To observe or not to observe peers when learning physical examination skills; That is the question

Background: Learning physical examination skills is an essential element of medical education. Teaching strategies include practicing the skills either alone or in-group. It is unclear whether students benefit more from training these skills individually or in a group, as the latter allows them to observing their peers. The present study, conducted in a naturalistic setting, investigated the effects of peer observation on mastering psychomotor skills necessary for physical examination. Methods. The study included 185 2§ssup§nd§esup§-year medical students, participating in a regular head-to-toe physical examination learning activity. Students were assigned either to a single-student condition (n = 65), in which participants practiced alone with a patient instructor, or to a multiple-student condition (n = 120), in which participants practiced in triads under patient instructor supervision. The students subsequently carried out a complete examination that was videotaped and subsequently evaluated. Student's performance was used as a measure of learning. Results: Students in the multiple-student condition learned more than those who practiced alone (8

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

On the constraints of encapsulated knowledge: Clinical case representations by medical experts and subexperts

This article is concerned with the role of so-called encapsulated knowledge and biomedical knowledge in the process of diagnosing clinical cases within and outside the medical specialist's domain of expertise. Based on the theory of knowledge encapsulation, we predicted that subexperts (i.e., medical specialists diagnosing a clinical case outside their specialty) could not diagnose a clinical case in an encapsulated mode, and therefore they would relapse into an elaborate biomedical processing approach to understand the described signs and symptoms. Cardiologists (the experts) and Neurologists (the subexperts) were instructed to study 2 clinical case descriptions for a period of 3 min per case. After each case they were asked to provide a diagnosis, write down everything they remembered of the case, and finally to explain the signs and symptoms displayed in the case. The results show that cardiologists achieved a higher diagnostic accuracy than did neurologists. Furthermore, the cardiologists' recall and pathophysiological explanations contained more high-level inferences (i.e., encapsulations) than those of neurologists. These outcomes are in line with the predictions made on the basis of the theory of knowledge encapsulation

Detrimental influence of contextual change on spacing effects in free recall.

Two experiments were conducted to determine the mechanism underlying the spacing effect in free-recall tasks. Participants were required to study a list containing once-presented words as well as massed and spaced repetitions. In both experiments, presentation background at repetition was manipulated. The results of Experiment 1 demonstrated that free recall was higher for massed items repeated in a different context than for massed items repeated in the same context, whereas free recall for spaced items was higher when repeated in the same context. Furthermore, a spacing effect was shown for words repeated in the same context, whereas an attenuated spacing effect was revealed for words repeated in a different context. These findings were replicated in Experiment 2 under a different presentation background manipulation. Both experiments seem to be most consistent with a model that combines the contextual variability and the study-phase retrieval mechanism to account for the spacing effect in free-recall tasks

On the constraints of encapsulated knowledge : Clinical case representations by medical experts and subexperts

This article is concerned with the role of so-called encapsulated knowledge and biomedical knowledge in the process of diagnosing clinical cases within and outside the medical specialist's domain of expertise. Based on the theory of knowledge encapsulation, we predicted that subexperts (i.e., medical specialists diagnosing a clinical case outside their specialty) could not diagnose a clinical case in an encapsulated mode, and therefore they would relapse into an elaborate biomedical processing approach to understand the described signs and symptoms. Cardiologists (the experts) and Neurologists (the subexperts) were instructed to study 2 clinical case descriptions for a period of 3 min per case. After each case they were asked to provide a diagnosis, write down everything they remembered of the case, and finally to explain the signs and symptoms displayed in the case. The results show that cardiologists achieved a higher diagnostic accuracy than did neurologists. Furthermore, the cardiologists' recall and pathophysiological explanations contained more high-level inferences (i.e., encapsulations) than those of neurologists. These outcomes are in line with the predictions made on the basis of the theory of knowledge encapsulation

Monitoring accuracy and self-regulation when learning to play a chess endgame

In order to examine the effect of monitoring and self-regulation on skill acquisition, the present study asked novice chess players to provide judgments of learning (JOLs) and to select moves for restudy after studying an endgame of chess. In four groups, we varied the JOL instruction (present versus absent) and the selection instruction (free number of move selections versus selection of at least two moves per chess exercise). After four learning trials, participants were required to play against a chess computer. In the learning phase, participants who were forced to select moves for restudy outperformed those who were free to select moves for restudy when predicting the next computer move, even after controlling for the actual number of restudied moves. Although the groups that did provide JOLs showed better self-regulatory behaviour, there were no or even negative performance differences between the groups that did provide JOLs and the groups that did not provide JOLs. This same pattern emerged in the test phase: Although no differences were found between the groups with and without JOLs, the groups that were forced to select moves for restudy outperformed the groups that were free in the number of move selections. These data show that, for novice chess players, the instruction to provide JOLs possibly places a high and ineffective load on working memory and therefore has no effect on learning a chess endgame. To examine the relation between prior knowledge and quality of self-regulation, further research is needed that examines the effect of the JOL and selection instruction in groups that differ in chess experience

A critical look at the discrepancy reduction mechanism of study time allocation

The discrepancy reduction mechanism predicts that most study time is allocated to information for which the discrepancy between the current and the desired state of learning is perceived to be largest. The aim of the present series of two experiments was to assess this mechanism by examining the influence of prior knowledge activation on information processing. In Experiment 1, participants activated either the names of Dutch cities, the names of European cities, or animal names before studying a list comprising the names of Dutch and European cities. Subsequently, participants studied the items in the list for a following free recall task. The results revealed that the Dutch-cities group and the European-cities group spent less time on items that had already been activated. However, the between-group comparisons of the processing times of activated and nonactivated items did not demonstrate significant effects. Further, the Dutch-cities group and the European-cities group did not outperform the control group in free recall. In Experiment 2, the activation procedure was identical to the one used in Experiment 1. However, instead of asking participants to memorise the items in the learning list, participants were required to give a judgement of learning (JOL) for each item in the study list. The JOL results showed a pattern that was comparable to the pattern of processing times demonstrated in Experiment 1. On the basis of the findings in Experiment 1 and Experiment 2 it was concluded that the concept of the desired state of learning should be considered as a relative rather than as an absolute criterion of study-time allocation. Furthermore, the concept of the desired state of learning should be specified in order to make predictions about the relationship between the activation of prior knowledge and study-time allocation

Case representation by medical experts, intermediates and novices for laboratory data presented with or without a clinical context

BACKGROUND: Based on cognitive psychological research, a number of theoretical frameworks have been put forward to describe the structure of experts' medical knowledge and to explain experts' case-processing. PURPOSE: To provide evidence for the theory of knowledge encapsulation, which states that medical knowledge constitutes of interlinked biomedical and clinical knowledge. METHODS: Fourth-year medical students, clerks and medical experts evaluated six case descriptions, consisting of laboratory data either with or without a clinical context. For each case description, the participants were required to study the case, to formulate a diagnosis, and to write down everything they could remember of the case. RESULTS: When the laboratory data were not embedded within a clinical context, medical experts' case-processing increased and their diagnostic accuracy became worse. Furthermore, laboratory data recall of medical experts was more elaborate in cases where the laboratory data were presented without a clinical context. Similar results were obtained for students and clerks. CONCLUSIONS: The findings are only partially consistent with a prediction made by the theory of knowledge encapsulation. Further research, using a different paradigm than the traditionally used method of free recall, is required to unearth whether medical experts use qualitatively different knowledge structures than novices while solving cases