The impact of feedback during formative testing on study behaviour and performance of (bio)medical students: a randomised controlled study.

BACKGROUND: A potential concern of formative testing using web-based applications ("apps") is provision of limited feedback. Adopting a randomised controlled trial in 463 first year (bio) medical students, we explored if providing immediate, detailed feedback during "app"-based formative testing can further improve study behaviour and study performance of (bio)medical students. METHODS: Students had access to a formative testing "app", which involved 7 formative test modules throughout the 4-week course. In a randomised order, subjects received the "app" with (n = 231, intervention) or without (n = 232, control) detailed feedback during the formative test modules. RESULTS: No differences in app-use was found between groups (P = 0.15), whereas the intervention group more frequently reviewed information compared to controls (P = 0.007). Exam scores differed between non-/moderate-/intensive- users of the "app" (P  0.05). CONCLUSIONS: Providing detailed feedback did not further enhance the effect of a web-based application of formative testing on study behaviour or study performance in (bio)medical students, possibly because of a ceiling-effect

P2X6 knockout mice exhibit normal electrolyte homeostasis

ATP-mediated signaling is an important regulator of electrolyte transport in the kidney. The purinergic cation channel P2X6 has been previously localized to the distal convoluted tubule (DCT), a nephron segment important for Mg2+ and Na+ reabsorption, but its role in ion transport remains unknown. In this study, P2x6 knockout (P2x6-/-) mice were generated to investigate the role of P2X6 in renal electrolyte transport. The P2x6-/- animals displayed a normal phenotype and did not differ physiologically from wild type mice. Differences in serum concentration and 24-hrs urine excretion of Na+, K+, Mg2+ and Ca2+ were not detected between P2x6+/+, P2x6+/- and P2x6-/- mice. Quantitative PCR was applied to examine potential compensatory changes in renal expression levels of other P2x subunits and electrolyte transporters, including P2x1-5, P2x7, Trpm6, Ncc, Egf, Cldn16, Scnn1, Slc12a3, Slc41a1, Slc41a3, Cnnm2, Kcnj10 and Fxyd2. Additionally, protein levels of P2X2 and P2X4 were assessed in P2x6+/+ and P2x6-/- mouse kidneys. However, significant changes in expression were not detected. Furthermore, no compensatory changes in gene expression could be demonstrated in heart material isolated from P2x6-/- mice. Except for a significant (P<0.05) upregulation of P2x2 in the heart of P2x6-/- mice compared to the P2x6+/+ mice. Thus, our data suggests that purinergic signaling via P2X6 is not significantly involved in the regulation of renal electrolyte handling under normal physiological conditions

Conscious versus unconscious thinking in the medical domain: the deliberation-without-attention effect examined

Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called ‘deliberation-without-attention effect’ in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that experienced physicians would outperform students as a result of their superior knowledge. The central question was whether unconscious thought in this task would lead to better performance in experts or novices, in line with the deliberation-without-attention effect. We created four fictitious male 60-year-old patients, each of whom with signs and symptoms related to likely prognosis, from 12 (Complex) or 4 (Simple) categories. This manipulation resulted in objectively different life expectancies for these patients. Participants (86 experienced physicians and 57 medical students) were randomly allocated to the Simple or Complex condition. Statements were randomly presented for 8 s. Next, each participant assessed the life expectancies after either conscious or unconscious thought. As expected, experienced physicians were better in assessing life expectancies than medical students. No significant differences were found in performance between conscious and unconscious thought, nor did we detect a significant interaction between expertise level and mode of thought. In a medical decision task, unconscious thought did not lead to better performance of experienced physicians or medical students than conscious thought. Our findings do not support the deliberation-without-attention effect