http://repub.eur.nl/res/aut/3463/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/26619/ 2011-05-01T00:00:00Z The testing effect (i.e., long-term memory is improved more by intermediate testing than by restudying the information) has been studied using a variety of materials. However, almost all testing effect studies to date have used purely verbal materials such as word pairs, facts and prose passages. The testing effect has not yet been established using symbol-word pairs. In the present study symbol-word pairs were used as to-be-learned materials to demonstrate the generalisability of the testing effect to symbol learning. The results showed that there was no difference in final memory-test performance after a retention interval of 5 minutes, but after a retention interval of a week tested pairs were retained better than repeatedly studied pairs. Hence, the present research suggests that the testing effect can also be obtained in symbol learning. http://repub.eur.nl/res/pub/27329/ 2010-09-15T00:00:00Z Context: Diagnostic errors have been associated with bias in clinical reasoning. Empirical evidence on the cognitive mechanisms underlying biases and effectiveness of educational strategies to counteract them is lacking. Objectives: To investigate whether recent experience with clinical problems provokes availability bias (overestimation of the likelihood of a diagnosis based on the ease with which it comes to mind) resulting in diagnostic errors and whether reflection (structured reanalysis of the case findings) counteracts this bias. Design, Setting, and Participants: Experimental study conducted in 2009 at the Erasmus Medical Centre, Rotterdam, with 18 first-year and 18 second-year internal medicine residents. Participants first evaluated diagnoses of 6 clinical cases (phase 1). Subsequently, they diagnosed 8 different cases through nonanalytical reasoning, 4 of which had findings similar to previously evaluated cases but different diagnoses (phase 2). These 4 cases were subsequently diagnosed again through reflective reasoning (phase 3). Main Outcome Measures: Mean diagnostic accuracy scores (perfect score, 4.0) on cases solved with or without previous exposure to similar problems through nonanalytical (phase 2) or reflective (phase 3) reasoning and frequency that a potentially biased (ie, phase 1) diagnosis was given. Results: There were no main effects, but there was a significant interaction effect between "years of training" and "recent experiences with similar problems." Results consistent with an availability bias occurred for the second-year residents, who scored lower on the cases similar to those previously encountered (1.55; 95% confidence interval [CI], 1.15-1.96) than on the other cases (2.19; 95% CI, 1.73-2.66; P=.03). This pattern was not seen among the first-year residents (2.03; 95% CI, 1.55-2.51 vs 1.42; 95% CI, 0.92-1.92; P=.046). Second-year residents provided the phase 1 diagnosis more frequently for phase 2 cases they had previously encountered than for those they had not (mean frequency per resident, 1.44; 95% CI, 0.93-1.96 vs 0.72; 95% CI, 0.28-1.17; P=.04). A significant main effect of reasoning mode was found: reflection improved the diagnoses of the similar cases compared with nonanalytical reasoning for the second-year residents (2.03; 95% CI, 1.49-2.57) and the first-year residents (2.31; 95% CI, 1.89-2.73; P=.006). Conclusion: When faced with cases similar to previous ones and using nonanalytic reasoning, second-year residents made errors consistent with the availability bias. Subsequent application of diagnostic reflection tended to counter this bias; it improved diagnostic accuracy in both first- and second-year residents. http://repub.eur.nl/res/pub/27931/ 2010-03-30T00:00:00Z Contrary to what common sense makes us believe, deliberation without attention has recently been suggested to produce better decisions in complex situations than deliberation with attention. Based on differences between cognitive processes of experts and novices, we hypothesized that experts make in fact better decisions after consciously thinking about complex problems whereas novices may benefit from deliberation-without-attention. These hypotheses were confirmed in a study among doctors and medical students. They diagnosed complex and routine problems under three conditions, an immediate-decision condition and two delayed conditions: conscious thought and deliberation-without-attention. Doctors did better with conscious deliberation when problems were complex, whereas reasoning mode did not matter in simple problems. In contrast, deliberation-without-attention improved novices' decisions, but only in simple problems. Experts benefit from consciously thinking about complex problems; for novices thinking does not help in those cases. http://repub.eur.nl/res/pub/16754/ 2009-09-01T00:00:00Z Background: Constructivist views of learning have brought conceptions of learning to attention again. Conceptions are considered important determinants of effective learning. Students can differ in their conceptions depending on their educational experience. Aims: The present study investigated students' conceptions of constructivist learning. Do students with greater experience in their academic programme differ in their conceptions of constructivist learning compared to students with less experience? In addition, to what extent are conceptions of constructivist learning different in a conventional, lecture-based curriculum compared to a constructivist, problem-based learning