Fostering diagnostic competence in different domains

Diagnosekompetenz zu fördern ist ein wichtiges Ziel in der medizinischen und in der Lehramtsausbildung. Bisher ist unklar ob instruktionale Unterstützung von einer Domäne in die andere übertragen werden kann. In empirischen Studien in zwei medizinischen Domänen (Medizin und Pflege) und in der Lehramtsausbildung wurde untersucht ob Scaffolding mit Selbsterklärungsprompts und mit adaptierbarem Feedback Diagnosekompetenz in einer computerbasierten Lernumgebung mit fehlerhaften Lösungsbeispielen fördern kann. Die Ergebnisse zeigen Unterschiede zwischen den Domänen: während Scaffolding mit Selbsterklärungsprompts nachteilige Effekte in der Pflege- und in der Lehramtsausbildung hatten, zeigte sich dieser Effekt nicht in der medizinischen Ausbildung. Die Ergebnisse der drei Studien geben Hinweise, dass Scaffolding mit Selbsterklärungsprompts nicht unter allen Bedingungen von Vorteil ist und im Kontext des Fehlerlernens sogar nachteilig sein kann, zumindest in Domänen in denen weniger wissenschaftliches Wissen verfügbar und dessen Gebrauch als Beleg für praktisches Handeln weniger üblich ist.It is an important goal in medical and in teacher education to foster diagnostic competences. It is not clear if effective instructional support can be transferred from one domain to another. In empirical studies in two medical domains (medicine and nursing) and in teaching it was investigated if scaffolding by self-explanation prompts and adaptable feedback can foster diagnostic competence in an computer based learning environment using erroneous worked examples. The results show differences between the domains: while the scaffolding with self-explanation prompts was detrimental for learning of diagnostic competence in teacher and nursing education, they had no such effects in medical education. The results of the three studies suggest that scaffolding self-explanation may not be an advantage under all circumstances and may in fact even hinder learning in the context of learning from errors, at least in domains where less scientific knowledge is available and it is less used as evidence for practice

Fostering diagnostic competence in different domains

Diagnosekompetenz zu fördern ist ein wichtiges Ziel in der medizinischen und in der Lehramtsausbildung. Bisher ist unklar ob instruktionale Unterstützung von einer Domäne in die andere übertragen werden kann. In empirischen Studien in zwei medizinischen Domänen (Medizin und Pflege) und in der Lehramtsausbildung wurde untersucht ob Scaffolding mit Selbsterklärungsprompts und mit adaptierbarem Feedback Diagnosekompetenz in einer computerbasierten Lernumgebung mit fehlerhaften Lösungsbeispielen fördern kann. Die Ergebnisse zeigen Unterschiede zwischen den Domänen: während Scaffolding mit Selbsterklärungsprompts nachteilige Effekte in der Pflege- und in der Lehramtsausbildung hatten, zeigte sich dieser Effekt nicht in der medizinischen Ausbildung. Die Ergebnisse der drei Studien geben Hinweise, dass Scaffolding mit Selbsterklärungsprompts nicht unter allen Bedingungen von Vorteil ist und im Kontext des Fehlerlernens sogar nachteilig sein kann, zumindest in Domänen in denen weniger wissenschaftliches Wissen verfügbar und dessen Gebrauch als Beleg für praktisches Handeln weniger üblich ist.It is an important goal in medical and in teacher education to foster diagnostic competences. It is not clear if effective instructional support can be transferred from one domain to another. In empirical studies in two medical domains (medicine and nursing) and in teaching it was investigated if scaffolding by self-explanation prompts and adaptable feedback can foster diagnostic competence in an computer based learning environment using erroneous worked examples. The results show differences between the domains: while the scaffolding with self-explanation prompts was detrimental for learning of diagnostic competence in teacher and nursing education, they had no such effects in medical education. The results of the three studies suggest that scaffolding self-explanation may not be an advantage under all circumstances and may in fact even hinder learning in the context of learning from errors, at least in domains where less scientific knowledge is available and it is less used as evidence for practice

Fostering interprofessional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project

Background: Poor communication between physicians and nursing staff could result in inadequate interprofessional collaboration with negative effects on patient health. In order to ensure optimal health care for patients, it is important to strengthen interprofessional communication and collaboration between physicians and nurses during their education. Aim: The aim of this project is to foster communication for medical and nursing students through interprofessional case discussions and simulated ward rounds as a form of training. Method: In 2013-15 a total of 39 nursing students and 22 medical students participated in eight seminars, each covering case discussions and simulated ward rounds. The seminar was evaluated based on student assessment of the educational objectives. Results: Students who voluntarily signed up for the seminar profited from the interprofessional interaction and gathered positive experiences working in a team. Conclusion: Through practicing case discussions and ward rounds as a group, interprofessional communication could be fostered between medical and nursing students. Students took advantage of the opportunity to ask those from other profession questions and realized that interprofessional interaction can lead to improved health care

Learning to diagnose accurately through virtual patients: do reflection phases have an added benefit?

