Henny P. A. Boshuizen

A Qualitative Analysis of the Transition from Theory to Practice in Undergraduate Training in a PBL-Medical School

In spite of numerous curricular innovations, the problems medical students encounter in making the transition from theoretical training to clinical training remain unresolved and the problem has received scant attention in the literature. We performed a qualitative study to explore students perceptions and attitudes regarding this transition in undergraduate medical training. Twenty fifth-year students of the Maastricht Medical School participated in focus group discussions about the transition from the preclinical phase to the clinical phase of the curriculum. All focus group discussions were videotaped, literally transcribed and qualitatively analysed using content analysis. The results suggest that students have difficulty in bridging the gap between the theoretical and clinical phase of the curriculum. The problems they experience arise largely from professional socialisation processes. However, students also find it difficult to apply theoretical knowledge in clinical practice. Students find contacts with real patients highly motivating. In the clinical phase their learning changes from passive acquisition of knowledge to more active learning.Since the problem-based learning approach is supposed to enhance application of basic science concepts to clinical problems, it is surprising that students experience difficulties in applying their knowledge in practice. To facilitate the transition from theory to practice in the Maastricht Medical School some curricular changes could be introduced, such as early patient contacts to motivate students and help them learn usable knowledge. Furthermore, the advantages of a problem-based preclinical curriculum to student learning should be fully exploited. Finally, the assessment system must be congruent with the educational programme, because examinations have a powerful effect on student learning.

Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians

The present study was conducted to investigate qualitative changes that occur in the structure of knowledge in acquiring medical expertise. Therefore, the representation of pathophysiological knowledge was compared in subjects at four different levels of expertise. Subjects studied four clinical cases under three different time constraints, and provided a diagnosis and a pathophysiological explanation for the signs and symptoms in each case. Both diagnostic accuracy and quality of explanations increased with level of expertise. The explanations of experts, however, were less elaborate and less detailed than those of students. Constraining processing time affected the quality of explanations of advanced students, but not that of experts; conversely, the elaborateness and level of detail of explanations was affected in experts but not in students. The findings are explained by a network model integrating the two-world hypothesis in which biomedical and clinical knowledge are organised as two worlds apart (Patel, Evans, & Groen, 1989a, b) and the hypothesis of knowledge encapsulation in which biomedical knowledge becomes encapsulated into clinical knowledge (Schmidt & Boshuizen, 1992).

Comparative Study of Medical Education as Perceived by Students at Three Dutch Universities

AbstractObjective. The aim of the present study was to identify the differences that may exist in professional satisfaction and skills (clinical patient management and psychosocial skills) in students and graduates from two traditional medical schools and their counterparts from a problem-based medical school in the Netherlands. Also their satisfaction for their training was investigated.nMethod. Questionnaires were designed containing items reflecting the earlier mentioned differences between the students. Following an initial pilot study, the questionnaire used in this study was constructed accordingly.nSample. The questionnaires were sent to 180 near and recent graduates of these three schools.nResults. A total of 127 questionnaires were returned (response rate of 70.5%). The students of the PBL curriculum felt better prepared in psychosocial and interpersonal skills. They felt more satisfied with their training, but were less enthusiastic with the profession. The results also suggest that in their own opinion students and graduates from the three schools do not differ in clinical patient management skills acquired in medical school.nConclusion. A limitation of this study lies in the fact that results are based on actual self-assessment of the students. One must be aware that self-assessment does not always provide for objective information. However, since this limitation applied equally to respondents of all three medical schools, the differences between the schools can be considered indicative of the effects resulting from the different curricula.

Students' and tutors' perceptions of problems in PBL tutorial groups at a Brazilian medical school.