curriculum? Samples: Three groups (i.e. first-year, second-year, and third-year students) in two different curricula (i.e. conventional, lecture-based and constructivist, problem-based) were tested. Methods: A cross-sectional design was used. Students' conceptions of constructivist activities (i.e. knowledge construction, cooperative learning, self-regulation, use of authentic problems, self-perceived inability to learn, and motivation to learn) were measured by a questionnaire. Data were analyzed using a two-way multivariate analysis of variance (MANOVA). Results: A significant difference in questionnaire's scores between year 1 and year 2 (but not between year 2 and 3) was found with respect to conceptions about knowledge construction, self-regulation, and the use of authentic problems, but not for cooperative learning and motivation to learn. For self-perceived inability, an interaction effect was found. Furthermore, results showed significant differences between both curriculum groups on all dependent measures. Conclusions: Differences in conceptions can be perceived between students who enter a new learning programme (i.e. higher education) and students who already have one year of experience in higher education. Among students with more than one year of educational experience, differences disappear. Furthermore, this study shows that the learning environment can make a difference with respect to students' conceptions of constructivist learning activities. http://repub.eur.nl/res/pub/16961/ 2009-06-01T00:00:00Z This paper examines the transferability of successful cueing approaches from text and static visualization research to animations. Theories of visual attention and learning as well as empirical evidence for the instructional effectiveness of attention cueing are reviewed and, based on Mayer’s theory of multimedia learning, a framework was developed for classifying three functions for cueing: (1) selection—cues guide attention to specific locations, (2) organization—cues emphasize structure, and (3) integration—cues explicate relations between and within elements. The framework was used to structure the discussion of studies on cueing in animations. It is concluded that attentional cues may facilitate the selection of information in animations and sometimes improve learning, whereas organizational and relational cueing requires more consideration on how to enhance understanding. Consequently, it is suggested to develop cues that work in animations rather than borrowing effective cues from static representations. Guidelines for future research on attention cueing in animations are presented. http://repub.eur.nl/res/pub/15347/ 2009-01-01T00:00:00Z To examine how visual attentional resources are allocated when learning from a complex animation about the cardiovascular system, eye movements were registered in the absence and presence of visual cues. Cognitive processing was assessed using cued retrospective reporting, whereas comprehension and transfer tests measured the quality of the constructed representation. Within the framework of Cognitive Load Theory, visual cues highlighting the subsystems of the heart were hypothesized to guide attention, reduce visual search and extraneous cognitive load, and enhance learning. As predicted, learners looked more often and longer at cued parts. However, we found no effects of cueing on visual search and cognitive load. With respect to cognitive processing, performance differences were found on the number of statements in the learners' verbal reports. These findings suggest that visual cueing can guide attention in an animation, but other factors are also important in determining the effectiveness of visual cues on learning. http://repub.eur.nl/res/pub/14250/ 2008-12-01T00:00:00Z This study investigated the role of self-directed learning (SDL) in problem-based learning (PBL) and examined how SDL relates to self-regulated learning (SRL). First, it is explained how SDL is implemented in PBL environments. Similarities between SDL and SRL are highlighted. However, both concepts differ on important aspects. SDL includes an additional premise of giving students a broader role in the selection and evaluation of learning materials. SDL can encompass SRL, but the opposite does not hold. Further, a review of empirical studies on SDL and SRL in PBL was conducted. Results suggested that SDL and SRL are developmental processes, that the "self" aspect is crucial, and that PBL can foster SDL. It is concluded that conceptual clarity of what SDL entails and guidance for both teachers and students can help PBL to bring forth self-directed learners. http://repub.eur.nl/res/pub/15662/ 2008-12-01T00:00:00Z PURPOSE: While diagnosing problems, physicians frequently switch from nonanalytical to reflective reasoning. The conditions inducing doctors to reflect are largely unknown. The authors investigated whether a shift to reflection occurs when physicians perceive a case as problematic, and its effects on diagnostic accuracy. METHOD: The authors conducted two within-subjects experiments in Brazilian teaching hospitals in 2007. In Experiment 1, 20 medical residents diagnosed the same 10 clinical cases under two experimental conditions: a nonproblematic versus a problematic context. (The latter was created by informing participants that other physicians failed to diagnose the case previously.) In addition, participants judged whether a set of medical concepts were related to the case, and response time was measured. In Experiment 2, 18 residents diagnosed two