Anique B. H. de Bruin

Generating Keywords Improves Metacomprehension and Self-Regulation in Elementary and Middle School Children.

The ability to monitor understanding of texts, usually referred to as metacomprehension accuracy, is typically quite poor in adult learners; however, recently interventions have been developed to improve accuracy. In two experiments, we evaluated whether generating delayed keywords prior to judging comprehension improved metacomprehension accuracy for children. For sixth and seventh graders, metacomprehension accuracy was greater when generating keywords. By contrast, for fourth graders, metacomprehension accuracy did not differ across conditions. Improved metacomprehension accuracy led to improved regulation of study. The delayed keyword effect in children reported here is discussed in terms of situation model activation.

The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.

Purpose To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning. Method In 2000–01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning. Results Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately. Conclusion The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Perceptual simulation in developing language comprehension

We tested an embodied account of language proposing that comprehenders create perceptual simulations of the events they hear and read about. In Experiment 1, children (ages 7-13years) performed a picture verification task. Each picture was preceded by a prerecorded spoken sentence describing an entity whose shape or orientation matched or mismatched the depicted object. Responses were faster for matching pictures, suggesting that participants had formed perceptual-like situation models of the sentences. The advantage for matching pictures did not increase with age. Experiment 2 extended these findings to the domain of written language. Participants (ages 7-10years) of high and low word reading ability verified pictures after reading sentences aloud. The results suggest that even when reading is effortful, children construct a perceptual simulation of the described events. We propose that perceptual simulation plays a more central role in developing language comprehension than was previously thought.

Influences on anatomical knowledge: The complete arguments

Eight factors are claimed to have a negative influence on anatomical knowledge of medical students: (1) teaching by nonmedically qualified teachers, (2) the absence of a core anatomy curriculum, (3) decreased use of dissection as a teaching tool, (4) lack of teaching anatomy in context, (5) integrated curricula (problem‐based learning or systems‐based curricula), (6) inadequate assessment of anatomical knowledge, (7) decreased anatomy teaching time, and (8) neglect of vertical integration of anatomy teaching. A recent review revealed a lack of evidence underpinning any of the claims owing to the poor quality of papers, and recommendations were made for education and research on teaching in context and the implementation of vertical integration and of assessment strategies. In this article, we will describe the alleged factors fully, revealing additional recommendations for improving anatomy education by promoting recognition for teaching in institutions, by enhancing the professional recognition of anatomists through the implementation of a national postgraduate training program, and by encouraging anatomists to participate in educational research. Clin. Anat. 27:296–303, 2014.

Checklists improve experts' diagnostic decisions.

Context  Checklists are commonly proposed tools to reduce error. However, when applied by experts, checklists have the potential to increase cognitive load and result in ‘expertise reversal’. One potential solution is to use checklists in the verification stage, rather than in the initial interpretation stage of diagnostic decisions. This may avoid expertise reversal by preserving the experts’ initial approach. Whether checklist use during the verification stage of diagnostic decision making improves experts’ diagnostic decisions is unknown.

Students' perceptions of anatomy across the undergraduate problem-based learning medical curriculum: a phenomenographical study.

BackgroundTo get insight in how theoretical knowledge is transformed into clinical skills, important information may arise from mapping the development of anatomical knowledge during the undergraduate medical curriculum. If we want to gain a better understanding of teaching and learning in anatomy, it may be pertinent to move beyond the question of how and consider also the what, why and when of anatomy education.MethodsA purposive sample of 78 medical students from the 2nd, 3rd, 4th and 6th year of a PBL curriculum participated in 4 focus groups. Each group came together twice, and all meetings were recorded and transcribed verbatim. Data were analysed with template analysis using a phenomenographical approach.ResultsFive major topics emerged and are described covering the students’ perceptions on their anatomy education and anatomical knowledge: 1) motivation to study anatomy, 2) the relevance of anatomical knowledge, 3) assessment of anatomical knowledge, 4) students’ (in)security about their anatomical knowledge and 5) the use of anatomical knowledge in clinical practice.ConclusionsResults indicated that a PBL approach in itself was not enough to ensure adequate learning of anatomy, and support the hypothesis that educational principles like time-on-task and repetition, have a stronger impact on students’ perceived and actual anatomical knowledge than the educational approach underpinning a curriculum. For example, students state that repetitive studying of the subject increases retention of knowledge to a greater extent than stricter assessment, and teaching in context enhances motivation and transfer. Innovations in teaching and assessment, like spiral curriculum, teaching in context, teaching for transfer and assessment for learning (rewarding understanding and higher order cognitive skills), are required to improve anatomy education.

