Margaretha W. J. van de Wiel

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).

The Effect of Graphic Organizers on Subjective and Objective Comprehension of a Health Education Text

This study examined the effect of graphic organizers on the comprehension of a health education brochure text and compared subjective with objective comprehension measures. Graphic organizers are graphical depictions of relations among concepts in a text. Participants read a brochure text about asthma with and without these organizers, and subjective and objective text comprehension was measured. It was found that graphic organizers had effects on four levels of objective comprehension as indicated by open comprehension questions. However, on the subjective comprehension measure using Likert-type scales, the groups with and without graphic organizers did not differ from each other. It is concluded that health education texts could benefit from relatively simple techniques to increase comprehension. Furthermore, in developing health education materials, comprehension should be measured objectively.

The Explanation of Clinical Concepts by Expert Physicians, Clerks, and Advanced Students

Background: Research has shown that medical expertise is the result of changes in the nature and organization of knowledge. Purpose: This study investigated the content and organization of medical knowledge in participants with different clinical experience. Methods: Advanced students, clerks, and internists were required to explain 20 current clinical concepts in approximately 2 min per concept. The explanations were analyzed on elaborateness, quality, and fluency with which they were provided. Results: The more experienced participants generally provided more elaborate, qualitatively better, and more fluent explanations. For some concepts, the explanations of students and clerks equaled those of experts in quality, but these were less fluently and coherently formulated. Conclusions: Practical experience is an important mediator for meaningful integration of biomedical and clinical knowledge. Pathophysiological knowledge relating causes and consequences of disease does not decay with experience, but rath...

Increasing Readers’ Comprehension of Health Education Brochures: A Qualitative Study Into How Professional Writers Make Texts Coherent

The aim of this study was to gain insight into the extent to which health education text writers apply writing principles derived from cognitive psychological theory. Seventeen professional text writers of health education materials participated in a qualitative study, consisting of a rewriting task combined with a think-aloud procedure and a semistructured interview. The verbal data were explored carefully in light of seven text coherence principles that have proven effective in cognitive psychological research to increase text comprehension. Findings indicate text writers vary in their ideas and use of coherence principles to make a text comprehensible. It is argued that the health education profession can benefit greatly from knowledge about cognitive text processing and cognitive coherence principles for realizing effective comprehension of written health education messages.

Establishing a European research agenda on 'gut feelings' in general practice. A qualitative study using the nominal group technique.

Abstract Objective: Although ‘gut feelings’ are perceived as playing a substantial role in the diagnostic reasoning of the general practitioner (GP), there is little evidence about their diagnostic and prognostic value. Consensus on both types of ‘gut feelings’ (a ‘sense of alarm’, a ‘sense of reassurance’) has enabled us to operationalize the concept. As a next step we wanted to identify research questions that are considered relevant to validate the concept of ‘gut feelings’ and to estimate its usefulness for daily practice and medical education. Moreover, we were interested in the study designs considered appropriate to study these research questions. Methods: The nominal group technique (NGT) is a qualitative research method of judgmental decision-making involving four phases: generating ideas, recording them, evaluation and prioritization. Dutch and Belgian academics whose subject is general practice (n = 18), attended one of three meetings during which NGT was used to produce a ‘research agenda’ on ‘gut feelings’. Results: NGT yielded ten research questions and nine corresponding appropriate designs on four topics, i.e. the diagnostic value of ‘gut feelings’, the validation of its determinants, the opportunities for integrating ‘gut feelings’ in medical education and a rest group. The study designs respectively included recording and follow-up of ‘gut feelings’, video recording of consultations with stimulated recall using simulated and real patients respectively, analysing trainees’ consultation stories and videos, linguistic analyses, and vignette studies. Furthermore, two experimental designs were proposed. Conclusion: A European research agenda on ‘gut feelings’ in general practice has been established and could be used in collaborative research.

Testing the usability of access structures in a health education brochure

OBJECTIVES In health education, the design of written materials is seldom subject to experimental tests. Using insights from cognitive-ergonomic literature on usability we tested a brochure against three stepwise improved versions. Effects were assessed of pictorials that flagged references in the brochure text, the use of tabs and colour coding of these pictorials and tabs, on finding information in the brochure. METHODS One hundred Dutch adults from the general population were videotaped while looking up search items. Dependent measures relating to search effectiveness, efficiency, satisfaction and learnability were extracted. RESULTS Results showed a general inferiority of the original brochure. The presence of coloured tabs and pictorials contributed to a more usable brochure design, although errors were still made. CONCLUSION It is concluded that this kind of research may provide valuable insights for more effective health education material design and thus contributes to the effectiveness of health education practice.

Learning in a clinical education programme in primary care: the Maastricht Adoption Programme.

Introduction  At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an ‘Adoption Programme’, where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme.