Schmidt, H.G.

Midterm peer feedback in problem-based learning groups: the effect on individual contributions and achievement (Article)

2013-05-09T00:00:00Z

Even though peer process feedback is an often used tool to enhance the effectiveness of collaborative learning environments like PBL, the conditions under which it is best facilitated still need to be investigated. Therefore, this study investigated the effects of individual versus shared reflection and goal setting on students' individual contributions to the group and their academic achievement. In addition, the influence of prior knowledge on the effectiveness of peer feedback was studied. In this pretest-intervention-posttest study 242 first year students were divided into three conditions: condition 1 (individual reflection and goal setting), condition 2 (individual and shared reflection and goal setting), and condition 3 (control group). Results indicated that the quality of individual contributions to the tutorial group did not improve after receiving the peer feedback, nor did it differ between the three conditions. With regard to academic achievement, only males in conditions 1 and 2 showed better academic achievement compared with condition 3. However, there was no difference between both ways of reflection and goal setting with regard to achievement, indicating that both ways are equally effective. Nevertheless, it is still too early to conclude that peer feedback combined with reflection and goal setting is not effective in enhancing students' individual contributions. Students only had a limited number of opportunities to improve their contributions. Therefore, future research should investigate whether an increase in number of tutorial group meetings can enhance the effectiveness of peer feedback. In addition, the effect of quality of reflection and goal setting could be taken into consideration in future research.

The effect of midterm peer feedback on student functioning in problem-based tutorials (Article)

2013-01-01T00:00:00Z

Within Problem-Based Learning successful learning depends on the quality of cognitive, social and motivational contributions students make to the tutorial group. But at the same time, not all students in PBL automatically contribute in a high quality manner, which might impede successful group functioning. This study investigated whether peer process feedback combined with goal setting can be used to improve the quality of students' individual contributions. A mixed-methods explanatory design, in which 74 second-year Health Sciences students participated, combined a pre- and posttest with a focus group. The results indicated that the quality of the contributions only increased for students with a below average score on the pre-test. The qualitative data confirmed that the impact of the feedback could be increased by combining individual reflection by means of goal setting with face-to-face discussion. Another suggestion is to investigate whether midterm peer process feedback is more effective for first year students, because they are still developing their tutorial behavior, as opposed to second year students.

Elaboration during problem-based group discussion: Effects on recall for high and low ability students (Article)

2012-09-28T00:00:00Z

Although elaboration has been investigated frequently, there is little evidence for the beneficial effect of elaboration in problem-based learning. A controlled experiment tested the effect of elaboration during problem-based discussion on recall. Sixty-seven students observed a video-recorded, problem-based discussion. In one experimental condition, a tutor in the video encouraged participants to elaborate by asking elaborative questions. In a second condition, the tutor asked superficial questions. After the discussion, all participants studied a text with relevant new information. Elaborative questions had no significant effect on recall of idea units from the text, p = .39, η2= .01. High-ability students outperformed low-ability students, p = .04, η2= .07, but this effect did not interact with the experimental treatment, p = .22, η2= .02. Suggestions for further research are presented.

What kind of university does Erasmus want to be in fifteen years’ time? (Miscellaneous)

2011-11-08T00:00:00Z

Dies Lecture 8 November 2011, on the occasion of the 98th Dies natalis of the Erasmus University Rotterdam. I’m sure that none of you will have failed to notice that for a year now Erasmus University has been talking about working closly together with the universities of Delft and Leiden. The talks on cooperation are part of the efforts of the Executive Board and the deans to find an appropriate answer to the quetion of the kind of university Erasmus want to be and can be in fifteen years’ time.

Effect of worksheet scaffolds on student learning in problem-based learning (Article)

2011-10-01T00:00:00Z

The purpose of this study was to investigate the effect of worksheets as a scaffolding tool on students' learning achievement in a problem-based learning (PBL) environment. Seventeen PBL classes (N = 241) were randomly assigned to two experimental groups-one with a worksheet provided and the other without. Students' learning of the topic at hand was evaluated by comparing results from pre- and post-lesson concept recall tests. We also obtained information about students' perceptions of factors impacting their learning using a Learning Impact Questionnaire. The data was analyzed by means of analyses of variance. Results of the study indicated that there was no statistically significant difference between the levels of understanding for both groups of students. In addition, survey results revealed that the strongest factor perceived by students to impact their learning in a PBL context is the tutor followed by team and class dynamics, while the influence of the worksheet was rated lowest. These findings suggest that scaffolds such as worksheets may not play a significant role in enhancing students' learning within the social constructivist framework of problem-based learning. On the other hand, the importance of the role of tutor and collaborative small group learning which are key features of PBL is reinforced.

Is learning in problem-based learning cumulative? (Article)

2011-10-01T00:00:00Z

Problem-based learning (PBL) is generally organized in three phases, involving collaborative and self-directed learning processes. The hypothesis tested here is whether learning in the different phases of PBL is cumulative, with learning in each phase depending on that of the previous phase. The scientific concepts recalled by 218 students at the end of each PBL phase were used to estimate the extent of students' learning. The data were then analyzed using structural equation modeling. Results show that our hypothesized model fits the data well. Alternative hypotheses according to which achievement is predicted either by collaborative learning alone or by self-directed learning alone did not fit the data. We conclude that the learning in each PBL phase is cumulative, and strongly influenced by the earlier phase, thus providing support for the PBL cycle of problem analysis, self-directed learning, and a subsequent reporting phase. We also demonstrate an efficient method to capture and quantify students' learning during the PBL process.

Cognitive engagement in the problem-based learning classroom (Article)

2011-10-01T00:00:00Z

The objective of the present study was to examine to what extent autonomy in problem-based learning (PBL) results in cognitive engagement with the topic at hand. To that end, a short self-report instrument was devised and validated. Moreover, it was examined how cognitive engagement develops as a function of the learning process and the extent to which cognitive engagement determines subsequent levels of cognitive engagement during a one-day PBL event. Data were analyzed by means of confirmatory factor analysis, repeated measures ANOVA, and path analysis. The results showed that the new measure of situational cognitive engagement is valid and reliable. Furthermore, the results revealed that students' cognitive engagement significantly increased as a function of the learning event. Implications of these findings for PBL are discussed.

The relationships between problem characteristics, achievement-related behaviors, and academic achievement in problem-based learning (Article)

2011-10-01T00:00:00Z

This study investigated the influence of five problem characteristics on students' achievement-related classroom behaviors and academic achievement. Data from 5,949 polytechnic students in PBL curricula across 170 courses were analyzed by means of path analysis. The five problem characteristics were: (1) problem clarity, (2) problem familiarity, (3) the extent to which the problem stimulated group discussion, (4) self-study, and (5) identification of learning goals. The results showed that problem clarity led to more group discussion, identification of learning goals, and self-study than problem familiarity. On the other hand, problem familiarity had a stronger and direct impact on academic achievement.

Effects of tutor-related behaviours on the process of problem-based learning (Article)

2011-10-01T00:00:00Z

Tutors in a Problem-Based Learning (PBL) curriculum are thought to play active roles in guiding students to develop frameworks for use in the construction of knowledge. This implies that both subject-matter expertise and the ability of tutors to facilitate the learning process must be important in helping students learn. This study examines the behavioural effects of tutors in terms of subject-matter expertise, social congruence and cognitive congruence on students' learning process and on their final achievement. The extent of students' learning at each PBL phase was estimated by tracking the number of relevant concepts recalled at the end of each learning phase, while student achievement was based on students' ability to describe and elaborate upon the relationship between relevant concepts learned. By using Analysis of Covariance, social congruence of the tutor was found to have a significant influence on learning in each PBL phase while all of the tutor-related behaviours had a significant impact on student achievement. The results suggest that the ability of tutors to communicate informally with students and hence create a less threatening learning environment that promotes a free flow exchange of ideas, has a greater impact on learning at each of the PBL phases as compared to tutors' subject-matter expertise and their ability to explain concepts in a way that is easily understood by students. The data presented indicates that these tutor-related behaviours are determinants of learning in a PBL curriculum, with social congruence having a greater influence on learning in the different PBL phases.

The process of problem-based learning: What works and why (Article)

2011-08-01T00:00:00Z

Objectives In this review, we portray the process of problem-based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation-elaboration hypothesis and a situational interest hypothesis. Methods Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new 'micro-analytical' methodology was used to trace the process of PBL in the natural classroom setting. Conclusions We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small-group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long-term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to 'hard' scaffolding represented by, for instance, worksheets or questions added to problems. Small-group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self-study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.

What students learn in problem-based learning: a process analysis (Article)

2011-07-25T00:00:00Z

This study aimed to provide an account of how learning takes place in problem-based learning (PBL), and to identify the relationships between the learning-oriented activities of students with their learning outcomes. First, the verbal interactions and computer resources studied by nine students for an entire PBL cycle were recorded. The relevant concepts articulated and studied individually while working on the problem-at-hand were identified as units of analysis and counted to demonstrate the growth in concepts acquired over the PBL cycle. We identified two distinct phases in the process-an initial concept articulation, and a later concept repetition phase. To overcome the sample-size limitations of the first study, we analyzed the verbal interactions of, and resources studied, by another 35 students in an entire PBL cycle using structural equation modeling. Results show that students' verbal contributions during the problem analysis phase strongly influenced their verbal contributions during self-directed learning and reporting phases. Verbal contributions and individual study influenced similarly the contributions during the reporting phase. Increased verbalizations of concepts during the reporting phase also led to higher achievement. We found that collaborative learning is significant in the PBL process, and may be more important than individual study in determining students' achievement.

Student and tutor perceptions on attributes of effective problems in problem-based learning (Article)

2011-07-01T00:00:00Z

This study aimed to identify the attributes that students and tutors associated with effective PBL problems, and assess the extent to which these attributes related to the actual effectiveness of problems. To this end, students and tutors in focus groups were asked to discuss about possible attributes of effective problems. The same participants were then asked to individually and independently judge eight sample problems they had worked with. Text analysis of the focus group discussion transcripts identified eleven problem attributes. Participants' judgments of the sample problems were then frequency-scored on the eleven problem attributes. Relating the participants' judgments with the entire student cohort's grades yielded high and significant correlations, suggesting that the eleven problem attributes reflect aspects of problem effectiveness.

Examining continuity of early expressive vocabulary development: The generation R study (Article)

2011-06-01T00:00:00Z

The authors investigated continuity and discontinuity of vocabulary skills in a population-based cohort in the Netherlands. Mothers of 3,759 children completed the Dutch version of the MacArthur Short Form Vocabulary Checklist (Zink & Lejaegere, 2003) at 18 months and a Dutch translation of the Language Development Survey (Rescorla, 1989) at 30 months. At both ages, expressive vocabulary delay was defined as vocabulary scores <10th age- and gender-specific percentile. Results: Of the children, 85.2% had normal vocabulary development at both ages, 6.2% were "late bloomers," 6.0% had late onset expressive vocabulary delay, and 2.6% had persistent expressive vocabulary delay. Word production and comprehension at 18 months explained 11.5% of the variance in 30-month vocabulary scores, with low birth weight, child age, gender and ethnicity, maternal age and education, and parenting stress explaining an additional 6.2%. Multinomial logistic regression was used to identify biological, demographic, and psychological factors associated with each of the vocabulary delay outcome groups relative to the typically developing group. Although multiple perinatal, demographic, and maternal psychosocial factors significantly predicted vocabulary skills at 30 months, positive predictive value and sensitivity were low. Future studies should address to what extent additional factors, such as brain maturation and genetic influences, can improve the prediction and understanding of continuity and discontinuity of language delay.

Parental family stress during pregnancy and cognitive functioning in early childhood: The Generation R Study (Article)

2011-05-09T00:00:00Z

We investigated whether parental family stress during pregnancy is associated with cognitive functioning in early childhood in a population-based cohort (n= 3139). Family stress was assessed using the Family Assessment Device at the 20th week of pregnancy and was reported by mothers and fathers. Mothers completed the MacArthur Communicative Development Inventory, measuring children's verbal cognitive functioning, when children were 18 months and they completed the Parent Report of Children's Abilities, measuring nonverbal cognitive functioning, when children were 2 years old. Maternal prenatal family stress was related to children's low word comprehension and poorer nonverbal cognitive development independent of paternal reports. In a subset of 639 children, maternal prenatal family stress was also associated with observational assessments of poor effortful control at age 37 months. Paternal prenatal family stress was only related to poorer nonverbal cognitive development, independent of the mother. When both parents had high levels of prenatal family stress, children displayed particularly poor nonverbal cognitive development. These findings emphasize the significance of parental prenatal family stress for child developmental outcomes.

Self-reflection and academic performance: is there a relationship? (Article)

2011-05-05T00:00:00Z

The purposes of the present study were two-fold: first, to evaluate whether reflection journal writing was effective in promoting self-reflection and learning, and whether students become better at self-reflection if they engage continuously in reflection journal writing. To that end, the reflection journals of 690 first-year applied science students at a local polytechnic were studied by means of an automated coding procedures using software. Data was collected twice, once at the beginning and again towards the end of an academic year. Outcomes of the textual content analyses revealed that students reflected on both the process and contents of their learning: critical review of past learning experiences, learning strategies and summaries of what was learned. Correlational analyses showed weak to moderate inter-relationships between the textual categories and their classroom and knowledge acquisition test grades. Taken together, the findings suggest that self-reflection on both how and what students have learned does lead to improvements in academic performance, although to a limited extent.

Which cognitive processes support learning during small-group discussion? The role of providing explanations and listening to others (Article)

2011-03-01T00:00:00Z

Seventy students participated in an experiment to measure the effects of either providing explanations or listening during small group discussions on recall of related subject-matter studied after the discussion. They watched a video of a small group discussing a problem. In the first experimental condition, the video was stopped at various points in time, enabling the participants to verbally respond to the discussion. In the second condition, they listened to the same discussion, without contributing. In the control condition, they listened to a discussion that was not related to the subject-matter subsequently studied. After the discussion, all participants studied a text and answered questions that tested their recall of information from this text. No immediate differences in recall were found. One month later, participants who had actively engaged in explaining remembered more from the text. The conclusion appears justified that actively providing explanations during a discussion positively affects long-term memory.

Stress amongst dental students: A systematic review (Article)

2011-02-01T00:00:00Z

The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer-reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.

Accuracy of students' self-assessment and their beliefs about its utility (Article)

2010-12-01T00:00:00Z

The purpose of the two studies presented here was to evaluate the accuracy of students' self-assessment ability, to examine whether this ability improves over time and to investigate whether self-assessment is more accurate if students believe that it contributes to improving learning. To that end, the accuracy of the self-assessments of 3588 first-year students enrolled in a post-secondary institution was studied throughout a semester during which each student made approximately 80 self-assessments about his or her own learning process. These self-assessments were then compared with multiple judgements by peers and tutors. The overall correlations between the scores of self-, peer and tutor assessments suggest weak to moderate accuracy of student self-assessment ability. The findings also reveal an ability effect; students judged as more academically competent were able to self-assess with higher accuracy than their less competent peers. Comparing the accuracy of student self-assessment averaged over four consecutive periods indicates that the accuracy does not improve over time. In a second study, a questionnaire aimed at eliciting student's beliefs about the effects of self-assessment on their learning was administered to 936 first-year students. Based on their responses, sub-groups of students were identified: those who either believed in the usefulness of self-assessment or did not. Results suggest that there is no significant association between student beliefs about the utility of selfassessment and the accuracy of their self-assessments.

Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents (Article)

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.

Wie bepaalt het universitaire onderzoeksbeleid? Studenten? Uitgevers? (Miscellaneous)

2010-09-06T00:00:00Z

De Erasmus Universiteit Rotterdam maakt dit academisch jaar een grote sprong voorwaarts met Open Access: het gratis publiceren van wetenschappelijk werk op het internet. Alle publicaties van EUR- en Erasmus MC-onderzoekers komen vanaf 2011 in de online databank Repub en zijn voor iedereen beschikbaar. Dit kondigde rector magnificus prof.dr. Henk Schmidt aan in zijn toespraak op de Opening van het Academisch Jaar 2010-2011 op maandag 6 september 2010.

Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: The generation R study (Article)

2010-09-01T00:00:00Z

Context: Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and children's cognitive development are sparse. Objective: Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T4(FT4) levels across the entire range with cognitive functioning in early childhood. Design and Setting: We conducted a population-based cohort in The Netherlands. Participants: Participants included 3659 children and their mothers. Main Measures: In pregnant women with normal TSH levels at 13 wk gestation (SD = 1.7), mild and severe maternal hypothyroxinemia were defined as FT4concentrations below the 10th and 5th percentile, respectively. Children's expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring verbal and nonverbal cognitive functioning. Results: Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT4predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.09-1.91; P = 0.010 and OR = 1.80; 95% CI = 1.24-2.61; P = 0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR = 2.03; 95% CI = 1.22-3.39; P = 0.007). Conclusions: Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood. Copyright

Fetal growth from mid- to late pregnancy is associated with infant development: The Generation R Study (Article)

2010-07-01T00:00:00Z

Aim: The aim of this study was to investigate within a population-based cohort of 4384 infants (2182 males, 2202 females) whether fetal growth from early pregnancy onwards is related to infant development and whether this potential relationship is independent of postnatal growth. Method: Ultrasound measurements were performed in early, mid-, and late pregnancy. Estimated fetal weight was calculated using head and abdominal circumference and femur length. Infant development was measured with the Minnesota Infant Development Inventory at 12 months (SD 1.1mo, range 10-17mo). Information on postnatal head size and body weight at 7 months was obtained from medical records. Results: After adjusting for potential confounders and for postnatal growth, faster fetal weight gain from mid- to late pregnancy predicted a reduced risk of delayed social development (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.71-0.95, p=0.008), self-help abilities (OR 0.84; 95% CI 0.73-0.98, p=0.023), and overall infant development (OR 0.65; 95% CI 0.49-0.87, p=0.003). Similar findings were observed for fetal head growth from mid- to late pregnancy. Interpretation: Faster fetal growth predicts a lower risk of delayed infant development independent of postnatal growth. These results suggest that reduced fetal growth between mid- and late pregnancy may determine subsequent developmental outcomes.

Maternal psychological distress and fetal growth trajectories: the Generation R Study (Article)

2010-04-01T00:00:00Z

Abstract BACKGROUND: Previous research suggests, though not consistently, that maternal psychological distress during pregnancy leads to adverse birth outcomes. We investigated whether maternal psychological distress affects fetal growth during the period of mid-pregnancy until birth. METHOD: Pregnant women (n=6313) reported levels of psychological distress using the Brief Symptom Inventory (anxious and depressive symptoms) and the Family Assessment Device (family stress) at 20.6 weeks pregnancy and had fetal ultrasound measurements in mid- and late pregnancy. Estimated fetal weight was calculated using head circumference, abdominal circumference and femur length. RESULTS: In mid-pregnancy, maternal distress was not linked to fetal size. In late pregnancy, however, anxious symptoms were related to fetal size after controlling for potential confounders. Anxious symptoms were also associated with a 37.73 g [95% confidence interval (CI) -69.22 to -6.25, p=0.019] lower birth weight. When we related maternal distress to fetal growth curves using multilevel models, more consistent results emerged. Maternal symptoms of anxiety or depression were associated with impaired fetal weight gain and impaired fetal head and abdominal growth. For example, depressive symptoms reduced fetal weight gain by 2.86 g (95% CI -4.48 to -1.23, p<0.001) per week. CONCLUSIONS: The study suggests that, starting in mid-pregnancy, fetal growth can be affected by different aspects of maternal distress. In particular, children of prenatally anxious mothers seem to display impaired fetal growth patterns during pregnancy. Future work should address the biological mechanisms underlying the association of maternal distress with fetal development and focus on the effects of reducing psychological distress in pregnancy.

Conscious thought beats deliberation without attention in diagnostic decision-making: At least when you are an expert (Article)

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.

Situational interest and academic achievement in the active-learning classroom (Article)

2010-01-01T00:00:00Z

The aim of the present study was to investigate how situational interest develops over time and how it is related to academic achievement in an active-learning classroom. Five measures of situational interest were administered at critical points in time to 69 polytechnic students during a one-day, problem-based learning session. Results revealed that situational interest significantly increased after the problem stimulus was presented. Subsequently, situational interest gradually decreased but at the end of the day increased again. Testing a path model relating the situational interest measures showed strong (directional) interrelations. Moreover, situational interest was highly predictive for observed achievement-related classroom behaviors. The latter, in turn, proved to be a significant predictor of academic achievement. Aggregating situational interest over the day led to less accurate predictions of achievement-related classroom behaviors and academic achievement. Implications of these findings for situational interest research are discussed.

The role of teachers in facilitating situational interest in an active-learning classroom (Article)

2010-01-01T00:00:00Z

The study sought to explore whether interactional teacher characteristics such as social congruence, subject-matter expertise, and cognitive congruence increase situational interest in students. Correlational and path analyses were conducted on a sample of 498 polytechnic students to assess potential differences in situational interest based on these three teacher characteristics and how well these characteristics predicted situational interest. Results revealed that students supported by teachers who scored high on these characteristics reported significantly higher levels of situational interest. Cognitive congruence was the most significant predictor of situational interest. Overall, the findings suggest that teachers play an influential role in increasing students' situational interest in the active-learning classroom.

Students' conceptions of constructivist learning in different programme years and different learning environments (Article)

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.

Are Independent Probes Truly Independent? (Article)

2009-07-01T00:00:00Z

The independent cue technique has been developed to test traditional interference theories against inhibition theories of forgetting. In the present study, the authors tested the critical criterion for the independence of independent cues: Studied cues not presented during test (and unrelated to test cues) should not contribute to the retrieval process. Participants first studied a subset of cues (e.g., rope) that were subsequently studied together with a target in a 2nd study phase (e.g., rope-sailing, sunflower-yellow). In the test phase, an extralist category cue (e.g., sports, color) was presented, and participants were instructed to recall an item from the study list that was a member of the category (e.g., sailing, yellow). The experiments showed that previous study of the paired-associate word (e.g., rope) enhanced category cued recall even though this word was not presented at test. This experimental demonstration of covert cuing has important implications for the effectiveness of the independent cue technique.

Fetal size in mid- and late pregnancy is related to infant alertness: The generation R study (Article)

2009-06-03T00:00:00Z

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.

Evidence for constructive, self-regulatory, and collaborative processes in problem-based learning (Article)

2009-05-01T00:00:00Z

The goal of this study was to increase our understanding of the learning-oriented verbal interactions taking place between students during the problem-based learning (PBL) cycle. The verbal interactions of one PBL group of five students throughout an entire PBL cycle were recorded in this data-intensive case study. The verbatim transcript consisting of more than 1,000 utterances was analyzed to investigate whether and how PBL stimulates students towards constructive, self-directed and collaborative learning. Our results demonstrate the occurrence of all above-mentioned learning activities, with 53.3% of episodes being collaborative, 27.2% self-directed and 15.7% constructive.

Impact of problem-based, active learning on graduation rates for 10 generations of Dutch medical students (Article)

2009-03-01T00:00:00Z

Objectives: We aimed to study the effects of active-learning curricula on graduation rates of students and on the length of time needed to graduate. Methods: Graduation rates for 10 generations of students enrolling in the eight Dutch medical schools between 1989 and 1998 were analysed. In addition, time needed to graduate was recorded. Three of the eight schools had curricula emphasising active learning, small-group instruction and limited numbers of lectures; the other five had conventional curricula to varying degrees. Results: Overall, the active-learning curricula graduated on average 8% more students per year, and these students graduated on average 5 months earlier than their colleagues from conventional curricula. Conclusions: Four hypotheses potentially explaining the effect of active learning on graduation rate and study duration were considered: (i) active-learning curricula promote the social and academic integration of students; (ii) active-learning curricula attract brighter students; (iii) active-learning curricula retain more poor students, and (iv) the active engagement of students with their study required by active-learning curricula induces better academic performance and, hence, lower dropout rates. The first three hypotheses had to be rejected. It was concluded that the better-learning hypothesis provides the most parsimonious account for the data.

Influence of perceived difficulty of cases on physicians' diagnostic reasoning. (Article)

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.

Is clinical competence perceived differently for student daily performance on the wards versus clerkship grading? (Article)

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.

Deliberate practice predicts performance over time in adolescent chess players and drop-outs: A linear mixed models analysis (Article)

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.

Are specialist certification examinations a reliable measure of physician competence? (Article)

2008-10-01T00:00:00Z

High stakes postgraduate specialist certification examinations have considerable implications for the future careers of examinees. Medical colleges and professional boards have a social and professional responsibility to ensure their fitness for purpose. To date there is a paucity of published data about the reliability of specialist certification examinations and objective methods for improvement. Such data are needed to improve current assessment practices and sustain the international credibility of specialist certification processes. To determine the component and composite reliability of the Fellowship examination of the College of Physicians of South Africa, and identify strategies for further improvement, generalizability and multivariate generalizability theory were used to estimate the reliability of examination subcomponents and the overall reliability of the composite examination. Decision studies were used to identify strategies for improving the composition of the examination. Reliability coefficients of the component subtests ranged from 0.58 to 0.64. The composite reliability of the examination was 0.72. This could be increased to 0.8 by weighting all test components equally or increasing the number of patient encounters in the clinical component of the examination. Correlations between examination components were high, suggesting that similar parameters of competence were being assessed. This composite certification examination, if equally weighted, achieved an overall reliability sufficient for high stakes examination purposes. Increasing the weighting of the clinical component decreased the reliability. This could be rectified by increasing the number of patient encounters in the examination. Practical ways of achieving this are suggested.

Relationships between students' conceptions of constructivist learning and their regulation and processing strategies (Article)

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.

