W.S. de Grave

Problem based learning : cognitive and metacognitive processes during problem analysis

An important phase of problem-based learning in a tutorial group is problem analysis. This article describes a study investigating the ongoing cognitive and metacognitive processes during problem analysis, by analysing the verbal communication among group members, and their thinking processes. Thinking processes were tapped by means of a stimulated recall procedure. Verbatim transcripts of both the verbal interaction in the group and the recall protocols were analysed. The goal of this research is two-fold, i.e., to investigate whether PBL indeed leads to conceptual change and to develop a method that is sensitive to these phenomena.The results suggest that the verbal interaction in a group shows only the tip of the iceberg of the cognitive and metacognitive processes on which it is based. The verbal interaction in the small group discussion mainly concerned theory building, and to a lesser extent, data exploration and meta-reasoning. Stimulated recall of the thinking process during that discusion, however, provides more and unique information about hypothesis evaluation and meta-reasoning. In the protocols of stimulated recall, the process of conceptual change by students could be made visible. The ways of dealing with anomalous data could be described as well as the conditions that determine how students deal with anomalous data. These results suggest that the method was sensitive for detecting conceptual change during problem analysis.

Comparison of text and video cases in a postgraduate problem-based learning format

Objective  To investigate whether adding a brief video case instead of an equivalent written text improves the cognitive and metacognitive processes (data exploration, theory building, theory evaluation and metareasoning) of residents in problem‐based learning.

A framework of teaching competencies across the medical education continuum

Background: The quality of teachers in higher education is subject of increasing attention, as exemplified by the development and implementation of guidelines for teacher qualifications at Universities in The Netherlands. Aim: Because medical education takes a special position in higher education the Council of Deans of Medical Schools in The Netherlands installed a national task force to explore a method to weigh criteria for teacher qualifications of medical teachers. Methods: A framework was developed covering competencies of teachers throughout the medical education continuum and including medicine, dentistry and veterinary medicine. Results: The framework distinguishes 3 dimensions: (a) six domains of teaching (development – organization – execution – coaching – assessment – evaluation); (b) three levels in the organization at which teachers perform (micro, meso and macro level) and (c) competencies as integration of knowledge, skills and attitude and described as behaviour in specific context. The current framework is the result of several cycles of descriptions, feedback from the field and adaptations. It is meant as a guideline, leaving room for local detailing. Conclusion: The framework provides a common language that may be used not only by teachers and teacher trainers, but also by quality assurance committees, human resource managers and institutional boards.

Providing physicians with feedback on how they supervise students during patient contacts

In this descriptive study an instrument is presented that has been developed to provide physicians with feedback about their strengths and weaknesses in facilitating student learning during patient contacts. The instrument is strongly theory based, i.e. it is based on current general theories of context-bound learning environments, and forms of facilitation promoting transfer of knowledge to actual professional practice. In addition, it has been developed in cooperation with physicians supervising students during patient contacts. The authors have shown how physicians can be provided with individualized feedback on their performance in supervising students during patient contacts.

Approaches to learning in a problem-based medical programme: a developmental study

Summary. In this study we investigate how the introductory phase of the problem‐based medical programme in Maastricht affects the study methods of students. On the first day of the academic year, 142 men and women medical students completed the Short Inventory of Study Approaches and again at the end of the introductory period. The study indicates that these study methods are fostered by training in problem‐based learning given during the introductory period.

Clinical supervisors' perceived needs for teaching communication skills in clinical practice

Background: Lack of faculty training is often cited as the main obstacle to post-graduate teaching in communication skills. Aims: To explore clinical supervisors’ needs and perceptions regarding their role as communication skills trainers. Methods: Four focus group discussions were conducted with clinical supervisors from two in-patient and one out-patient medical services from the Geneva University Hospitals. Focus groups were audio taped, transcribed verbatim and analyzed in a thematic way using Maxqda© software for qualitative data analysis. Results: Clinical supervisors said that they frequently addressed communication issues with residents but tended to intervene as rescuers, clinicians or coaches rather than as formal instructors. They felt their own training did not prepare them to teach communication skills. Other barriers to teach communication skills include lack of time, competing demands, lack of interest and experience on the part of residents, and lack of institutional priority given to communication issues. Respondents expressed a desire for experiential and reflective training in a work-based setting and emphasised the need for a non-judgmental learning atmosphere. Conclusions: Results suggest that organisational priorities, culture and climate strongly influence the degree to which clinical supervisors may feel comfortable to teach communication skills to residents. Attention must be given to these contextual factors in the development of an effective communication skills teaching program for clinical supervisors.

