tasks, like clinical reasoning based on visual observations of patients, require not only conceptual knowledge about diagnostic classes but also the skills to visually search for symptoms and interpret these observations. However, medical education so far has focused very little on how visual observation skills can be efficiently conveyed to novices. The current study applied a novel instructional method to teach these skills by showing the learners how an expert model visually searches and interprets symptoms (i.e., eye-movement modelling examples; EMMEs). Case videos of patients were verbally explained by a model (control condition) and presented to students. In the experimental conditions, the participants received a recording of the model’s eye movements superimposed on the case videos. The eye movements were displayed by either highlighting the features the model focused on with a circle (the circle condition) or by blurring the features the model did not focus on (the spotlight condition). Compared to the other two conditions, results show that a spotlight on the case videos better guides the students’ attention towards the relevant features. Moreover, when testing the students’ clinical reasoning skills with videos of new patient cases without any guidance participants studying EMMEs with a spotlight showed improved their visual search and enhanced interpretation performance of the symptoms in contrast to participants in either the circle or the control condition. These findings show that a spotlight EMME can successfully convey clinical reasoning based on visual observations

Learning perceptual aspects of diagnosis in medicine via eye movement modeling examples on patient video cases

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010). Learning perceptual aspects of diagnosis in medicine via eye movement modeling examples on patient video cases. In S. Ohlsson & R. Catrambone (Eds.), Proceedings of the 32nd Annual Conference of the Cognitive Science Society (pp. 1703-1708). Austin, TX: Cognitive Science Society.Complex tasks with a visually rich component, like diagnosing seizures based on patient video cases, not only require the acquisition of conceptual but also of perceptual skills. Medical education has found that besides biomedical knowledge (knowledge of scientific facts) clinical knowledge (actual experience with patients) is crucial. One important aspect of clinical knowledge that medical education has hardly focused on, yet, are perceptual skills, like visually searching, detecting, and interpreting relevant features. Research on instructional design has shown that in a visually rich, but simple classification task perceptual skills could be conveyed by means of showing the eye movements of a didactically behaving expert. The current study applied this method to medical education in a complex task. This was done by example video cases, which were verbally explained by an expert. In addition the experimental groups saw a display of the expert’s eye movements recorded, while he performed the task. Results show that blurring non-attended areas of the expert enhances diagnostic performance of epileptic seizures by medical students in contrast to displaying attended areas as a circle and to a control group without attention guidance. These findings show that attention guidance fosters learning of perceptual aspects of clinical knowledge, if implemented in a spotlight manner

How doctors build community and socialize into a clinical department through morning reports. A positioning theory study

PHENOMENON: The morning report is one of the longest surviving hospital practices. Most studies of the morning report focus on the effectiveness of formal medical training, while focus on social and communicative aspects is rarer. This study explores the social interactions and communication in morning reports, examining the ways in which they contribute to the construction of professional identity and socialization into the community of the clinical department.APPROACH: We used a qualitative explorative design with video observations of morning reports. Our data consisted of 43 video-recorded observations (in all, 15.5 hours) from four different hospital departments in Denmark. These were analyzed using the theoretical framework of positioning theory.FINDINGS: A key finding was that each department followed its own individual structure. This order was not articulated as such but played out implictly. Two alternative storylines unfolded in the elements of the morning report: 1) being equal members of the specialty and department, and 2) preserving the hierarchical community and its inherent positions.INSIGHTS: The morning report can be seen as playing an important role in community making. It unfolds as a "dance" of repeated elements in a complex collegial space. Within this complexity, the morning report is a space for positioning oneself and others as a collegial "we", i.e., equal members of a department and specialty, at the same time as "having a place" in a hierarchal community. Thus, morning reports contribute to developing professional identity and socialization into the medical community.</p

Role and Development of Perceptual Skills in Medical Education

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010, May). Role and Development of Perceptual Skills in Medical Education. The Scandinavian Workshop on Applied Eye-Tracking (SWAET), Lund, Sweden.This talk is about a study in which we tried to convey perceptual skills in clinical reasoning on patient video cases

Fostering perceptual skills in medical diagnosis

Jarodzka, H., Balslev, T., Holmqvist, K., Nyström, M., Scheiter, K., Gerjets, P., & Eika, B. (2010, August). Fostering perceptual skills in medical diagnosis. Meeting of the EARLI SIG6/7 Instructional Design and Learning and Instruction with Computers, Ulm, Germany.Perceptually demanding tasks, like diagnosing seizures based on patient video cases, not only require the acquisition of conceptual but also of perceptual skills; like visually searching and interpreting relevant features. Showing the eye movements of a didactically behaving expert conveyed perceptual skills in a perceptually demanding, but conceptually simple task. The current study applied this method to medical education – a conceptually complex task – by example videos, which were verbally explained by an expert. In addition the experimental groups saw a display of the expert's eye movements recorded, while he performed the task. Results show that blurring non-attended areas of the expert guides the attention of the students during example study, leads to enhanced visual search and interpretation of relevant features in contrast to displaying attended areas as a circle and to a control group without attention guidance. Thus, spotlight attention guidance fosters learning of perceptual skills in medical diagnosis

Veterinary student competence in equine lameness recognition and assessment: a mixed methods study

The development of perceptual skills is an important aspect of veterinary education. The authors investigated veterinary student competency in lameness evaluation at two stages, before (third year) and during (fourth/fifth year) clinical rotations. Students evaluated horses in videos, where horses were presented during trot on a straight line and in circles. Eye-tracking data were recorded during assessment on the straight line to follow student gaze. On completing the task, students filled in a structured questionnaire. Results showed that the experienced students outperformed inexperienced students, although even experienced students may classify one in four horses incorrectly. Mistakes largely arose from classifying an incorrect limb as lame. The correct detection of sound horses was at chance level. While the experienced student cohort primarily looked at upper body movement (head and sacrum) during lameness assessment, the inexperienced cohort focused on limb movement. Student self-assessment of performance was realistic, and task difficulty was most commonly rated between 3 and 4 out of 5. The inexperienced students named a considerably greater number of visual lameness features than the experienced students. Future dedicated training based on the findings presented here may help students to develop more reliable lameness assessment skills