Nicole N. Woods

Science is fundamental: the role of biomedical knowledge in clinical reasoning

Context  Although training in basic science is generally considered a critical aspect of medical education, there is little consensus regarding its precise role in clinical reasoning. Whereas some reports suggest that biomedical knowledge is rarely used in routine diagnosis, other research has found that biomedical knowledge can become an integral part of the expert knowledge base.

The value of basic science in clinical diagnosis.

Background The role of basic science knowledge in clinical diagnosis is unclear. There has been no experimental demonstration of its value in helping students recall and organize clinical information. This study examines how causal knowledge may lead to better recall and diagnostic skill over time. Method Undergraduate medical students learned either four neurological or rheumatic disorders. One group learned a basic science explanation for the symptoms. The other learned epidemiological information. Both were then tested with the same set of clinical cases immediately after learning and one week later. Results On immediate test, there was no difference in accuracy (70% for both groups). However, one week later, performance in the epidemiology group dropped to 51%; the basic science group only dropped to 62%. Conclusions Basic science knowledge relating causal knowledge to disease symptoms can improve diagnostic accuracy after a delay.

Cognition before curriculum: rethinking the integration of basic science and clinical learning.

Purpose Integrating basic science and clinical concepts in the undergraduate medical curriculum is an important challenge for medical education. The health professions education literature includes a variety of educational strategies for integrating basic science and clinical concepts at multiple levels of the curriculum. To date, assessment of this literature has been limited. Method In this critical narrative review, the authors analyzed literature published in the last 30 years (1982–2012) using a previously published integration framework. They included studies that documented approaches to integration at the level of programs, courses, or teaching sessions and that aimed to improve learning outcomes. The authors evaluated these studies for evidence of successful integration and to identify factors that contribute to integration. Results Several strategies at the program and course level are well described but poorly evaluated. Multiple factors contribute to successful learning, so identifying how interventions at these levels result in successful integration is difficult. Evidence from session-level interventions and experimental studies suggests that integration can be achieved if learning interventions attempt to link basic and clinical science in a causal relationship. These interventions attend to how learners connect different domains of knowledge and suggest that successful integration requires learners to build cognitive associations between basic and clinical science. Conclusions One way of understanding the integration of basic and clinical science is as a cognitive activity occurring within learners. This perspective suggests that learner-centered, content-focused, and session-level-oriented strategies can achieve cognitive integration.

Speed kills? Speed, accuracy, encapsulations and causal understanding

Background  The role of basic science, which provides causal explanations for clinical phenomena in medical education, is poorly understood. Schmidt has postulated that expert clinicians maintain this knowledge in ‘encapsulated’ form, indexed by words or phrases describing the processes. In the present paper we show that students who learn causal explanations have a more coherent understanding of the relation between diseases and clinical features which, in turn, influences recognition of words or phrases describing ‘encapsulated knowledge’ and the ability to maintain performance under speeded conditions.

Preparing medical students for future learning using basic science instruction

The construct of ‘preparation for future learning’ (PFL) is understood as the ability to learn new information from available resources, relate new learning to past experiences and demonstrate innovation and flexibility in problem solving. Preparation for future learning has been proposed as a key competence of adaptive expertise. There is a need for educators to ensure that opportunities are provided for students to develop PFL ability and that assessments accurately measure the development of this form of competence. The objective of this research was to compare the relative impacts of basic science instruction and clinically focused instruction on performance on a PFL assessment (PFLA).

Expanding the basic science debate: the role of physics knowledge in interpreting clinical findings

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical information. Participants studied a handout about several respiratory disorders and how to interpret respiratory exam findings. The control group received the information in standard “textbook” format and the experimental group was presented with the same information as well as a causal explanation about how sound travels through lungs in both the normal and disease states. Comprehension and memory of the information was evaluated with a multiple-choice exam. Several questions that were not related to the causal knowledge served as control items. Questions related to the interpretation of physical exam findings served as the critical test items. The experimental group outperformed the control group on the critical test items, and our study shows that a causal explanation can improve a student’s memory for interpreting clinical details. We suggest an expansion of which basic sciences are considered fundamental to medical education.

Having our cake and eating it too: seeking the best of both worlds in expertise research

Context  Education researchers in a variety of disciplines have attempted to use their understanding of expert processes to inform learning across the continuum from school learning to lifelong learning. In medical education, this has led to models of expertise that aim to understand accurate and efficient clinical reasoning. More recently, researchers outside medicine have begun to develop models of ‘adaptive expertise’. As these additional constructions of expertise are introduced into health professions education, there is considerable potential to enhance research in medical expertise by providing opportunities for us to identify our implicit assumptions and reflect on the ways in which our theoretical lenses bias our perceptions of what it means to be an expert.

Informal self-regulated learning on a surgical rotation: uncovering student experiences in context

The ability to guide one’s own learning is an essential skill for the health professional. The apprenticeship model of undergraduate education offers an opportunity to engage in self-regulated learning as students work to set goals, evaluate the available opportunities and seek out those with the greatest potential for learning. A close examination of how students navigate their clinical rotations could therefore foster greater understanding of how students learn to guide their own learning. The study presented here aimed to examine undergraduate medical students’ day-to-day learning strategies in order to better understand the process of informal self-regulated learning in practice. As a secondary objective, we sought to provide a forum for students to share and critically reflect on their own self-regulated learning strategies. A series of focus groups were conducted with medical students on a surgical rotation. Participants were asked to discuss issues relating to the strategies and behaviours that they had implemented in order to maximize their educational experience. Three distinct approaches to informal self-regulated learning were identified: Participants articulated tendencies to acquiesce to a perceived lack of learning opportunities choose from available learning opportunities and create their own learning opportunities. The results are interpreted through the lens of self-regulated learning theory and implications for medical education are discussed.

Preparation for future learning: a missing competency in health professions education?

Evidence suggests that clinicians may not be learning effectively from all facets of their practice, potentially because their training has not fully prepared them to do so. To address this gap, we argue that there is a need to identify systems of instruction and assessment that enhance clinicians’ ‘preparation for future learning’. Preparation for future learning (PFL) is understood to be the capacity to learn new information, to use resources effectively and innovatively, and to invent new strategies for learning and problem solving in practice.

Cause and Effect: Testing a Mechanism and Method for the Cognitive Integration of Basic Science.

Background Methods of integrating basic science with clinical knowledge are still debated in medical training. One possibility is increasing the spatial and temporal proximity of clinical content to basic science. An alternative model argues that teaching must purposefully expose relationships between the domains. The authors compared different methods of integrating basic science: causal explanations linking basic science to clinical features, presenting both domains separately but in proximity, and simply presenting clinical features Method First-year undergraduate health professions students were randomized to four conditions: (1) science–causal explanations (SC), (2) basic science before clinical concepts (BC), (3) clinical concepts before basic science (CB), and (4) clinical features list only (FL). Based on assigned conditions, participants were given explanations for four disorders in neurology or rheumatology followed by a memory quiz and diagnostic test consisting of 12 cases which were repeated after one week. Results Ninety-four participants completed the study. No difference was found on memory test performance, but on the diagnostic test, a condition by time interaction was found (F[3,88] = 3.05, P < .03, &eegr;p2 = 0.10). Although all groups had similar immediate performance, the SC group had a minimal decrease in performance on delayed testing; the CB and FL groups had the greatest decreases. Conclusions These results suggest that creating proximity between basic science and clinical concepts may not guarantee cognitive integration. Although cause-and-effect explanations may not be possible for all domains, making explicit and specific connections between domains will likely facilitate the benefits of integration for learners.