The challenges of studying visual expertise in medical image diagnosis

Visual expertise is the superior visual skill shown when executing domain‐specific visual tasks. Understanding visual expertise is important in order to understand how the interpretation of medical images may be best learned and taught. In the context of this article, we focus on the visual skill of medical image diagnosis and, more specifically, on the methodological set‐ups routinely used in visual expertise research.

Research Paradigms and Perspectives on Learning

What is the most important factor influencing human learning? Different instructional theories give very different answers to this question, because they take different perspectives on learning and thus focus on other desired learning outcomes, other methods affecting learning processes, and other conditions under which learning takes place. This chapter describes how eight prevailing research paradigms have influenced and still strongly influence theory development in the field of educational communications and technology. According to the perspective of Gestalt psychology, the most important factor influencing learning is insight and understanding; according to behaviorism and neo-behaviorism, it is reinforcement; according to developmental psychology, it is the learner’s stage of cognitive development; according to cultural-historical theory, it is interaction with the world; according to information processing theory, it is active and deep processing of new information; according to cognitive symbolic theory, it is what the learner already knows; according to cognitive resource models, it is the limited processing capacity of the human mind, and according to social constructivism, it is the social construction of meaning. It is argued that research is typically done within one particular paradigm, but that researchers should be conscious of the fact that paradigms heavily affect their research methods and findings. Moreover, researchers should be open to alternative theories and paradigms because new developments often take place at the interface between paradigms.

Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam

Background Few studies have investigated whether clinicians can use checklists to verify their diagnostic decisions. Checklists may improve accuracy by prompting clinicians to reconsider or recollect information but might impair decision making by adding to clinicians’ cognitive load. This study assessed whether checklists improve cardiac exam diagnostic accuracy, and whether this benefit is dependent on collecting additional information. Methods 191 internal medicine residents examined a cardiopulmonary simulator. They provided a diagnosis, subjective rating of certainty, and key findings before and after using a checklist. Residents were randomised; half were allowed access to the simulator and half were prohibited access to the simulator while using the checklist. Residents rated their cognitive load in each step: prechecklist diagnosis, checklist use and postchecklist diagnosis. Result Verifying with a checklist resulted in improved diagnostic accuracy; 88 residents (46%) made the correct diagnosis before using the checklist compared with 97 (51%) afterwards, p=0.04. The benefit of checklist use was restricted to residents allowed to re-examine the simulator (10 changed to correct diagnosis and one to an incorrect diagnosis) whereas no net benefit was seen among residents unable to re-examine the simulator (two changed to a correct diagnosis and two to an incorrect diagnosis, p=0.03). Those able to re-examine the simulator were slightly more confident after checklist use, whereas those unable to re-examine were slightly less confident after checklist use (p=0.01). The opportunity to re-examine the simulator had no effect on the accuracy of key findings reported. Of the three steps, checklist use was associated with the lowest cognitive load (F1,189=68 p<0.001). Conclusions Verifying diagnostic decisions with a checklist improved diagnostic accuracy. This benefit was only seen when more information could be collected. Checklist use was not associated with increased cognitive load.

Improving metacomprehension accuracy and self-regulation in cognitive skill acquisition: The effect of learner expertise

The positive learning effect of metacognitive strategy instructions based on the cue-utilisation framework (Koriat, 1997) has been shown in memorising word pairs and studying expository text. The present study explored the relevance of this framework in cognitive skill acquisition for learners with and without prior domain knowledge. That is, the quality of metacomprehension and self-regulation of novices and more experienced chess players were compared, when learning an endgame of chess. The experienced chess players not only became more skilled at the endgame, but also exemplified higher metacomprehension accuracy and self-regulation than the novices. The absolute level of metacomprehension accuracy and self-regulation of the novices was close to zero. This is the first study that shows an effect of expertise on metacomprehension accuracy in cognitive skill acquisition. Differences between cognitive skill acquisition and text comprehension that might explain differences in quality of metacognitive processes between these domains are discussed.