http://repub.eur.nl/res/aut/1531/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/38893/ 2013-04-01T00:00:00Z The worked example effect indicates that learning by studying worked examples is more effective than learning by solving the equivalent problems. The expertise reversal effect indicates that this is only the case for novice learners; once prior knowledge of the task is available problem solving becomes more effective for learning. These effects, however, have mainly been studied using highly structured tasks. This study investigated whether they also occur on less structured tasks, in this case, learning to reason about legal cases. Less structured tasks take longer to master, and hence, examples may remain effective for a longer period of time. Novice and advanced law students received either a description of general process steps they should take, worked examples, worked examples including the process steps, or no instructional support for reasoning. Results show that worked examples were more effective for learning than problem-solving, both for novice and advanced students, even though the latter had significantly more prior knowledge. So, a worked example effect was found for both novice and advanced students, and no evidence for an expertise-reversal effect was found with these less structured tasks. http://repub.eur.nl/res/pub/26382/ 2011-05-01T00:00:00Z Reasoning about legal cases is a complex skill that imposes a high working memory load, especially for novice students. Not only do novices lack necessary conceptual knowledge, searching through the information sources that are used during reasoning can also be assumed to impose a high additional working memory load that does not contribute to learning. Therefore, this study investigated the effects of supporting novice law students' learning by (a) providing the meaning of important concepts in the case and (b) reducing the search process by providing a condensed (relevant articles only) rather than a complete civil code. Results show that performance on a test case (for which they had to use the complete civil code) was significantly better for participants who had used the condensed civil code during learning. Performance on a conceptual knowledge post-test was significantly enhanced when students had received the concept explanations during learning. http://repub.eur.nl/res/pub/2844/ 2002-02-05T00:00:00Z 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%. 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. http://repub.eur.nl/res/pub/2851/ 2002-01-01T00:00:00Z This article is concerned with the role of so-called encapsulated knowledge and biomedical knowledge in the process of diagnosing clinical cases within and outside the medical specialist’s domain of expertise. Based on the theory of knowledge encapsulation, we predicted that subexperts (i.e., medical specialists diagnosing a clinical case outside their specialty) could not diagnose a clinical case in an encapsulated mode, and therefore they would relapse into an elaborate biomedical processing approach http://repub.eur.nl/res/pub/2852/ 2002-01-01T00:00:00Z 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. To shed light on this issue, we asked cardiologists and pulmonologists to evaluate 4 clinical cases, 2 in the domain of cardiology and 2 in pulmonology. Their task was to study, diagnose, recall, and explain the signs and symptoms of the clinical case descriptions. The cardiologists and pulmonologists alike processed cases in their specialties faster and more accurately, but recall and pathophysiological explanations did not reveal significant differences. These results suggest that medical specialists do not process cases outside their specialties in a qualitatively different mode from cases within their specialties. http://repub.eur.nl/res/pub/2861/ 2001-01-01T00:00:00Z The Purpose of this study was to examine effects of group discussion of a medical problem on the comprehension of a subsequent problem-relevant text by first year medical students. Forty-eight first-year medical students were randomly assigned to one of two conditions: The experimental group discussed a problem of blood pressure regulation, where the control group discussed a problem of vision. Subsequently, all students studied a text on the physiology of blood pressure regulation. Finally, a free recall test was administered. Numbers of propositions accurately recalled were analyzed using analysis of variance (ANOVA). Students who discussed the blood pressure regulation problem recalled 25% more from the text than those who discussed the control problem. This difference was statistically significant. The present study represented the first truly randomized trial in the ecologically valid context of a medical curriculum. It demonstrated the positive effects of problem-based tutorial group discussion on the comprehension of text. It