Henk G. Schmidt

Problem-based learning: rationale and description

Problem‐based learning is an instructional method that is said to provide students with knowledge suitable for problem solving. In order to test this assertion the process of problem‐based learning is described and measured against three principles of learning: activation of prior knowledge, elaboration and encoding specificity. Some empirical evidence regarding the approach is presented.

A cognitive perspective on medical expertise: theory and implication [published erratum appears in Acad Med 1992 Apr;67(4):287]

A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the featurA new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as “illness scripts,” contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis.

Foundations of problem-based learning: Some explanatory notes

Summary. The present article elaborates on cognitive effects of problem‐based learning put forward by Schmidt, De Volder, De Grave, Moust & Patel (1989) and Norman & Schmidt (1992) . Its purpose is to discuss, in some detail, the theoretical premises of this approach to learning and instruction. It is argued that problem‐based learning, above all, promotes the activation of prior knowledge and its elaboration. Evidence is reviewed demonstrating that these processes actually occur in small‐group tutorials and that the processing of new information is indeed facilitated by discussion of a relevant problem. These effects must be attributed to a reorganization taking place in the knowledge structures of students as a result of problem‐oriented study. In addition, a cognitive process called epistemic curiosity (or intrinsic interest) is enabled. Some directions for further research are outlined. The contribution starts, however, with a discussion of the philosophical and pedagogical roots of problem‐based learning.

Effectiveness of problem-based learning curricula: theory, practice and paper darts.

In a recent review article, Colliver concluded that there was no convincing evidence that problem‐based learning was more effective than conventional methods. He then went on to lay part of the blame on cognitive psychology, claiming that ‘the theory is weak, its theoretical concepts are imprecise... the basic research is contrived and ad hoc’. This paper challenges these claims and presents evidence that (a) cognitive research is not contrived and irrelevant, (b) curriculum level interventions are doomed to fail and (c) education needs more theory‐based research.

On the Role of Biomedical Knowledge in Clinical Reasoning by Experts, Intermediates and Novices

In two studies the role of biomedical knowledge in the diagnosis of clinical cases was explored. Experiment 1 demonstrated a decrease in the use of biomedical knowledge with increasing expertise. This result appeared to be at variance with some findings reported in the literature (e.g., Lesgold, 1984), but supported those of others (e.g., Patel, Evans, & Groen, 1989). In Experiment 2, three possible explanations for this phenomenon were investigated: (1) rudimentation of biomedical knowledge, (2) inertia, and (3) encapsulation of biomedical knowledge under higher order concepts. Using a combined think-aloud and post-hoc explanation methodology, it was shown that experts have more in-depth biomedical knowledge than novices and subjects at intermediate levels of expertise. The findings generally support a three-stage model of expertise development in medicine consisting of acquisition of biomedical knowledge, practical experience, and integration of theoretical and experientall knowledge resulting in knowledge encapsulation.

How expertise develops in medicine: knowledge encapsulation and illness script formation

Context  For over 30 years, research has focused on the question of how knowledge is organised in the doctor’s mind. The development of encapsulated knowledge, followed by the formation of illness scripts, may both be considered as important stages in the development of medical expertise.

The process of problem-based learning: what works and why

Medical Education 2011: 45: 792–806

On Acquiring Expertise in Medicine

This article presents a new theory of expertise development in medicine and the empirical evidence available. This theory describes expertise development as the progression through a series of consecutive phases, each of which is characterized by functionally different knowledge structures underlying performance. The first phase is characterized by the accumulation of causal knowledge about disease and its consequences. Through experience with real cases, this knowledge transforms into narrative structures called illness scripts. The cognitive mechanisms responsible for this transition are: Encapsulation of elaborated knowledge into high level but simplified causal models or even diagnostic categories and tuning through the inclusion of contextual information. The third phase is characterized by the use of episodic memories of actual patients in the diagnosis of new cases. It is assumed that knowledge acquired in different phases form layers in memory through a sedimentation process. These knowledge sediments, although usually not applied any more in subsequent phases in the development of expertise, remain available for use when ontologically more recently acquired structures fail to produce an adequate representation of a clinical problem.

Maternal Thyroid Function during Early Pregnancy and Cognitive Functioning in Early Childhood: The Generation R Study

CONTEXT Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and childrens cognitive development are sparse. OBJECTIVE Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T(4)(FT(4)) levels across the entire range with cognitive functioning in early childhood. DESIGN AND SETTING We conducted a population-based cohort in The Netherlands. PARTICIPANTS Participants included 3659 children and their mothers. MAIN MEASURES In pregnant women with normal TSH levels at 13 wk gestation (SD = 1.7), mild and severe maternal hypothyroxinemia were defined as FT(4) concentrations below the 10th and 5th percentile, respectively. Childrens expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Childrens Abilities measuring verbal and nonverbal cognitive functioning. RESULTS Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT(4) predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.09-1.91; P = 0.010 and OR = 1.80; 95% CI = 1.24-2.61; P = 0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR = 2.03; 95% CI = 1.22-3.39; P = 0.007). CONCLUSIONS Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood.

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.