BACKGROUND Simulation-based learning with virtual patients is a highly effective method that could potentially be further enhanced by including reflection phases. The effectiveness of reflection phases for learning to diagnose has mainly been demonstrated for problem-centered instruction with text-based cases, not for simulation-based learning. To close this research gap, we conducted a study on learning history-taking using virtual patients. In this study, we examined the added benefit of including reflection phases on learning to diagnose accurately, the associations between knowledge and learning, and the diagnostic process. METHODS A sample of N = 121 medical students completed a three-group experiment with a control group and pre- and posttests. The pretest consisted of a conceptual and strategic knowledge test and virtual patients to be diagnosed. In the learning phase, two intervention groups worked with virtual patients and completed different types of reflection phases, while the control group learned with virtual patients but without reflection phases. The posttest again involved virtual patients. For all virtual patients, diagnostic accuracy was assessed as the primary outcome. Current hypotheses were tracked during reflection phases and in simulation-based learning to measure diagnostic process. RESULTS Regarding the added benefit of reflection phases, an ANCOVA controlling for pretest performance found no difference in diagnostic accuracy at posttest between the three conditions, F(2, 114) = 0.93, p = .398. Concerning knowledge and learning, both pretest conceptual knowledge and strategic knowledge were not associated with learning to diagnose accurately through reflection phases. Learners' diagnostic process improved during simulation-based learning and the reflection phases. CONCLUSIONS Reflection phases did not have an added benefit for learning to diagnose accurately in virtual patients. This finding indicates that reflection phases may not be as effective in simulation-based learning as in problem-centered instruction with text-based cases and can be explained with two contextual differences. First, information processing in simulation-based learning uses the verbal channel and the visual channel, while text-based learning only draws on the verbal channel. Second, in simulation-based learning, serial cue cases are used to gather information step-wise, whereas, in text-based learning, whole cases are used that present all data at once

The relation between learners' experience in simulations and diagnostic accuracy: generalizability across medical and teacher education

Simulation-based learning is being increasingly implemented across different domains of higher education to facilitate essential skills and competences (e.g. diagnostic skills, problem-solving, etc.). However, the lack of research that assesses and compares simulations used in different contexts (e.g., from design perspective) makes it challenging to effectively transfer good practices or establish guidelines for effective simulations across different domains. This study suggests some initial steps to address this issue by investigating the relations between learners' experience in simulation-based learning environments and learners' diagnostic accuracy across several different domains and types of simulations, with the goal of facilitating cross-domain research and generalizability. The findings demonstrate that used learners' experience ratings are correlated with objective performance measures, and can be used for meaningful comparisons across different domains. Measures of perceived extraneous cognitive load were found to be specific to the simulation and situation, while perceived involvement and authenticity were not. Further, the negative correlation between perceived extraneous cognitive load and perceived authenticity was more pronounced in interaction-based simulations. These results provide supporting evidence for theoretical models that highlight the connection between learners' experience in simulated learning environments and their performance. Overall, this research contributes to the understanding of the relationship between learners’ experience in simulation-based learning environments and their diagnostic accuracy, paving the way for the dissemination of best practices across different domains within higher education

Representational scaffolding in digital simulations – learning professional practices in higher education

Purpose To advance the learning of professional practices in teacher education and medical education, this conceptual paper aims to introduce the idea of representational scaffolding for digital simulations in higher education. Design/methodology/approach This study outlines the ideas of core practices in two important fields of higher education, namely, teacher and medical education. To facilitate future professionals’ learning of relevant practices, using digital simulations for the approximation of practice offers multiple options for selecting and adjusting representations of practice situations. Adjusting the demands of the learning task in simulations by selecting and modifying representations of practice to match relevant learner characteristics can be characterized as representational scaffolding. Building on research on problem-solving and scientific reasoning, this article identifies leverage points for employing representational scaffolding. Findings The four suggested sets of representational scaffolds that target relevant features of practice situations in simulations are: informational complexity, typicality, required agency and situation dynamics. Representational scaffolds might be implemented in a strategy for approximating practice that involves the media design, sequencing and adaptation of representational scaffolding. Originality/value The outlined conceptualization of representational scaffolding can systematize the design and adaptation of digital simulations in higher education and might contribute to the advancement of future professionals’ learning to further engage in professional practices. This conceptual paper offers a necessary foundation and terminology for approaching related future research. </jats:sec

Simulation-based learning in higher education and professional training: Approximations of practice through representational scaffolding

In this article, we reviewed the nine studies included in a special issue that addresses the assessment and evaluation of simulation-based learning in higher education and professional training. We discussed the results of each study, integrated them in terms of their individual and collective contributions to evaluating the effectiveness of simulation-based learning, and related the studies’ results to the presage, process, and product factors of simulation-based learning. We concluded that research on simulation-based learning can benefit from employing a variety of methodological approaches and venturing beyond its primary focus on cognitive processes and outcomes to analyze the different types of process indicators and learning outcomes. Moreover, we identified a promising direction for future research: the selection and adjustment of representations of practice included in simulations by means of representational scaffolding. By proceeding with increasingly detailed analyses of simulation-based learning, research can further advance our understanding of the relevant learning mechanisms

Simulation-Based Learning in Higher Education: A Meta-Analysis

Simulation-based learning offers a wide range of opportunities to practice complex skills in higher education and to implement different types of scaffolding to facilitate effective learning. This meta-analysis includes 145 empirical studies and investigates the effectiveness of different scaffolding types and technology in simulation-based learning environments to facilitate complex skills. The simulations had a large positive overall effect: g = 0.85, SE = 0.08; CIs 0.69, 1.02. Technology use and scaffolding had positive effects on learning. Learners with high prior knowledge benefited more from reflection phases; learners with low prior knowledge learned better when supported by examples. Findings were robust across different higher education domains (e.g., medical and teacher education, management). We conclude that (1) simulations are among the most effective means to facilitate learning of complex skills across domains and (2) different scaffolding types can facilitate simulation-based learning during different phases of the development of knowledge and skills