cases while thinking aloud. The authors hypothesized that a case perceived as problematic would trigger reflection, leading to higher diagnostic accuracy, lower response times for recognizing concepts (Experiment 1), more time for diagnosing, and more elaborate think-aloud protocols (Experiment 2). RESULTS: Experiment 1: Accuracy of diagnosis was significantly higher within the problematic context, and participants were faster in deciding whether concepts were related to the case. The same cases were evaluated as more complex and less frequently seen. Experiment 2: Time spent on diagnosis, memory for case findings, and inferences derived from the cases were significantly higher within the problematic context. CONCLUSIONS: A context perceived as problematic induced reflection in the participating clinicians, as indicated by lower response times, more time spent on diagnosis, and more elaborate protocols. Reflective reasoning comprised more careful analysis of findings and alternative diagnoses, and increased diagnostic accuracy. http://repub.eur.nl/res/pub/14116/ 2008-11-21T00:00:00Z In this study, the longitudinal relation between deliberate practice and performance in chess was examined using a linear mixed models analysis. The practice activities and performance ratings of young elite chess players, who were either in, or had dropped out of the Dutch national chess training, were analysed since they had started playing chess seriously. The results revealed that deliberate practice (i.e. serious chess study alone and serious chess play) strongly contributed to chess performance. The influence of deliberate practice was not only observable in current performance, but also over chess players' careers. Moreover, although the drop-outs' chess ratings developed more slowly over time, both the persistent and drop-out chess players benefited to the same extent from investments in deliberate practice. Finally, the effect of gender on chess performance proved to be much smaller than the effect of deliberate practice. This study provides longitudinal support for the monotonic benefits assumption of deliberate practice, by showing that over chess players' careers, deliberate practice has a significant effect on performance, and to the same extent for chess players of different ultimate performance levels. The results of this study are not in line with critique raised against the deliberate practice theory that the factors deliberate practice and talent could be confounded. http://repub.eur.nl/res/pub/14908/ 2008-09-01T00:00:00Z This special issue on the effects of constructivist learning environments is based on a symposium organized during the last annual meeting of the American Educational Research Association in Chicago. The studies in this issue not only provide an overview of the multitude of forms a constructivist learning environment can take, they also provide the reader with an overview of recent advances in this domain of research. The present discussion article provides a critical reflection on the studies in this special issue and tries to identify their prospects and limitations. http://repub.eur.nl/res/pub/17789/ 2008-09-01T00:00:00Z The present study investigated relationships between students' conceptions of constructivist learning on the one hand, and their regulation and processing strategies on the other hand. Students in a constructivist, problem-based learning curriculum were questioned about their conceptions of knowledge construction and self-regulated learning, as well as their beliefs regarding their own (in)ability to learn and motivation to learn. Two hypothesized models were tested within 98 psychology students, using a structural equation modelling approach: The first model implemented regulation and processing variables of the Inventory of Learning Styles [ILS, Vermunt (Learning styles and regulation of learning in higher education - towards process-oriented instruction in autonomous thinking, 1992)], the second model of the Motivated Strategies for Learning Questionnaire [MSLQ, Pintrich and de Groot (Journal of Educational Psychology, 82, 33-40, 1990)]. Results showed that structural relations exist between conceptions of constructivist learning and regulation and processing strategies. Furthermore, students who express doubt with regard to their own learning capacities are at risk for adopting an inadequate regulation strategy. A three-tiered structure of conceptual, controlling, and operational level appeared valid for the MSLQ variables, but not entirely for those of the ILS. http://repub.eur.nl/res/pub/17795/ 2008-05-01T00:00:00Z Context: Previous studies have shown that an initial diagnostic hypothesis biases automatic information processing. It is unclear if an initial hypothesis has a similar effect on analytic information processing. Our first objective was to study the effect of an initial diagnostic hypothesis on analytic processing. Our second objective was to assess the effect of clinical experience on analytic processing by evaluating the effect of clinical frequency and urgency of an alternative diagnosis on diagnosis selection. Methods: During a 12-minute objective structured clinical examination station, 19 subspecialty medical residents diagnosed the cause of 3 clinical presentations: dyspnoea; headache, and chest pain. Subjects were randomly allocated cases for which the suggested initial hypothesis was either correct or incorrect. For cases with an incorrect initial hypothesis, the alternative diagnoses varied in the frequency with which