The effects of deliberate practice in undergraduate medical education

INTRODUCTION: Ericsson and colleagues introduced the term 'deliberate practice' to describe training activities that are especially designed to maximise improvement. They stressed that how much one practises is as important as how one practises. Essential aspects of deliberate practice are the presence of well defined tasks, informative feedback, repetition, self-reflection, motivation and endurance. Deliberate practice is often difficult, laborious, and even unpleasant. Previous studies in the fields of sports and music have shown a positive relation between deliberate practice and level of expertise. PURPOSE: The present study investigated the relationship between several aspects of deliberate practice and study achievements among undergraduate medical students. METHODS: A questionnaire was developed to measure important aspects of deliberate practice. It was filled out by 777 medical students at Maastricht University Medical School (response rate 90%). Scores on 3 regular tests were used to define student levels of expertise. RESULTS: Positive correlations between aspects of deliberate practice (self-study, study resources, planning, study style and motivation) and study achievements were found. Furthermore, high achieving students showed more characteristics of deliberate practice than low achieving students. CONCLUSION: Some important aspects of deliberate practice appear to contribute to the performance of medical students

Growth of medical knowledge

Background Knowledge is an essential component of medical competence and a major objective of medical education. Thus, the degree of acquisition of knowledge by students is one of the measures of the effectiveness of a medical curriculum. We studied the growth in student knowledge over the course of Maastricht Medical School's 6-year problem-based curriculum. Methods We analysed 60 491 progress test (PT) scores of 3226 undergraduate students at Maastricht Medical School. During the 6-year curriculum a student sits 24 PTs (i.e. four PTs in each year), intended to assess knowledge at graduation level. On each test occasion all students are given the same PT, which means that in year 1 a student is expected to score considerably lower than in year 6. The PT is therefore a longitudinal, objective assessment instrument. Mean scores for overall knowledge and for clinical, basic, and behavioural/social sciences knowledge were calculated and used to estimate growth curves. Findings Overall medical knowledge and clinical sciences knowledge demonstrated a steady upward growth curve. However, the curves for behavioural/social sciences and basic sciences started to level off in years 4 and 5, respectively. The increase in knowledge was greatest for clinical sciences (43%), whereas it was32% and 25% for basic and behavioural/social sciences, respectively. Interpretation Maastricht Medical School claims to offer a problem-based, student-centred, horizontally and vertically integrated curriculum in the first 4 years, followed by clerkships in years 5 and 6. Students learn by analysing patient problems and exploring pathophysiological explanations. Originally, it was intended that students' knowledge of behavioural/social sciences would continue to increase during their clerkships. However, the results for years 5 and 6 show diminishing growth in basic and behavioural/social sciences knowledge compared to overall and clinical sciences knowledge, which appears to suggest there are discrepancies between the actual and the planned curricula. Further research is needed to explain this

Panel expertise for an Angoff standard setting procedure in progress testing: item writers compared to recently graduated students

Introduction An earlier study showed that an Angoff procedure with greater than or equal to 10 recently graduated students as judges can be used to estimate the passing score of a progress test. As the acceptability and feasibility of this approach are questionable, we conducted an Angoff procedure with test item writers as judges. This paper reports on thereliability and credibility of this procedure and compares the standards set by the two different panels. Methods Fourteen item writers judged 146 test items. Recently graduated students had assessed these items in a previous study. Generalizability was investigated as a function of the number of items and judges. Credibility was judged by comparing the pass/fail rates associated with the Angoff standard, a relative standard and a fixed standard. The Angoff standards obtained by item writers and graduates were compared. Results The variance associated with consistent variability of item writers across items was 1.5% and for graduate students it was 0.4%. An acceptable error score required 39 judges. Item-Angoff estimates of the two panels and item P -values correlated highly. Failure rates of 57%, 55% and 7% were associated with the item writers' standard, the fixed standard and the graduates' standard, respectively. Conclusion The graduates' and the item writers' standards differed substantially, as did the associated failure rates. A panel of 39 item writers is not feasible. The item writers' passing score appears to be less credible. The credibility of the graduates' standard needs further evaluation. The acceptability and feasibility of a panel consisting of both students and item writers may be worth investigating

Trafikbullerskärmar nära bebyggelse /

In this article, an alternative for Tinto's integration theory of student persistence is proposed and tested. In the proposed theory, time available for individual study is considered a major determinant of both study duration and graduation rate of students in a particular curriculum. In this view, other activities in the curriculum, in particular lectures, constrain self-study time and therefore must have a negative impact on persistence. To test this theory, we collected study duration and graduation rate information of all-almost 14,000 students-enrolling in eight Dutch medical schools between 1989 and 1998. In addition, information was gathered regarding the timetables of each of these curricula in the particular period: lectures hours, hours spent in small-group tutorials, practicals, and time available for self-study. Structural equation modeling was used to study relations among these variables. In line with our predictions, time available for self-study was the only determinant of graduation rate and study duration. Lectures were negatively related to self-study time, negatively related to graduation rate, and positively related to study duration. The results suggest that extensive lecturing may be detrimental in higher education. However, in the curricula employing limited lecturing considerable energy was spent in supporting self-study activities of students and preventing postponement of learning. Given our findings, both activities will likely have large pay offs, in particular in curricula with low graduation rates