The role of encapsulated knowledge in clinical case representations of medical students and family doctors

BACKGROUND: Previous studies on the development of medical expertise, predominantly using measures of free recall and pathophysiological explanations, have shown ambiguous results concerning the relationship between expertise level and encapsulated knowledge. PURPOSE: To investigate differences in clinical case representations by medical students and family doctors. In particular, the role of encapsulated knowledge in clinical case representations was investigated. METHODS: Year 2 (n = 15) and Year 4 (n = 15) medical students and family doctors (n = 15) were instructed to study carefully 2 case descriptions associated with a particular disease. After each case description participants were asked to provide a diagnosis. Subsequently, they judged whether or not a target item presented on a computer screen was related to the case description. Target items consisted of literally stated signs and symptoms, inferred encapsulated items and filler items. RESULTS: Family doctors provided more accurate diagnoses than Year 2 and Year 4 medical students. Furthermore, family doctors were faster and made fewer errors in judging the relatedness of all item types than Year 2 and 4 medical students. In particular, family doctors showed their best performance on the encapsulated items. CONCLUSIONS: The present study showed that encapsulated knowledge becomes increasingly more prominent as expertise develops. For experienced doctors, encapsulated concepts function as the most important building blocks of clinical case representations

Predicting educational success and attrition in problem-based learning: do first impressions count?

This study examines whether tutors (N = 15) in a problem-based learning curriculum were able to predict students' success in their first year and their entire bachelor programme. Tutors were asked to rate each student in their tutorial group in terms of the chance that this student would successfully finish their first year and the entire bachelor programme. The results indicated that tutors can predict students' first-year success and attrition in the bachelor programme, even on top of prior grades. Moreover, tutors seem to be better at predicting completion of the first year and bachelor programme versus failure or non-completion. The results suggest that tutors can assess whether students will be successful at an early stage of the programme. Tutor judgments of students' future success have the potential to be used as an additional source of information to identify students at risk of leaving college without a degree