Learning environment, learning process, academic outcomes and career success of university graduates (Article)

2008-08-01T00:00:00Z

This study expands on literature covering models on educational productivity, student integration and effectiveness of instruction. An expansion of the literature concerning the impact of higher education on workplace performance is also covered. Relationships were examined between the quality of the academic learning environment, the process of learning, learning outcomes, and career success of graduates. The responses to a questionnaire of 3324 graduates at a Dutch university, emphasising conventional large-scale classes, were analysed using structural equation modelling. The results suggest an indirect influence of university education on career success. A learning environment increases the motivation of students, which, in turn, increases their learning outcomes. Learning outcomes show a significant relationship with success in the initial phase of graduates' careers. Furthermore, success in subsequent phases of one's career is influenced by experience gained by students during their involvement in extra-curricular activities. Therefore, it is argued that the learning environment is important for students' learning as well as their involvement in extra-curricular activities, and that these two elements of university education are determinants of career success.

Effects of reflective practice on the accuracy of medical diagnoses (Article)

2008-05-01T00:00:00Z

Context: Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy. Methods: Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables. Results: A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases. Conclusions: Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors.

Initial diagnostic hypotheses bias analytic information processing in non-visual domains (Article)

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.

Is analytic information processing a feature of expertise in medicine? (Article)

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.

Description, justification and clarification: A framework for classifying the purposes of research in medical education (Article)

2008-02-01T00:00:00Z

Context: Authors have questioned the degree to which medical education research informs practice and advances the science of medical education. Objective: This study aims to propose a framework for classifying the purposes of education research and to quantify the frequencies of purposes among medical education experiments. Methods: We looked at articles published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine (1459 articles). From the 185 articles describing education experiments, a random sample of 110 was selected. The purpose of each study was classified as description ('What was done?'), justification ('Did it work?') or clarification ('Why or how did it work?'). Educational topics were identified inductively and each study was classified accordingly. Results: Of the 105 articles suitable for review, 75 (72%) were justification studies, 17 (16%) were description studies, and 13 (12%) were clarification studies. Experimental studies of assessment methods (5/6, 83%) and interventions aimed at knowledge and attitudes (5/28, 18%) were more likely to be clarification studies than were studies addressing other educational topics (< 8%). Conclusions: Clarification studies are uncommon in experimental studies in medical education. Studies with this purpose (i.e. studies asking: 'How and why does it work?') are needed to deepen our understanding and advance the art and science of medical education. We hope that this framework stimulates education scholars to reflect on the purpose of their inquiry and the research questions they ask, and to strive to ask more clarification questions.

Academic and social integration and study progress in problem based learning (Article)

2008-01-01T00:00:00Z

The present study explores the effects of problem-based learning (PBL) on social and academic integration and study progress. Three hundred and five first-year students from three different psychology curricula completed a questionnaire on social and academic integration. Effects of a full-fledged PBL environment were compared to (1) effects of a conventional lecture-based learning environment, and (2) effects of a learning environment that combined lectures and other methods aimed at activating students. Lisrel analyses show direct positive effects of the learning environment on study progress: students in PBL obtained more credits compared to students in more conventional curricula. Moreover, the levels of social and academic integration were also higher among students in the PBL curriculum. The links between integration and study progress were less straightforward. Formal social integration positively affected study progress, but informal academic integration was negatively related to study progress.

How expertise develops in medicine: Knowledge encapsulation and illness script formation (Article)

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.

Breaking down automaticity: Case ambiguity and the shift to reflective approaches in clinical reasoning (Article)

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.

Clinical case processing: A diagnostic versus a management focus (Article)

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.

Computer Anxiety: "Trait" or "State"? (Article)

2007-11-01T00:00:00Z

A recurring question in the study of computer anxiety is whether computer anxiety is a relatively stable personality trait or a mutable, temporary state. The two studies reported examined this question in two groups of first year psychology students. These students were requested to complete a computer anxiety test, a trait anxiety test, and a state anxiety test. Some groups were administered the tests in a pen and paper format, while others were tested using computerized tests. In the first study, a Dutch version of the Profile of Mood States (POMS) was used; in the second study, a Dutch adaptation of the State-Trait Anxiety Inventory (STAI). The data were analyzed using structural equation modeling. In both studies, computer anxiety turned out to be related more strongly to trait anxiety than to state anxiety. In fact, there was no relationship between computer anxiety and state anxiety in the pen and paper format. In the computerized versions however, computer anxiety and state anxiety were related, suggesting that state anxiety in situations involving a computer is caused by pre-existing computer anxiety.

Clinical competence: General ability or case-specific? (Article)

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.

Quality of psychiatric referrals in Saudi Arabia: a structural equation modeling approach (Article)

2007-01-01T00:00:00Z

Objective: This study seeks to model proposed causal relationships between the quality of psychiatric referral letters, and its indicators, linked to the features of the referred patient, referring physician, and practice setting. Methods: This study was executed at Buraidah Mental Health Hospital, Saudi Arabia, in the year 2000-2002. Data regarding 18 independent variables underlying 3 latent constructs and one dependent variable represented by quality of psychiatric referral letter score (outcome) was derived from patient files, physician training records, and 540 psychiatric referrals. Structural equation modeling was used to analyze the data for examining proposed causal relationships between the quality of psychiatric referral letters, and its potential predictors. Results: The structural equation modeling analysis revealed a reasonably good fit of the proposed model to the data based on various fit indices. The tested model explained 67% of the variance in the quality of psychiatric referral letters. The referring physician characteristics (experience, education, and psychiatric training) and features of the referral setting (nature of setting and referral letters-administrative information) were highly significant indicators of quality of psychiatric referral letters, which in turn was negatively predicted by patient features including severity of the mental illness. Conclusion: Despite some caveats, the quality of psychiatric referral letters is accurately predicted by 3 latent constructs represented by referring physician skills, nature of the setting, and patient socio-clinical features.

Limitations to the Spacing Effect: Demonstration of an Inverted U-shaped Relationship Between Interrepetition Spacing and Free Recall (Article)

2005-11-24T00:00:00Z

The spacing effect refers to the finding that memory for repeated items improves when the interrepetition interval increases. To explain the spacing effect in free-recall tasks, a two-factor model has been put forward that combines mechanisms of contextual variability and study-phase retrieval (e.g., Raaijmakers, 2003; Verkoeijen, Rikers, & Schmidt, 2004). An important, yet untested, implication of this model is that free recall of repetitions should follow an inverted u-shaped relationship with interrepetition spacing. To demonstrate the suggested relationship an experiment was conducted. Participants studied a word list, consisting of items repeated at different interrepetition intervals, either under incidental or under intentional learning instructions. Subsequently, participants received a free-recall test. The results revealed an inverted u-shaped relationship between free recall and interrepetition spacing in both the incidental-learning condition and the intentionallearning condition. Moreover, for intentionally learned repetitions, the maximum free-recall performance was located at a longer interrepetition interval than for incidentally learned repetitions. These findings are interpreted in terms of the twofactor model of spacing effects in free-recall tasks.

