http://repub.eur.nl/res/aut/3962/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/17787/ 2008-12-01T00:00:00Z Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers consider the same competencies important for clerkship grading, a survey that consisted of 21 different student characteristics was administered to clinical teachers. Two independent factor analyses using structural equation modeling were conducted to abstract underlying latent relationships among the different student characteristics and to define a clinical competence profile for daily performance of students on the wards and clerkship grading. Differences between the degree of importance for student daily ward performance and clerkship grading are considered and discussed. The results of the survey indicate that the degree of importance of competencies are rated different for daily performance of students on the wards and clerkship grades. Competencies related to the diagnostic process are more important for clerkship grading, whereas interpersonal skills, professional qualities, and motivation are more important for daily ward performance. It is concluded that the components of clinical competence considered important for adequate performance are not necessarily in alignment with what is required for grading. Future research should focus on an explanation why clinical educators think differently about the importance of competencies for student examination in contrast to what is required for adequate daily performance on the wards. http://repub.eur.nl/res/pub/36786/ 2007-08-01T00:00:00Z Before the 1970s, research into the development of clinical competence was mainly focused on general problem-solving abilities. The scope of research changed when Elstein and colleagues discovered that individual ability to solve clinical problems varies considerably across cases. It was concluded that problem solving abilities are highly dependent on domain-specific knowledge rather than on general problem solving skills. Elstein called this phenomenon "case specificity." The finding of content specificity will be contrasted with the existence of a general clinical problem solving ability, and the relationship between preclinical knowledge and a problem solving ability will be investigated. A correlation matrix was calculated with clerkship final scores from 10 disciplines to examine the magnitude of the interrelations. A confirmatory factor analysis was applied to the corresponding covariances using structural equation modeling to investigate whether scores on finals shared any common variance across clerkships. Finally, two additional models were tested to examine the nature of the relationship between preclinical knowledge and problem solving. Low to moderate correlations across clerkship disciplines were found, supporting the original findings of content specificity. Further investigation showed that in addition to specific knowledge, a general, content-independent ability is needed to perform on these examinations. Clinical competence, as measured in this study, is based on a combination of specific preclinical knowledge and a problem-solving ability. Case specificity fits perfectly well in this interactional perspective on clinical problem solving but does not explain it. The phenomenon "case specificity" is therefore not solely a result of content knowledge, but of level of experience and level of case difficulty. http://repub.eur.nl/res/pub/10631/ 2006-10-19T00:00:00Z The development of clinical competence is the main purpose of medical education. The long road to become clinically competent starts on the first day of medical school, and every institution strives to select the best students. The responsibility of medical schools is to train those students to become clinically competent physicians who are highly qualified and specialized professionals able to function in a constantly changing society that puts continuously growing demands on the medical profession. Understanding clinical competence is therefore crucial not only for medical education, assessment, and licensing examinations, but also for society and its responsibility for the quality of health care. However, there is little consensus about what clinical competence is and how to measure it. A proper definition and a better understanding of clinical competence and its components would serve as a criterion for validating medical educational programs and would ! assure a minimum level of competency at the end of medical school and beyond during residency. Each of the previous chapters of this thesis highlights different aspects of clinical competence and its development. In the introductory chapter the lack of consistency in definitions of clinical competence is emphasized and a historical overview is given to shed light on the variety of definitions used over the last decades. The study presented in Chapter 2 explores the effect of level of pre-university performance on preclinical and clinical performance. The study in Chapter 3 addresses the impact of clinical training during clerkships on students’ learning. Specifically, the relationship among the nature and volume of patient encounters, quality of supervision, and the learning outcomes were explored. The study of Chapter 4 is directed at the interaction between knowledge and a problem-solving ability during students’ diagnostic problem solving at end-of-clerkship examinations. Chapter 5 focuses on clinical competence during clerkships and end-of-clerkship examinatio! ns. In this study we explored whether clinical teachers place different values on individual components of competence while students work on the wards or while students are examined during clerkship examinations. The study reported in Chapter 6 investigates how recall of case information changed for different expertise groups under different conditions, while research discussed in Chapter 7 was conducted to find out how the selection of case information by students and doctors during different stages of the diagnostic process is related to different expertise groups. In the present and final chapter of this thesis the main findings of all previous chapters are summarized and discussed. At the end of this chapter, conclusions and suggestions for further research are given. http://repub.eur.nl/res/pub/9316/ 2005-09-01T00:00:00Z Background This study was directed at illuminating a well known phenomenon in the medical expertise literature, the 'intermediate effect' in clinical case recall. This robust phenomenon consists of the finding that medical students of intermediate levels of expertise outperform both experts and novices in clinical case recall after diagnosing cases. It deals in particular with the findings of some researchers who have reported a monotonically increasing recall with level of expertise. Purpose To address possible causes for this anomaly in medical expertise and to experimentally demonstrate how data elaboration can cause expertise effects in clinical case recall. Method Expert nephrologists, intermediate level students and novices were presented with 6 medical cases under 3 different conditions: laboratory data cases without special instructions, laboratory data cases with instructions to elaborate, and cases with laboratory data and a relevant clinical context. Results Only when participants were required to elaborate on each of the information units presented to them did case recall show an expertise effect. If laboratory data are framed within the context of a patient's history and physical examination data, the 'intermediate effect' appears. Conclusions The instructions used in the elaboration condition seem to have induced a deeper, more detailed, analysis of the patient case. It is therefore interesting to note that these instructions only affected the recall of the experts and had no effect on the novices' or intermediates' recall. We might conclude from this that expertise effects in clinical case recall are only produced when the normal processing of patient information is disrupted.