The development of shared cognition in paediatric residents analysing a patient video versus a paper patient case

In a previous study, we established that compared to a written case, a video case enhances observable cognitive processes in the verbal interaction in a postgraduate problem-based learning format. In a new study we examined non-observable cognitive processes using a stimulated recall procedure alongside a reanalysis of the data from the first study. We examined the development of shared cognition as reflected in collaborative concept link formation, an approach to connecting a series of concepts related to a particular topic. Eleven paediatric residents were randomly allocated to two groups. After both analysing the same written case vignette, one group watched a video of the case in the vignette and the other group read a written description of the video. Both groups then reanalysed the vignette. After the group sessions, time-logged transcripts were made of the verbal interaction in both groups and all residents individually took part in a stimulated recall procedure. Causal reasoning concept links were labelled as individual or collaborative depending on whether they originated from individual residents or were directly elicited by verbal utterances from others. The video led to a significantly increased frequency ratio (after intervention: before intervention) of collaborative concept links but did not affect the frequency of individual concept links. This novel process approach to chronological registration of concept link formation offered additional evidence that shared cognition by means of co-elaboration of concept formation is stimulated by the use of patient video recordings in small group learning.

How do clinicians become teachers? A communities of practice perspective

There is widespread acceptance that clinical educators should be trained to teach, but faculty development for clinicians is undermined by poor attendance and inadequate learning transfer. As a result there has been growing interest in situating teacher development initiatives in clinical workplaces. The relationship between becoming a teacher and clinical workplace contexts is under theorised. In response, this qualitative research set out to explore how clinicians become teachers in relation to clinical communities and institutions. Using communities of practice (CoP) as a conceptual framework this research employed the sensitising concepts of regimes of competence and vertical (managerial) and horizontal (professional) planes of accountability to elucidate structural influences on teacher development. Fourteen hospital physicians completed developmental timelines and underwent semi-structured interviews, exploring their development as teachers. Despite having very different developmental pathways, participants’ descriptions of their teacher identities and practice that were remarkably congruent. Two types of CoP occupied the horizontal plane of accountability i.e. clinical teams (Firms) and communities of junior doctors (Fraternities). Participants reproduced teacher identities and practice that were congruent with CoPs’ regimes of competence in order to gain recognition and legitimacy. Participants also constructed their teacher identities in relation to institutions in the vertical plane of accountability (i.e. hospitals and medical schools). Institutions that valued teaching supported the development of teacher identities along institutionally defined lines. Where teaching was less valued, clinicians adapted their teacher identities and practices to suit institutional norms. Becoming a clinical educator entails continually negotiating one’s identity and practice between two potentially conflicting planes of accountability. Clinical CoPs are largely conservative and reproductive of teaching practice whereas accountability to institutions is potentially disruptive of teacher identity and practice.

Een raamplan voor docentcompetenties binnen het medisch opleidingscontinuüm

Achtergrond: De kwaliteit van docenten in het hoger onderwijs staat sterk in de belangstelling, zoals blijkt uit de ontwikkeling en implementatie van richtlijnen voor docentkwalificaties aan de Nederlandse Universiteiten.

De student als observator en feedbackgever voor docenten: een procesevaluatie

Inleiding: Studentevaluaties van onderwijs, en de schriftelijke feedback die hieruit voortkomt, blijken onvoldoende veranderingen te bewerkstelligen in de kwaliteit van het onderwijs. Een combinatie van studentoordelen en directe observaties lijkt uitkomst te bieden. Meestal wordt de rol van observator vervuld door een onderwijskundige of collega; de rol van studenten als observator is nog niet onderzocht.