Clinical reasoning in pharmacy: What do eye movements and verbal protocols tell us about the processing of a case task?

This study investigates pharmacy students' reasoning while solving a case task concerning an acute patient counselling situation in a pharmacy. Participants' (N = 34) reasoning processes were investigated with written tasks utilizing eye-tracking in combination with verbal protocols. The case was presented in three pages, each page being followed by written questions.

Conceptual changes for and during working life.

Rapid and radical changes in science, technology and society may result in new scientific concepts and new workplace practices, which require fundamental restructuring of prior knowledge. Over the years a noteworthy body of research has documented the processes of conceptual change, the learning mechanisms involved, and the instructional methods and strategies that can promote conceptual changes. This research, however, focused young learners in school settings.

To guide or to follow? Teaching visual problem solving at the workplace.

Visual problem solving is essential to highly visual and knowledge-intensive professional domains such as clinical pathology, which trainees learn by participating in relevant tasks at the workplace (apprenticeship). Proper guidance of the visual problem solving of apprentices by the master is necessary. Interaction and adaptation to the expertise level of the learner are identified as key ingredients of this guidance.

Expertise in clinical pathology: combining the visual and cognitive perspective.

Expertise studies in the medical domain often focus on either visual or cognitive aspects of expertise. As a result, characteristics of expert behaviour are often described as either cognitive or visual abilities. This study focuses on both aspects of expertise and analyses them along three overarching constructs: (1) encapsulations, (2) efficiency, and (3) hypothesis testing.

Expertise under the microscope: processing histopathological slides.

Objectives: Although the obvious goal of training in clinical pathology is to bring forth capable diagnosticians, developmental stages and their characteristics are unknown. This study therefore aims to find expertise-related differences in the processing of histopathological slides using a combination of eye tracking data and verbal data.

Methods: Participants in this study were 13 clinical pathologists (experts), 12 pathology residents (intermediates) and 13 medical students (novices).

The Handover Toolbox: a knowledge exchange and training platform for improving patient care.

Background: Safe and effective patient handovers remain a global organisational and training challenge. Limited evidence supports available handover training programmes. Customisable training is a promising approach to improve the quality and sustainability of handover training and outcomes.

Handover training: does one size fit all? The merits of mass customisation.

Background: Experts have recommended training and standardisation as promising approaches to improve handovers and minimise the negative consequences of discontinuity of care. Yet the content and delivery of handover training have been only superficially examined and described in literature.

Objective: The aim of this study was to formulate recommendations for effective handover training and to examine whether standardisation is a viable approach to training large numbers of healthcare professionals.

When only the real thing will do: junior medical students' learning from real patients.

Objectives: This study aimed to explore how medical students experience contacts with real patients and what they learn from them.

Methods: We carried out a post hoc, single-group study in one teaching sector of a 5-year, problem-based, horizontally integrated, outcome-based and community-oriented undergraduate programme, in which students lacked clinical exposure in the pre-clerkship phase. Subjects comprised five cohorts of students on their first clerkships.

Scripts and clinical reasoning.

Context: Each clinical encounter represents an amazing series of psychological events: perceiving the features of the situation; quickly accessing relevant hypotheses; checking for signs and symptoms that confirm or rule out competing hypotheses, and using related knowledge to guide appropriate investigations and treatment.

Objective: Script theory, issued from cognitive psychology, provides explanations of how these events are mentally processed. This essay is aimed at clinical teachers who are interested in basic sciences of education.

A comparison of learning strategies, orientations and conceptions of learning of first-year medical students in a traditional and an innovative curriculum.

Introduction: Students adapt their learning strategies, orientations and conceptions to differences in the learning environment. The new curriculum of the Faculty of Medicine, University of Peradeniya, Sri Lanka, which commenced in 2005, puts greater emphasis on student-centred learning. The aim of this study was to compare the learning strategies, orientations and conceptions measured by means of a validated Sri Lankan version of the Inventory of Learning Styles (ILS) at the end of the first academic year for a traditional curriculum student group and a new curriculum student group.

The cognitive validity of the Script Concordance Test: a processing time study.

Background: According to the theory on which the Script Concordance Test (SCT) is based, scripts contain expectations on features that are associated with each illness and about the range of values that are typical, atypical, or incompatible.

Purpose: To document the construct validity of the SCT, we investigated the theory prediction that once a script is activated, new incoming information (e.g.

Students' opinions about their preparation for clinical practice.

Introduction: There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre-clinical to clinical training causes problems.

Objectives: To seek quantitative verification of qualitative findings from an earlier focus group study on problems medical students encounter when entering the clinical phase of undergraduate training.

General competencies of problem-based learning (PBL) and non-PBL graduates.

Introduction: Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies.

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

Introduction: There 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.

The importance of active involvement in learning: a qualitative study on learning results and learning processes in different traineeships.

Introduction: In order to gain more insight into learning in different traineeships we sought students' opinions on their experiences.

Method: 24 students of Maastricht University, the Netherlands, were interviewed: 8 medical students, and 16 students in the mental health science programme of the Faculty of Health Sciences (8 research trainees (MHS-res.) and 8 trainees in mental health care practice (MHS-prac.

The robustness of medical expertise: clinical case processing by medical experts and subexperts.

Medical specialists confronted with problems in their domain of expertise do not rely on intentional causal reasoning, using explicit principles or rules. Rather, reasoning is an automatic process, using knowledge in an encapsulated mode. Less clear is what happens when medical specialists encounter problems outside their specialties.

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.

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

Four actors were requested to perform Sartre's 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%.

Medical informatics and problem-based learning.

Problem-based learning (PBL) is an educational method that can be considered as an alternative to the traditional, discipline-based, approach to teaching. In this paper the characteristics of both approaches are discussed and compared. Some background knowledge concerning the principles that determine the success of instructional methods is presented.

Do short cases elicit different thinking processes than factual knowledge questions do?

Purpose: To assess whether case-based questions elicit different thinking processes from factual knowledge-based questions.

Method: 20 general practitioners (GPs) and 20 students solved case-based questions and matched factual knowledge-based questions while thinking aloud. Verbatim protocols were analysed.

Knowledge Encapsulation and the Intermediate Effect.

The present study explored the role of so-called encapsulated knowledge in diagnosing clinical cases outside the expert physicians' domain of expertise. Neurologists and 2nd-year and 6th-year medical students were required to diagnose, recall, and explain the signs and symptoms of two cardiological and two pulmonological clinical case descriptions. Our experiment showed that neurologists diagnosed these clinical cases faster and more accurately than 2nd-year and 6th-year medical students.

Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.

Medical diagnosis is a categorization task that allows physicians to make predictions about features of clinical situations and to determine appropriate course of action. The script concept, which first arose in cognitive psychology, provides a theoretical framework to explain how medical diagnostic knowledge can be structured for diagnostic problem solving. The main characteristics of the script concept are pre-stored knowledge, values acceptable or not acceptable for each illness attribute, and default values.

A failure to reproduce the intermediate effect in clinical case recall.

Purpose: To investigate the differences between experts, intermediates, and novices in diagnosing and representing clinical cases under various time constraints.

Method: Second-, fourth-, and sixth-year medical students, and internists studied, diagnosed, and recalled four clinical cases from internal medicine. Participants were allowed to study each case for either 3 minutes, 1 minute 15 seconds, or 30 seconds.

Measuring knowledge and clinical reasoning skills in a problem-based curriculum.

The purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the Progress Test were compared with their scores on a Clinical Reasoning Tests. Both the Progress Test and the Clinical Reasoning Test revealed the same pattern of increasing scores over the years, and had a high intercorrelation.