they are encountered in clinical practice, and their clinical urgency, relative to the initial diagnostic hypothesis. Results: All correct initial hypotheses were retained, compared with 10.9% of incorrect hypotheses. All cases with a correct initial hypothesis were diagnosed correctly, compared with 65.2% of cases with an incorrect hypothesis (risk ratio 1.5 [95% confidence interval 1.2-1.9], P = 0.02). Clinical frequency and urgency were not associated with alternative diagnosis selection. Discussion: Our results suggest that an initial diagnostic hypothesis biases analytic processing. The data used to reject an initial hypothesis appear to drive selection of an alternative hypothesis. Further studies aimed at finding strategies for increasing the likelihood of generating a correct initial hypothesis or debiasing an initial hypothesis are needed. http://repub.eur.nl/res/pub/12095/ 2008-04-10T00:00:00Z The question how animations should be designed so that learning is optimised, is still under discussion. Animations are often cognitively very demanding, resulting in decreased learning outcomes. In this study, we tried to prevent cognitive overload and foster learning by focusing the learners’ attention to one element (i.e. process) of an animation using a cueing technique. Psychology students viewed an animation of the cardiovascular system and were subsequently given a comprehension test and a transfer test. One group studied the animation without a visual cue, while for another group a visual cue was added to the animation. Results indicated that cueing not only enhanced comprehension and transfer performance for cued information, but also for uncued information. It is concluded that cueing can be used as a technique to improve learning from an animation. Results are interpreted in terms of cognitive load theory (CLT). http://repub.eur.nl/res/pub/17797/ 2008-03-01T00:00:00Z Diagnosing begins by generating an initial diagnostic hypothesis by automatic information processing. Information processing may stop here if the hypothesis is accepted, or analytical processing may be used to refine the hypothesis. This description portrays analytic processing as an optional extra in information processing, leading us to questions if it actually contributes to diagnostic performance, and whether it heralds expertise or a lack of expertise. When we encourage students to solve problems using analytic processing-as is our teaching tradition-are we helping or hindering diagnostic performance and the evolution of expertise? The relationship between information processing, expertise and diagnostic performance is complex. At least four additional variables affect this relationship: context; task difficulty; clinical domain; and experimental conditions. Therefore, we cannot make a generic statement about the relationship between processing, expertise and performance-we can only say that when given a problem containing certain information, of certain difficulty, in a certain clinical domain and under certain experimental conditions, analytic processing appears to improve diagnostic performance and be a feature of expertise. No single processing strategy is a panacea. Training students in both automatic and analytic processing offers flexibility in information processing and better prepares them for the wide variety of problems that they may encounter. http://repub.eur.nl/res/pub/17800/ 2007-12-01T00:00:00Z Context: For over 30 years, research has focused on the question of how knowledge is organised in the doctor's mind. The development of encapsulated knowledge, followed by the formation of illness scripts, may both be considered as important stages in the development of medical expertise. Methods: This paper reviews research on the knowledge encapsulation and illness script hypotheses since their initial formulation. Findings in support of these views of expertise development are reported and conflicting data are discussed. Results: A great deal of empirical data have been collected over the years to investigate the view that, through clinical experiences, biomedical knowledge becomes encapsulated and eventually integrated into illness scripts. The findings of most studies, which have used various techniques to probe the ways by which students and doctors mentally represent clinical cases, are in line with this view of expertise development. However, there is still debate concerning the role of biomedical knowledge in clinical case processing. Conclusions: To facilitate the development of expertise in medical school, it is important to teach the basic sciences in a clinical context, and to introduce patient problems early in the curriculum in order to support the processes of encapsulation and illness script formation. In addition, during clerkships ample time should be devoted to enabling reflection on patient problems with peers and expert doctors. http://repub.eur.nl/res/pub/17801/ 2007-12-01T00:00:00Z Context: Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form of clinical reasoning is suggested to combine both modes. Conditions leading doctors to shift from the usual mode of non-analytical reasoning to reflective reasoning have not been identified. This paper reports a study aimed at exploring these conditions by investigating the effects of ambiguity of clinical cases on clinical reasoning. Methods: Participants were 16 internal medicine residents in the Brazilian state of Ceará. They were asked to diagnose 20 clinical cases and recall case information. The independent variable was the