INTRODUCTIONnThere are few published studies that address the problem of dysfunctional tutorial groups. Most studies are restricted to student or faculty opinions separately and to specific aspects affecting the tutorial group function. This study examined teacher and student perceptions of frequency and importance of problems observed in tutorial groups in a new PBL program.nnnMETHODSnTutors (n=30) and students in the second (n=75) and third (n=53) year completed a questionnaire at the beginning of the 1999 academic year. The questionnaire had 33 items grouped as seven factors related to tutor performance, feedback, assessment, educational resources, student performance, educational problems and external factorsnnnRESULTSnThe most important problems identified were related to tutors (mainly in training aspects) and students (mainly in problem discussion). Students and feedback (quality) were the most frequent. There were statistically significant differences between tutors and students (higher) and between second and third year (higher) students perceptions of different factors.nnnCONCLUSIONSn(1) Marilia Medical School (FAMEMA) has problems in the tutorial group function mainly related to contributions of students and tutors. (2) Students and tutors opinions, as well as those of second and third year students, differ and therefore all need to be consulted to solve tutorial group problems. (3) It is necessary to develop a better student training program and also to improve the tutors training program. (4) There is a need for continued evaluation of problem-based learning at FAMEMA. We must look at perceptions of students from all years.

Cognitive Effects of Practical Experience

Medical education aims at helping students acquire the large bodies of flexible medical knowledge that will enable them to diagnose and treat diseases in patients. Such a goal can be reached in numerous ways, but most medical schools do not start with teaching students only medical (clinical) knowledge, but instead begin with what are considered ‘basic sciences’ (e.g., anatomy and physiology) in order to teach students the normal structure and functions of the human body and the way these change over a lifetime. Next, students learn how these normal functions can be disturbed, e.g., through external agents such as bacteria, viruses, or toxic matter, through degenerative processes, or through neoplasms. They learn how these processes affect the body and how the body tries to maintain homoeostasis. It takes students several years to master these basics. (For example, in the medical curriculum of our university, University of Limburg, the Netherlands, two years are devoted to basic sciences, another two years to clinical sciences and two years to clinical rotations.) General knowledge about normal structure and function and about general pathology acquired during this period serves as a cornerstone for the clinical sciences that are taught and studied afterward. These clinical sciences describe specific diseases, their symptomatology, pathophysiology, epidemiology, prognosis, and treatment. In such a curricular approach, practical work is postponed until the students may be supposed to have mastered all the clinical knowledge needed for diagnosing and treating patients. Finally, the time comes to (learn to) apply that knowledge in practical settings. This paper describes how practical experience, in the clerkships but also after graduation from medical school, affects the cognitive structure students have built up during theoretical training.

Long-term retention of a theatrical script by repertory actors: The role of context

Four actors were requested to perform Sartres No Exit after a retention interval of more than 5 months. Their recall of the play was studied either with the spatial and visual contextual cues normally available during a performance or without such cues. Total recall was still considerable, equalling 85%. The number of paraphrases of, and inferences on, the original text was however quite large (32%), suggesting that the actors had learned their lines according to their meaning rather than as a result of rote memorisation. The context manipulation showed that actors recall is facilitated by the availability of spatial-visual information, but only to a limited extent. The relative importance of textual and contextual cues in the long-term retention of a play is discussed.

De overgang van theorie naar praktijk in het medisch curriculum

Er is onvoldoende bekend over de overgang in het medisch curriculum van de eerste vier, hoofdzakelijk op theoretische kennis gerichte jaren naar de vooral praktijkgerichte co-assistentschappen. De ervaringen van medisch studenten met deze overgang zijn onderzocht met behulp van focusgroepdiscussies waaraan twintig vijfdejaars studenten geneeskunde in Maastricht deelnamen. De studenten blijken een groot verschil te ervaren tussen de co-assistentschappen en de voorgaande jaren. Dit is deels toe te schrijven aan het proces van professionele socialisatie. Verder ervaren studenten hiaten in hun basiskennis en hebben ze moeite hun theoretische kennis in de praktijk toe te passen, met name bij het redeneren van symptomen naar diagnose. Dit is opmerkelijk, aangezien het probleemgestuurde onderwijs in Maastricht juist de integratie van basisvakken en klinische vakken en het leren denken vanuit symptomen zou moeten stimuleren. Een mogelijke verklaring is dat toetsing en examenreglement niet goed aansluiten bij de doelstellingen van het curriculum. Er worden suggesties gedaan hoe deze situatie verbeterd zou kunnen worden.

Leiden korte-casustoetsen tot andere denkprocessen dan feitenkennisvragen

Samenvatting nOnderzocht is of korte-casusvragen andere denkprocessen teweegbrengen dan feitenkennisvragen.