confirmed earlier findings from laboratory studies that problem-based learning, in addition to positive emotional and motivational long-term effects well-documented in the literature, also has positive effects on learning. http://repub.eur.nl/res/pub/2875/ 2000-04-01T00:00:00Z 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. An inverted U-shaped relationship with levels of expertise was found in recall and pathophysiological protocols: 6th-year medical students remembered more information from the cases and produced more elaborated explanations for the described signs and symptoms than both other groups. The proportion of encapsulating concepts in recall and pathophysiological explanations, on the other hand, increased with levels of expertise. This pattern is similar to that found in previous studies on clinical case representations using only cases within the expert physicians' domain of expertise. Therefore, these results suggest that expert physicians process clinical case descriptions both within and outside their domain of expertise in essentially the same way. http://repub.eur.nl/res/pub/2876/ 2000-01-01T00:00:00Z 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. http://repub.eur.nl/res/pub/2886/ 1999-01-01T00:00:00Z 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 rather forms a coherent knowledge structure that can be easily accessed. This supports the hypothesis of knowledge encapsulation. http://repub.eur.nl/res/pub/2678/ 1998-01-01T00:00:00Z In this article, we describe a study in which some current ideas about illness scripts are tested. Participants at 4 levels of medical expertise were asked to describe either a prototypical patient or the clinical picture associated with a number of different diseases. It was found that participants at intermediate levels of expertise mentioned, both absolutely and relatively, many enabling conditions (patient contextual factors such as sex, age, medical history, and occupation) when asked to describe a prototypical patient with a disease, whereas the instruction to describe the clinical picture of a disease revealed a monotonic relation with expertise level. The amount of biomedical information in the descriptions decreased with increasing expertise level for both types of instruction. In addition, a positive relation was found between number of actual patients seen with a particular disease and number of enabling conditions mentioned. These results were interpreted as supportive of the present conceptualization of the illness script theory. http://repub.eur.nl/res/pub/2895/ 1998-01-01T00:00:00Z 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. The study replicated in most ways the 1993 clinical case recall study of Schmidt and Boshuizen. RESULTS: As expected, diagnostic accuracy increased with level of expertise. However, this study failed to disclose the intermediate effect in clinical case recall that was found in the original study. Instead, a positive linear relation between expertise level and case recall was found. The discrepancy resulted from more elaborate recall by experts in the present study. Constraining processing time did not effect diagnostic accuracy, but equally affected the recall performances of the participants of all expertise levels. This contrasts with the earlier finding that experts' recall is independent of processing time. CONCLUSION: Although it is unclear why the experts' case processing was more elaborate in the present study than in the earlier study, it must be concluded that expert medical knowledge is so flexibly organized that experts can easily represent clinical cases in either the encapsulated or the elaborated mode. http://repub.eur.nl/res/pub/2680/ 1997-03-01T00:00:00Z 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. Further analyses revealed that the clinical sciences subscore in the progress test explained the variations in the clinical reasoning test scores. The knowledge of the behavioural sciences subscore made a small but independent contribution. The knowledge of the biomedical sciences subscore did not have this independent effect. These outcomes are discussed in this paper from the perspective of development of medical expertise research and theory. Some educational consequences are also discussed. http://repub.eur.nl/res/pub/2684/ 1996-09-01T00:00:00Z 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. http://repub.eur.nl/res/pub/2683/ 1996-05-01T00:00:00Z The present study investigated the influence of medical expertise, case typicality, and illness script component (enabling conditions vs. consequences) on the speed of case information processing and subjective disease probabilities. It was hypothesized that expert subjects would process case information faster than nonexpert subjects, that typical information would be processed faster than atypical information, and that an interaction would be found between expertise