degree of ambiguity of clinical cases, with 2 levels: straightforward (i.e. non-ambiguous) and ambiguous. Dependent variables were processing time, diagnostic accuracy and proposition per category recalled. Data were analysed using a repeated measures design. Results: Participants processed straightforward cases faster and more accurately than ambiguous ones. The proportion of text propositions recalled was significantly lower (t[15] = 2.29, P = 0.037) in ambiguous cases, and an interaction effect between case version and proposition category was also found (F[5, 75] = 4.52, P = 0.001, d = 0.232, observed power = 0.962). Furthermore, participants recalled significantly more literal propositions from the ambiguous cases than from the straightforward cases (t[15] = 2.28, P = 0.037). Conclusions: Ambiguity of clinical cases was shown to lead residents to switch from automatic to reflective reasoning, as indicated by longer processing time, and more literal propositions recalled in ambiguous cases. http://repub.eur.nl/res/pub/17808/ 2007-12-01T00:00:00Z Context: Most studies on medical expertise research have focused on diagnostic performance, whereas patient management has been largely ignored. According to knowledge encapsulation theory, applying encapsulated knowledge is a characteristic of expert doctors' diagnostic reasoning, but it is unclear whether or not encapsulated knowledge also plays a prominent role when processing a clinical case with a management focus. Methods: The participants were 40 medical students (20 in Year 4 and 20 in Year 6) and 20 expert doctors (internists). Participants were asked to study the cases with either a diagnostic (Dx) or a management (Mx) focus. Subsequently, participants were asked to write down what they remembered from the case. Results: In both conditions, experts recalled fewer propositions and used more high-level inferences than medical students. Furthermore, they processed the cases faster and more accurately than medical students, but no significant difference between Mx and Dx conditions was found. Year 4 students also showed no significant differences in recall and processing speed between conditions. By contrast, Year 6 students recalled more in a Dx than in an Mx condition, but there was no significant difference in processing speed between conditions. Conclusions: In both conditions, findings indicate that the experts' and Year 4 students' performance was not affected by processing focus. The fact that only Year 6 students were affected by processing focus might be explained by the assumption that their diagnostic knowledge and management knowledge are not fully integrated yet, a process that has already taken place in the expert's knowledge structure. http://repub.eur.nl/res/pub/9342/ 2006-04-27T00:00:00Z An experiment was conducted in the context of a problem-based learning course to investigate the influence of a learning-goal-free problem scenario on the quality and quantity of individual study. In half of the tutorial groups, the problem scenario was constructed in such a way that it provided useful learning issues (goal-specified condition), whereas in the other half of the tutorial groups, the problem scenario did not provide learning issues (goal-free condition). It was demonstrated that students in the goal-free condition read more articles, studied longer, and spent more time reporting the studied literature than their peers in the goal-specified condition. These findings suggest that the use of goal-free problems has a positive effect on the students’ individual study and the extensiveness of the tutorial group meeting. http://repub.eur.nl/res/pub/9313/ 2005-05-01T00:00:00Z http://repub.eur.nl/res/pub/9258/ 2005-01-01T00:00:00Z In this study, the authors examined the influence of prior knowledge activation on information processing by means of a prior knowledge activation procedure adopted from the read–generate paradigm. On the basis of cue-target pairs, participants in the experimental groups generated two different sets of items before studying a relevant list. Subsequently, participants were informed that they had to study the items in the list and that they should try to remember as many items as possible. The authors assessed the processing time allocated to the items in the list and free recall of those items. The results revealed that the experimental groups spent less time on items that had already been activated. In addition, the experimental groups outperformed the control group in overall free recall and in free recall of the activated items. Between-group comparisons did not demonstrate significant effects with respect to the processing time and free recall of nonactivated items. The authors interpreted these results in terms of the discrepancy reduction model of regulating the amount of processing time allocated to different parts of the list. http://repub.eur.nl/res/pub/2830/ 2004-10-01T00:00:00Z BACKGROUND: Previous studies on the development of medical expertise, predominantly using measures of free recall and pathophysiological explanations, have shown ambiguous results concerning the relationship between expertise level and encapsulated knowledge. PURPOSE: To investigate differences in clinical case representations by medical students and family doctors. In particular, the role of encapsulated knowledge in clinical case representations was investigated. METHODS: Year 2 (n = 15) and Year 4 (n = 15) medical students and family doctors (n = 15) were instructed to study carefully 2 case descriptions