http://repub.eur.nl/res/aut/3963/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl 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. 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/2856/ 2002-01-31T00:00:00Z A general approach to curriculum design in the context of Problem-Based Learning (PBL) is outlined. Ten general 'steps' for problem-based curriculum development are proposed, using the case study methodology to describe the underlying iterative process. Examples are given from the case of the development of a public health professions education curriculum. The process starts with defining the purpose of the curriculum. General objectives are generated in a top-down fashion. The prior knowledge, skills and misconceptions of future students are considered. A preliminary schedule of the curriculum is developed, including sketches of unit blueprints. These are further elaborated. Unit subgoals are related to planned educational activities. Only then, are the learning materials created, with problem writing as the most important aspect. In developing a problem-based curriculum, assessment deserves special attention, because of its influence on the learning process. Finally, educational organization, curriculum management and evaluation procedures are considered. http://repub.eur.nl/res/pub/2855/ 2002-01-01T00:00:00Z In this report, the method of free recall is put forward as a tool to evaluate a prototypical statistical learning environment. A number of students from the faculty of Health Sciences, Maastricht University, the Netherlands, were required to write down whatever they could remember of a statistics course in which they had participated. By means of examining the free recall protocols of the participants, insight can be obtained into the mental representations they had formed with respect to three statistical concepts. Quantitative as well as qualitative analyses of the free recall protocols showed that the effect of the constructive learning environment was not in line with the expectations. Despite small-group discussions on the statistical concepts, students appeared to have disappointingly low levels of conceptual understanding. http://repub.eur.nl/res/pub/9255/ 2002-01-01T00:00:00Z In this report, the method of free recall is put forward as a tool to evaluate a prototypical statistical learning environment. A number of students from the faculty of Health Sciences, Maastricht University, the Netherlands, were required to write down whatever they could remember of a statistics course in which they had participated. By means of examining the free recall protocols of the participants, insight can be obtained into the mental representations they had formed with respect to three statistical concepts. Quantitative as well as qualitative analyses of the free recall protocols showed that the effect of the constructive learning environment was not in line with the expectations. Despite small-group discussions on the statistical concepts, students appeared to have disappointingly low levels of conceptual understanding. 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/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/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.