Georges Bordage

Elaborated knowledge: a key to successful diagnostic thinking.

No abstract available.

Description, justification and clarification: a framework for classifying the purposes of research in medical education

Context  Authors have questioned the degree to which medical education research informs practice and advances the science of medical education.

Conceptual frameworks to illuminate and magnify

Context  In a recent study of the quality of reporting experimental studies in medical education, barely half the articles examined contained an explicit statement of the conceptual framework used. Conceptual frameworks represent ways of thinking about a problem or a study, or ways of representing how complex things work. They can come from theories, models or best practices. Conceptual frameworks illuminate and magnify one’s work. Different frameworks will emphasise different variables and outcomes, and their inter‐relatedness. Educators and researchers constantly use conceptual frameworks to guide their work, even if they themselves are not consciously aware of the frameworks.

Description, justification and clarification

Context  Authors have questioned the degree to which medical education research informs practice and advances the science of medical education.

Improving Continuing Medical Education for Surgical Techniques: Applying the Lessons Learned in the First Decade of Minimal Access Surgery

ObjectiveTo examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. Summary Background DataConcerns about the adequacy of training in new techniques for practicing surgeons began almost immediately after the introduction of laparoscopic cholecystectomy. The concern was restated throughout the following decade with seemingly little progress in addressing it. MethodsA preliminary search of the medical literature revealed no systematic review of continuing medical education for technical skills. The search was broadened to include educational, medical, and psychological databases in four general areas: surgical training curricula, continuing medical education, learning curve, and general motor skills theory. ResultsThe introduction and the evolution of minimal access surgery have helped to focus attention on technical skills training. The experience in the first decade has provided evidence that surgical skills training shares many characteristics with general motor skills training, thus suggesting several ways of improving continuing medical education in technical skills. ConclusionsThe educational effectiveness of the short-course type of continuing medical education currently offered for training in new surgical techniques should be established, or this type of training should be abandoned. At present, short courses offer a means of introducing technical innovation, and so recommendations for improving the educational effectiveness of the short-course format are offered. These recommendations are followed by suggestions for research.

The structure of medical knowledge in the memories of medical students and general practitioners: categories and prototypes

According to recent research on categorization, knowledge of a given category is structured in memory around key cases or clear examples, referred to as the prototypes, which capture the core meaning of the category. The purpose of this study was to establish a converging sequence of evidence concerning the internal structure of fourteen broad categories of medical disorders as stored in the long‐term memories of pre‐clinical medical students and experienced doctors. It was shown that the mental representation of the categories was better described by the overlapping features of the prototype view of categorization than the criterial features of the classical view. It is argued that the prototype view may help facilitate the understanding of the learning and problem‐solving process in medicine.

Quality of reporting of experimental studies in medical education: a systematic review

Objective  Determine the prevalence of essential elements of reporting in experimental studies in medical education.

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction

A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes.

Quantitative assessment of diagnostic ability

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56‐item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6‐point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first‐ and third‐year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual students and clinicians diagnostic thinking and to plan ways of improving their diagnostic thinking.

How specific is case specificity

Objectives  Case specificity implies that success on any case is specific to that case. In examining the sources of error variance in performance on case‐based examinations, how much error variance results from differences between cases compared with differences between items within cases? What is the optimal number of cases and questions within cases to maximise test reliability given some fixed period of examination time?