Inducing Expertise Shifts in Clinical Case Recall through the Manipulation of Processing (Article)

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.

A Critical Look at the Discrepancy Reduction Mechanism of Study Time Allocation (Article)

2005-05-01T00:00:00Z

The Effects of Prior Knowledge Activation on Study Time Allocation and Free Recall: Investigating the Discrepancy Reduction Model (Article)

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.

The role of encapsulated knowledge in clinical case representations of medical students and family doctors (Article)

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.

Detrimental Influence of Contextual Change on Spacing Effects in Free Recall (Article)

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.

Case Representation by Medical Experts, Intermediates and Novices for Laboratory Data presented with or without a Clinical Context (Article)

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.

The influence of computer anxiety on experienced computer users while performing complex computer tasks (Article)

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.

General practitioners pre- and post-training psychiatric knowledge and attitude towards psychiatry (Article)

2004-01-01T00:00:00Z

Objectives: General practitioners (GPs) often lack sufficient knowledge of psychiatric diagnoses and have unfavorable attitudes towards mental illness. The first aim of this intervention study is to assess the pre-and post-psychiatric training knowledge and attitudes of GPs. The second aim is to explore certain factors, which predict gain in knowledge and changes in attitude. Methods: This study was executed at Buraidah Mental Health Hospital in the year 2003. The research design consisted of a pre- and post-test comparison of GPs responses. The instruments were a Knowledge Test and an Attitude Questionnaire. Results: The psychiatric training had a discernible impact on GPs' knowledge. Though most of their pre-training attitudes were well-known either as positive or negative, certain attitudes were significantly changed post-intervention. Gain in knowledge was significantly predicted by the type of psychiatric help offered by the GPs. Gender and duration of GPs' practice significantly predicted the attitudinal changes. Conclusion: Psychiatric training courses significantly enhance GPs' knowledge together with significant changes in certain attitudes that have vast psychiatric implications including destigmatization, early diagnosis and better treatment of primary care patients with mental disorders.

Cognitive load theory as a tool for expertise development (Article)

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.

The efficiency of multimedia learning into old age (Article)

2003-12-01T00:00:00Z

Background: On the basis of a multimodal model of working memory, cognitive load theory predicts that a multimedia-based instructional format leads to a better acquisition of complex subject matter than a purely visual instructional format.

Computer experience and computer anxiety (Article)

2003-11-01T00:00:00Z

In this article two studies are reported that tested the nature of the relationship between computer experience and computer anxiety. In the first study 184 first year psychology students were given a questionnaire that measured their computer experience in terms of e.g. breadth of experience, hours spent on working with computers, skills level, the nature of the first computer experience and the occurrence of computer anxiety. A combined latent-factor path model depicting the relationship between experience and anxiety was construed and tested by means of EQS. The model in which computer experience unidirectionally influenced computer anxiety showed a reasonable fit (CFI=0.91). Two other models were also tested. The model in which experience was a consequence of anxiety in terms of physical arousal and affect and the reciprocal model showed insufficient fit (CFI=0.79 and 0.86). A second study among 225 first and third year psychology students was done to see if the original model could be improved upon. Adding the variables "sex" and "necessity of use of computers" into the model improved the fit of the model (CFI=0.93); it was also found that the amount of control felt during the first experience raised levels of feeling computer literate and liking the computer.

DSM-IV defined anxiety disorder symptoms in South-African children (Article)

2002-11-01T00:00:00Z

Objective: To examine DSM-IV-defined anxiety disorder symptoms in a large sample of normal South African school-children. Method: Children completed two self-report questionnaires: the Spence Children's Anxiety Scale (SCAS) and the 41-item version of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Results: Psychometric properties of the SCAS and the SCARED were moderate (convergent validity) to sufficient (reliability). Factor analyses yielded evidence for the presence of a number of hypothesized anxiety categories (i.e., social phobia, panic disorder, fears, and generalized anxiety disorder). Furthermore, anxiety levels of South African children were higher than those of Western (i.e., Dutch) children. Differences were found with regard to the content of prevalent anxiety symptoms among South African and Western children. Conclusion: Although psychometric properties of the SCAS and the SCARED in South African children somewhat deviated from those obtained in Western countries, both scales seem to be useful for assessing childhood anxiety symptoms in this country.

Kleine psychologie van de stad (Article)

2002-05-01T00:00:00Z

Modeling the connection between self-reported trauma and dissociation in a student sample (Article)

2002-03-01T00:00:00Z

A sample of 109 undergraduate students completed the Dissociative Experiences Scale and self-report measures on absent-mindedness, fantasy proneness, and childhood trauma. As in previous studies, dissociative tendencies were strongly related to absent-mindedness and fantasy proneness. Also, dissociative symptoms were linked to trauma self-reports. Structural equation modeling analyses showed that both the conventional trauma-dissociation model and an alternative dissociation-trauma model provided an adequate fit to our data. Thus, our results demonstrate that cross-sectional and non-clinical studies relying on self-reports of dissociation and trauma should seriously consider the possibility that dissociation, together with its correlates absent-mindedness and fantasy proneness, contribute to trauma self-reports.

Long-term retention of a theatrical script by repertory actors: The role of context (Article)

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.

Cognitive load theory and aging: Effects of worked examples on training efficiency (Article)

2002-02-01T00:00:00Z

Cognitive load theory (CLT) is aimed at developing training material that efficiently makes use of the available cognitive processing capacity and stimulates the learner's ability to use acquired knowledge and skills in new situations. It is claimed that CLT-based training formats meet the cognitive abilities of elderly learners particularly well. That is, cognitive aging brings about several declines of working memory, which impede the acquisition of complex cognitive skills. By making an optimal use of the ‘remaining’ cognitive resources, learning can be enhanced. For that purpose, CLT provides a promising range of training formats that have proven their effectiveness relative to conventional formats in young adults. This article presents an experimental study (N=54) aimed at the efficiency of worked examples as a substitute for conventional practice problems in training both elderly and young adults. According to CLT, studying worked examples is a more efficient means of training complex skills than solving conventional problems. As predicted, the results show that — with respect to the elderly — the efficiency of studying worked examples is higher than the efficiency of solving conventional problems in that less training time and cognitive load leads to a comparable level of performance.

