Medical students' cognitive load in volumetric image interpretation:Insights from human-computer interaction and eye movements

Medical image interpretation is moving from using 2D- to volumetric images, thereby changing the cognitive and perceptual processes involved. This is expected to affect medical students' experienced cognitive load, while learning image interpretation skills. With two studies this explorative research investigated whether measures inherent to image interpretation, i.e. human-computer interaction and eye tracking, relate to cognitive load. Subsequently, it investigated effects of volumetric image interpretation on second-year medical students' cognitive load. Study 1 measured human-computer interactions of participants during two volumetric image interpretation tasks. Using structural equation modelling, the latent variable 'volumetric image information' was identified from the data, which significantly predicted self-reported mental effort as a measure of cognitive load. Study 2 measured participants' eye movements during multiple 2D and volumetric image interpretation tasks. Multilevel analysis showed that time to locate a relevant structure in an image was significantly related to pupil dilation, as a proxy for cognitive load. It is discussed how combining human-computer interaction and eye tracking allows for comprehensive measurement of cognitive load. Combining such measures in a single model would allow for disentangling unique sources of cognitive load, leading to recommendations for implementation of volumetric image interpretation in the medical education curriculum

The development of research supervisors’ pedagogical content knowledge in a lesson study project

In this study, we aimed to identify how the learning activities elicited in a lesson study project contributed to self-perceived change in supervisors’ pedagogical content knowledge (PCK). Lesson study is a method which combines both professional and educational development. During a lesson study project, teachers collaborate in a team and develop, teach, evaluate, and redesign a research lesson. During the 4-month lesson study project described here, four supervisors designed a protocol for research supervision meetings aimed at enhancing undergraduate students’ learning. During the project, they experimented with open questioning and giving positive feedback instead of giving instruction and explanations. A mixed-methods design was used in this study. Data on the supervisors’ learning activities and PCK were gathered using learner reports, video-recordings of meetings, and exit interviews. The analyses of these data showed that the lesson study project contributed to the development of the supervisors’ PCK on instructional strategies and student understanding. The learning activity that contributed most to these changes was reflecting on their own practice and that of their students

Connecting academics’ disciplinary knowledge to their professional development as university teachers: a conceptual analysis of teacher expertise and teacher knowledge

Disciplinary knowledge lies at the heart of academic work. However, connecting academics’ disciplinary knowledge to their professional development as teachers has been a longstanding challenge for (research-intensive) universities. This is reflected in criticism of the practices that aim to support the professional development of university teachers. In order to create better connections, a deeper understanding is needed of how academics’ disciplinary knowledge relates to the development of their teaching. In this paper, we therefore aim to advance theoretical insights about how academics’ disciplinary knowledge connects to their professional development as university teachers. We do so by providing a conceptual analysis of teacher expertise and teacher knowledge perspectives. Literature discussed as part of the teacher expertise perspective provides insights into how knowledge is structured in order to perform teacher tasks. In our discussion of the teacher knowledge perspective, we include bodies of literature about teachers’ knowledge base to explore the role of disciplinary knowledge in how to teach and about powerful knowledge to explore the role of disciplinary knowledge in what to teach. Insights from these bodies of literature can, from a teacher knowledge perspective, offer theoretical underpinnings for connecting academics’ disciplinary knowledge to their professional development as university teachers. Adaptive expertise and practical knowledge are identified as concepts that include elements of both teacher expertise and teacher knowledge perspectives. Based on the conceptual analysis, we identify and discuss three aspects related to supporting the professional development of university teachers where attention to connection with teachers’ disciplinary knowledge is important

Юрій Іллєнко (1936–2010)

15 червня помер Юрій Іллєнко – кінематографіст Божою милістю, чия творчість давно стала класикою вітчизняного і світового кіно

A scoping review on the notions of Assessment as Learning (AaL), Assessment for Learning (AfL), and Assessment of Learning (AoL)

Associations between assessment and learning are widely studied and often organized around the notions of Assessment as Learning (AaL), Assessment for Learning (AfL), and Assessment of Learning (AoL). Although these notions are appealing in theory, the notions are unclear constructs to comprehend, as both their definitions and their practice are used inconsistently in educational research. We present a synthesis of common characteristics among these notions, based on a scoping review on definitions and descriptions of AaL, AfL, and AoL (131 studies). The synthesis of common characteristics consists of nine themes that refer to how educational assessment relates to learning. The themes are grouped into: 1) Student-teacher roles and relationships within assessment; 2) Assessment learning environment; and 3) Educational outcomes of assessment. Then, we used the themes within the synthesis to analyze the results of the included empirical studies on their contributions to practice (84 studies). The synthesis provides stakeholders with a clear and integrative view of how educational assessment relates to learning and may be beneficial to educators to support and design their assessment practices. We argue that the notions of AaL, AfL, and AoL should be seen in coherence with one another in order to establish an assessment culture that facilitates students’ learning maximally

Making knowledge clips with patients: What learning mechanisms are triggered in medical students?

Objective: To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course. Methods: In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis. Results: We identified four learning mechanisms: Challenging assumptions about patients’ information needs; Becoming aware of the origin of patients’ information needs; Taking a patient's perspective; Analyzing language to adapt to patients’ needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students. Conclusion: Collaborating with patients helped students to recognize and understand patients’ perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients. Practice implication: Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients’ perspectives

CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Introduction: We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. Methods: We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. Results: At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). Conclusion: In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment

Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: The Dutch acute stroke trial (DUST) study protocol

Background: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated.Methods/design: The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests.Discussion: This study will provide insight in the added prognosti

No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

Background: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine hours after symptom onset, who had an intracranial arterial occlusion on admission CT angiography, in 13 participating centres. We calculated the relation per every 0.1°Celsius increase in admission body temperature and recanalization at three days. Results: Recanalization occurred in 80% of occluded arteries. There was no relation between body temperature and recanalization at three days after adjustments for age, NIHSS score on admission and treatment with alteplase (adjusted odds ratio per 0.1°Celsius, 0.99; 95% confidence interval, 0.94-1.05; p = 0.70). Results for patients treated or not treated with alteplase were essentially the same. Conclusions: Our findings suggest that in patients with acute ischaemic stroke there is no relation between body temperature on admission and recanalization of an occluded intracranial artery three days later, irrespective of treatment with alteplase