associated with a particular disease. After each case description participants were asked to provide a diagnosis. Subsequently, they judged whether or not a target item presented on a computer screen was related to the case description. Target items consisted of literally stated signs and symptoms, inferred encapsulated items and filler items. RESULTS: Family doctors provided more accurate diagnoses than Year 2 and Year 4 medical students. Furthermore, family doctors were faster and made fewer errors in judging the relatedness of all item types than Year 2 and 4 medical students. In particular, family doctors showed their best performance on the encapsulated items. CONCLUSIONS: The present study showed that encapsulated knowledge becomes increasingly more prominent as expertise develops. For experienced doctors, encapsulated concepts function as the most important building blocks of clinical case representations. http://repub.eur.nl/res/pub/10790/ 2004-07-01T00:00:00Z Two experiments were conducted to determine the mechanism underlying the spacing effect in free-recall tasks. Participants were required to study a list containing once-presented words as well as massed and spaced repetitions. In both experiments, presentation background at repetition was manipulated. The results of Experiment 1 demonstrated that free recall was higher for massed items repeated in a different context than for massed items repeated in the same context, whereas free recall for spaced items was higher when repeated in the same context. Furthermore, a spacing effect was shown for words repeated in the same context, whereas an attenuated spacing effect was revealed for words repeated in a different context. These findings were replicated in Experiment 2 under a different presentation background manipulation. Both experiments seem to be most consistent with a model that combines the contextual variability and the study-phase retrieval mechanism to account for the spacing effect in free-recall tasks. http://repub.eur.nl/res/pub/10791/ 2004-06-01T00:00:00Z BACKGROUND: Based on cognitive psychological research, a number of theoretical frameworks have been put forward to describe the structure of experts' medical knowledge and to explain experts' case-processing. PURPOSE: To provide evidence for the theory of knowledge encapsulation, which states that medical knowledge constitutes of interlinked biomedical and clinical knowledge. METHODS: Fourth-year medical students, clerks and medical experts evaluated six case descriptions, consisting of laboratory data either with or without a clinical context. For each case description, the participants were required to study the case, to formulate a diagnosis, and to write down everything they could remember of the case. RESULTS: When the laboratory data were not embedded within a clinical context, medical experts' case-processing increased and their diagnostic accuracy became worse. Furthermore, laboratory data recall of medical experts was more elaborate in cases where the laboratory data were presented without a clinical context. Similar results were obtained for students and clerks. CONCLUSIONS: The findings are only partially consistent with a prediction made by the theory of knowledge encapsulation. Further research, using a different paradigm than the traditionally used method of free recall, is required to unearth whether medical experts use qualitatively different knowledge structures than novices while solving cases. http://repub.eur.nl/res/pub/2829/ 2004-01-01T00:00:00Z This study was conducted to test the hypothesis whether computer anxiety has a hindering effect on experienced computer users while performing complex computer tasks. Participants were 75 third-year psychology students taking a Delphi programming course. Prior to the course, a computer anxiety scale was filled in. Computer performance was measured in four different ways: through final course grade, predicted final grade, self-perceived programming skills, and through observed behavior while programming a computer application. The results showed that computer anxiety was found to correlate with the students’ prediction of their final grade and with the perception of their own computer skills, but had no effect on actual performance as measured by the final course grade. Furthermore, there was no significant effect of computer anxiety on behavioral measures while students were programming a computer application. The findings point into the direction of a “threshold effect”, where anxiety only hinders performance when this anxiety is sufficiently severe or when the context in which the task to be executed on a computer is ambiguous. http://repub.eur.nl/res/pub/2833/ 2004-01-01T00:00:00Z This special issue is dedicated to recentdevelopments within cognitive load theory (CLT)and identifies some instructional implicationsof the interaction between informationstructures and cognitive architecture. Thepresent article discusses the different studiesin this special issue. An important conclusionis that recent CLT research recognizes thelearners'' level of expertise as an importantfactor mediating the relation between cognitivearchitecture, information structures, andlearning outcomes. In this context, we discussthe role of expertise in CLT research and therole of CLT in expertise research. Based onthis discussion, the use of CLT as a tool todevelop expertise is identified as a verypromising approach. 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/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.