Design of a problem-based curriculum: a general approach and a case study in the domain of public health (Article)

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.

Design, Implementation and Evaluation of PsyWeb, a Learning Environment in a Problem Based Learning Curriculum. (In Book)

2002-01-01T00:00:00Z

In this article we describe the design and implementation of PsyWeb, a rich learning environment for the new problem based study in Psychology at Erasmus University Rotterdam Experiences are reported for the first five (of eight) courses of the first year of the new study. Students opinions have been collected as part of a survey at the end of each course. Results indicate that students are positive about PsyWeb. The overall appreciation shows a slight increase over time. Starting with the second course, usage of PsyWeb has been logged. Usage has been quantified in terms of the number of unique IP-addresses per day. Using this measure we assume that PsyWeb has a student reach between 25% and 100% per day. Usage shows a slight increase over the courses. The implementation of a series of additions to PsyWeb has been planned for the next year.

On the constraints of encapsulated knowledge: Clinical case representations by medical experts and subexperts (Article)

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

The robustness of medical expertise: Clinical case processing by medical experts and subexperts (Article)

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.

Assessing knowledge structures in a constructive statistical learning environment (Article)

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.

Assessing Knowledge Structures in a Constructive Statistical Learning Environment (Article)

2002-01-01T00:00:00Z

Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents (Article)

2001-07-18T00:00:00Z

In a previous study, Muris, Merckelbach, Wessel, and Van de Ven [Psychopathological correlates of self-reported behavioural inhibition in normal children. Behav. Res. Ther. 37 (1999) 575–584] found that children who defined themselves as high on behavioural inhibition displayed elevated levels of psychopathological symptoms compared to children who defined themselves as low or middle on behavioural inhibition. The present study further examined the relationship between self-reported behavioural inhibition and anxiety disorders and depression symptoms in a large sample of adolescents aged 12–18 years (N=968). Adolescents completed a measure of behavioural inhibition and questionnaires of anxiety and depression. Results indicated that adolescents who classified themselves as high on behavioural inhibition had higher scores of anxiety and depression than adolescents who classified themselves as low or middle on behavioural inhibition. Structural equations modelling was employed to test hypothetical models on the role of behavioural inhibition in childhood anxiety and depression. It was found that a pathway in which behavioural inhibition results in anxiety, which in turn leads to depression, provided the best fit for the data.

Protective and vulnerability factors of depression in normal adolescents (Article)

2001-04-05T00:00:00Z

The present study investigated the role of various protective and vulnerability factors in the development of depressive symptoms. A sample of normal adolescents (N=373) completed the Children’s Depression Inventory and measures of a negative attributional style, parental rearing behaviour, coping styles, and perceived self-efficacy. In addition to computing the correlations between depression and these protective and vulnerability factors, the present data were also subjected to structural equations modelling to examine the correlational structure of the data. Depression was accompanied by high levels of parental rejection, negative attributions, and passive coping, and by low levels of active coping and self-efficacy. Furthermore, a model in which negative parental rearing behaviour and a negative attributional style featured as the primary sources of depression, while coping styles and self-efficacy played a mediating role in the formation of depressive symptoms, provided a reasonable fit for the data.

The thought-action fusion scale: further evidence for its reliability and validity (Article)

2001-04-05T00:00:00Z

Thought-action fusion (TAF) refers to a set of cognitive biases that are thought to play a role in the development of obsessional phenomena. To measure these biases, R. Shafran, D. S. Thordarson, and S. Rachman (1996; Journal of Anxiety Disorders, 10, 379–391) developed the TAF-scale. They concluded that the TAF-scale possesses adequate psychometric qualities. The current study sought to further explore the reliability and validity of the TAF-scale. Results indicate that the TAF-scale has good internal consistency. TAF-scores correlated with self-reports of obsessional problems. Furthermore, mean scores in a mixed sample of anxiety disordered patients were higher than those in a normal sample. However, temporal consistency was somewhat disappointing. Also, the question remains whether TAF is specific to obsessive–compulsive disorder or taps more pervasive biases that play a role in a variety of disorders.

Self-reported competency ratings of graduates of a problem-based medical curriculum (Article)

2001-01-01T00:00:00Z

Purpose. To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. Method. All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own performances in 19 domains with those of colleagues trained at schools with conventional curricula. Results. Overall, alumni of the medical school rated themselves as better than colleagues who were trained at schools with conventional curricula for cooperation skills, problem-solving skills, skills relevant to running meetings, and the ability to work independently. There was no difference for possession of general academic knowledge and writing reports or articles. The self-reported ratings of better competencies were maintained after correcting the data for self-overestimation. Conclusion. The problem-based medical curriculum appears to contribute to the development of professional competencies. Further study is needed, however, to control for the effect of selection bias and respondents' emotional commitment to their alma mater.

The structure of computer anxiety: a six-factor model. (Article)

2001-01-01T00:00:00Z

A six-factor model of computer anxiety was tested in two samples of university students. The dimensions involved were: computer literacy, self-efficacy, physical arousal caused by computers, affective feelings about them, beliefs about the beneficial effects of computers, and beliefs about their dehumanizing aspects. Confirmatory factor analyses showed that, compared to a number of alternative models proposed in the literature, the data fitted this six-factor model relatively well. In addition, it was demonstrated that computer literacy has a strong directional influence on both physical arousal and affects. Beliefs about computers, in turn, were shown to be dependent on affects and physical arousal. Self-efficacy mainly contributed to increased computer literacy. These findings suggest that training programs that enhance self-efficacy and computer literacy may in principle reduce computer anxiety.

Motivation to commit oneself as a determinant of achievement in problem-based learning (Article)

2001-01-01T00:00:00Z

Problem-based learning is a constructivist approach to professional education stressing the use of real life problems in education. Several previous attempts to understand the intricacies of learning in the problem-based context have led to a causal model, elements of which were tested in the present study. The focus of the investigation was on the students' motivation to commit themselves to studying in a problem-based health sciences curriculum, expressed in term of levels of attendance at tutorial meetings. Data were collected regarding functioning of the tutorial group, tutor functioning, level of prior knowledge, quality of the instructional problems, time spent on individual study, academic achievement and increased interest. These data were analyzed using a structural equations modeling approach. As hypothesized, commitment appears to be a potent determinant of achievement. In fact, it represents one of the strongest determinants of learning in the model tested.

Effects of problem-based discussion on studying a subsequent text: A randomized trial among first year medical students (Article)

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.

