On the origin of intermediate effects in clinical case recall

In two experiments, the effects of level of medical expertise and study time on free recall of a clinical case were assessed. In Experiment 1, a nonmonotonic relationship between level of expertise and recall was found: Subjects of intermediate levels of expertise remembered more information from the case than both experts and novices. This "intermediate effect" disappeared, however, when study time was restricted. Analysis of post hoc acquired protocols of pathophysiological knowledge active during case processing suggested that this phenomenon could be attributed to the nature of the pathophysiological knowledge mobilized to comprehend the case. In Experiment 2, this assumption was directly tested by priming relevant pathophysiological knowledge for either a short or a longer period, before enabling subjects to study the case briefly. Free-recall data confirmed and extended the results of Experiment 1. Again, an intermediate effect was found; this time, however, it was generated experimentally. The findings were interpreted in terms of qualitative differences in the nature of the knowledge structures underlying performance between novices, advanced students, and medical experts: Experts use knowledge in an encapsulated mode while comprehending a case, whereas students use elaborated knowledge

Effects of problem-based discussion on studying a subsequent text: A randomized trial among first year medical students

The Purpose of this study was to examine effects of group discussion of a medical problem on the comprehension of a subsequent problem-relevant text by first year medical students. Forty-eight first-year medical students were randomly assigned to one of two conditions: The experimental group discussed a problem of blood pressure regulation, where the control group discussed a problem of vision. Subsequently, all students studied a text on the physiology of blood pressure regulation. Finally, a free recall test was administered. Numbers of propositions accurately recalled were analyzed using analysis of variance (ANOVA). Students who discussed the blood pressure regulation problem recalled 25% more from the text than those who discussed the control problem. This difference was statistically significant. The present study represented the first truly randomized trial in the ecologically valid context of a medical curriculum. It demonstrated the positive effects of problem-based tutorial group discussion on the comprehension of text. It confirmed earlier findings from laboratory studies that problem-based learning, in addition to positive emotional and motivational long-term effects well-documented in the literature, also has positive effects on learning

Knowledge development and restructuring in the domain of medicine; the role of theory and practice

How does the knowledge of the medical student, clerk, intern, and registrar develop and how do formal and informal, classroom and experiential learning contribute to this process? These questions were investigated in two experiments, focusing on knowledge restructuring rather than knowledge acquisition. The experiments showed that practical experience plays an important role in knowledge restructuring. The process was, however, not as continuous as was expected. Notably, advanced students appeared to have considerable knowledge about conditions in patients and their environments that can predispose to disease. However, they rarely applied it in clinical reasoning. Contrary to what was found in expert physicians, advanced students' knowledge about enabling conditions seems not yet to be integrated into their other knowledge about diseases

Unboxing the black box of visual expertise in medicine

Visual expertise in medicine has been a subject of research since many decades. Interestingly, it has been investigated from two little related fields, namely the field that focused mainly on the visual search aspects whilst ignoring higher-level cognitive processes involved in medical expertise, and the field that mainly focused on these higher-level cognitive processes largely ignoring the relevant visual aspects. Consequently, both research lines have traditionally used different methodologies. Recently, this gap is being increasingly closed and this special issue presents methods to investigate visual expertise in medicine from both research lines, namely those investigating vision (eye tracking, pupillometry, flash preview moving window paradigm), verbalisations, brain activity, and performance measures (ROC analysis, gesture coding, expert performance approach). We discuss the benefits and drawbacks of each method and suggest directions for future research that could help to unbox the black box of visual expertise in medicine

Unboxing the black box of visual expertise in medicine

Visual expertise in medicine has been a subject of research since many decades. Interestingly, it has been investigated from two little related fields, namely the field that focused mainly on the visual search aspects whilst ignoring higher-level cognitive processes involved in medical expertise, and the field that mainly focused on these higher-level cognitive processes largely ignoring the relevant visual aspects. Consequently, both research lines have traditionally used different methodologies. Recently, this gap is being increasingly closed and this special issue presents methods to investigate visual expertise in medicine from both research lines, namely those investigating vision (eye tracking, pupillometry, flash preview moving window paradigm), verbalisations, brain activity, and performance measures (ROC analysis, gesture coding, expert performance approach). We discuss the benefits and drawbacks of each method and suggest directions for future research that could help to unbox the black box of visual expertise in medicine