level, typicality, and illness script: Experts were expected to be sensitive to typicality of both illness script components, while advanced students would be sensitive only to typicality of consequences. This sensitivity would also be reflected in assigned probability estimates. The data supported the predictions concerning the effects of expertise level and typicality; it was also found that expert physicians are particularly sensitive to a combination of prototypical enabling conditions and prototypical consequences. Implications of these results for the illness script theory are discussed. http://repub.eur.nl/res/pub/2681/ 1996-01-01T00:00:00Z http://repub.eur.nl/res/pub/2691/ 1995-01-01T00:00:00Z How does the knowledge of the medical student, clerk, intern, and registrar develop and how do formal and informal, classroom and experiential learning contribute to this process? These questions were investigated in two experiments, focusing on knowledge restructuring rather than knowledge acquisition. The experiments showed that practical experience plays an important role in knowledge restructuring. The process was, however, not as continuous as was expected. Notably, advanced students appeared to have considerable knowledge about conditions in patients and their environments that can predispose to disease. However, they rarely applied it in clinical reasoning. Contrary to what was found in expert physicians, advanced students' knowledge about enabling conditions seems not yet to be integrated into their other knowledge about diseases. http://repub.eur.nl/res/pub/2705/ 1993-09-01T00:00:00Z http://repub.eur.nl/res/pub/38055/ 1993-05-01T00:00:00Z In two experiments, the effects of level of medical expertise and study time on free recall of a clinical case were assessed. In Experiment 1, a nonmonotonic relationship between level of expertise and recall was found: Subjects of intermediate levels of expertise remembered more information from the case than both experts and novices. This "intermediate effect" disappeared, however, when study time was restricted. Analysis of post hoc acquired protocols of pathophysiological knowledge active during case processing suggested that this phenomenon could be attributed to the nature of the pathophysiological knowledge mobilized to comprehend the case. In Experiment 2, this assumption was directly tested by priming relevant pathophysiological knowledge for either a short or a longer period, before enabling subjects to study the case briefly. Free-recall data confirmed and extended the results of Experiment 1. Again, an intermediate effect was found; this time, however, it was generated experimentally. The findings were interpreted in terms of qualitative differences in the nature of the knowledge structures underlying performance between novices, advanced students, and medical experts: Experts use knowledge in an encapsulated mode while comprehending a case, whereas students use elaborated knowledge. http://repub.eur.nl/res/pub/2708/ 1993-01-01T00:00:00Z http://repub.eur.nl/res/pub/2711/ 1993-01-01T00:00:00Z http://repub.eur.nl/res/pub/2714/ 1993-01-01T00:00:00Z http://repub.eur.nl/res/pub/2715/ 1993-01-01T00:00:00Z http://repub.eur.nl/res/pub/2768/ 1993-01-01T00:00:00Z http://repub.eur.nl/res/pub/2717/ 1992-01-01T00:00:00Z http://repub.eur.nl/res/pub/2719/ 1992-01-01T00:00:00Z In two studies the role of biomedical knowledge in the diagnosis of clinical cases was explored. Experiment 1 demonstrated a decrease in the use of biomedical knowledge with increasing expertise. This result appeared to be at variance with some findings reported in the literature (e.g., Lesgold, 1984), but supported those of others (e.g., Patel, Evans, & Groen, 1989). In Experiment 2, three possible explanations for this phenomenon were investigated: (1) rudimentation of biomedical knowledge, (2) inertia, and (3) encapsulation of biomedical knowledge under higher order concepts. Using a combined think-aloud and post-hoc explanation methodology, it was shown that experts have more in-depth biomedical knowledge than novices and subjects at intermediate levels of expertise. The findings generally support a three-stage model of expertise development in medicine consisting of acquisition of biomedical knowledge, practical experience, and integration of theoretical and experientall knowledge resulting in knowledge encapsulation. http://repub.eur.nl/res/pub/2722/ 1990-01-01T00:00:00Z A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as 'illness scripts,' contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis. http://repub.eur.nl/res/pub/2781/ 1990-01-01T00:00:00Z http://repub.eur.nl/res/pub/2782/ 1990-01-01T00:00:00Z http://repub.eur.nl/res/pub/2783/ 1990-01-01T00:00:00Z http://repub.eur.nl/res/pub/2729/ 1988-01-01T00:00:00Z http://repub.eur.nl/res/pub/2731/ 1988-01-01T00:00:00Z http://repub.eur.nl/res/pub/2736/ 1987-01-01T00:00:00Z