Anxiety sensitivity in adolescents: Factor structure and relationships to trait and symptoms of anxiety disorders and depression (Article)

2001-01-01T00:00:00Z

The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents aged 13–16 years (n=819). Children completed the Childhood Anxiety Sensitivity Index (CASI; Silverman, W. K., Fleisig, W., Rabian, B. and Peterson, R. A. (1991). Journal of Clinical Child Psychology, 20, 162–168) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular of panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability.

The structure of negative emotions in adolescents (Article)

2001-01-01T00:00:00Z

This study examined the structure of negative emotions in a sample of nonclinical adolescents, using an approach that exclusively relied on child self-report. A large sample of adolescents (N = 968) completed self-report questionnaires measuring symptoms of fear, anxiety, and depression. Confirmatory factor analysis provided support for the notion that fear, anxiety, and depression are distinct yet correlated components of negative emotions. This result is in agreement with recent empirical findings and current theoretical notions on the structure of negative emotions in children and should be taken as an encouragement for researchers to develop more specific measures for assessing fear, anxiety, and depression in children.

Reliability, factor structure, and validity of the Dutch Eysenck Personality Profiler (Article)

2000-11-01T00:00:00Z

The Eysenck Personality Profiler (EPP) is a questionnaire measuring 21 primary personality traits that are thought to constitute the three supertraits of Extraversion, Neuroticism and Psychoticism. The present study examined the reliability, factor structure and convergent validity of the Dutch translation of the EPP in a sample of introductory psychology students (N=215). Results indicate that the internal consistency of most EPP scales was satisfactory. Furthermore, exploratory and confirmatory factor analyses showed that the to-be-expected three-factor structure provided a reasonable fit for EPP data. Finally, Extraversion, Neuroticism and Psychoticism were found to correlate in a meaningful way with the "big 5" supertraits as indexed by the Five-Factor Personality Inventory.

Effectiveness of problem-based learning curricula: Theory, practice and paper darts (Article)

2000-09-01T00:00:00Z

In a recent review article, Colliver concluded that there was no convincing evidence that problem-based learning was more effective than conventional methods. He then went on to lay part of the blame on cognitive psychology, claiming that 'the theory is weak, its theoretical concepts are imprecise... the basic research is contrived and ad hoc'. This paper challenges these claims and presents evidence that (a) cognitive research is not contrived and irrelevant, (b) curriculum level interventions are doomed to fail and (c) education needs more theory-based research.

Relationships between thought-action fusion, thought suppression, and obsessive-compulsive symptoms: A structural equation modeling approach (Article)

2000-09-01T00:00:00Z

Research has shown that there are strong similarities in content between the obsessions and compulsions that characterize obsessive–compulsive disorder and nonclinical obsessions and compulsions. However, clinical and nonclinical obsessions and compulsions do differ with respect to characteristics like frequency, intensity, discomfort and elicited resistance. Two separate concepts have been invoked to explain how normal obsessions and compulsions may develop into clinical phenomena. First, it is suggested that thought–action fusion (TAF) contributes to obsessive–compulsive symptoms. Second, thought suppression may intensify obsessive–compulsive symptoms due to its paradoxical effect on intrusive thoughts. Although both phenomena have been found to contribute to obsessive–compulsive symptoms, possible interactions between these two have never been investigated. The current study explored how TAF and thought suppression interact in the development of obsessive–compulsive symptoms. Undergraduate psychology students (N=173) completed questionnaires pertaining to TAF, thought suppression and obsessive–compulsive symptoms. Covariances between the scores on these questionnaires were analyzed by means of structural equation modeling. Results suggest that TAF triggers thought suppression, while thought suppression, in turn, promotes obsessive–compulsive symptoms.

Assumptions underlying self-directed learning may be false (Article)

2000-04-01T00:00:00Z

Knowledge encapsulation and the intermediate effect (Article)

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.

Remembering the street names of one's childhood neighborhood: A study of very long-term retention (Article)

2000-01-01T00:00:00Z

Life-span retention of street names was studied in a sample of former students of a Dutch elementary school. Participants were requested to recall the street names of their childhood neighbourhood and indicate their position on a map. In addition, information was gathered concerning (a) the extensiveness of the original learning experience, (b) its elaborateness, and (c) the amount of interference from similar materials occurring between original learning experience and time of recall. Retention intervals varied from 0 to 71 years. Amount of exposure, elaborateness of learning, and retroactive interference all contributed to the memorability of names. In addition, the forgetting curve showed a permastore effect (Bahrick, 1984), suggesting that memory for non-schematic, incidentally learned material is subject to processes of forgetting similar to those that affect intentionally learned material, such as subject-matter acquired in school.

Hoe goed is ons geheugen? (Article)

2000-01-01T00:00:00Z

Het falen van ons geheugen geniet de laatste tijd meer belangstelling dan de goede kanten ervan. Ten onrechte, want zoals uit onderstaande bijdrage blijkt, kan ons geheugen ook verbluffende prestaties leveren. Daarnaast wordt betoogd dat ook het vergeten van zaken noodzakelijk is om goed te kunnen functioneren.

Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians (Article)

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.

Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: The Screen for Child Anxiety Related Emotional Disorders and the Spence Children's Anxiety Scale (Article)

2000-01-01T00:00:00Z

The Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Spence Children’s Anxiety Scale (SCAS) are recently developed self-report questionnaires for measuring DSM-IV defined anxiety disorder symptoms in children. The present study examined correlations among these measures in a large sample of Dutch school children (N=1011). Results showed that there was a strong correlation between the total anxiety scores of these instruments (r=0.89). Furthermore, most of the SCARED subscales were found to be convincingly connected to their SCAS counterparts. Finally, a confirmatory factor analysis revealed that SCARED and SCAS anxiety disorder subscales loaded uniquely on separate but intercorrelated factors (i.e., the DSM-IV anxiety disorder categories). These findings can be taken as evidence for the concurrent validity of the SCARED and the SCAS. Although these measures were developed independently, they seem to measure highly similar constructs, viz anxiety symptoms which can be clustered into the anxiety disorder categories as described in the DSM-IV.

A taxonomy of community-based medical education (Article)

2000-01-01T00:00:00Z

The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs.

"Thought-action fusion" en suppressie: Een model voor obsessieve-compulsieve symptomen (Article)

2000-01-01T00:00:00Z

In onderzoek is gebleken dat klinische obsessies en compulsies inhoudelijk niet verschillen van alledaagse intrusies en rituelen. De verschillen tussen beide betreffen veeleer kenmerken als frequentie, ervaren weerzin en opgeroepen weerstand. De verklaring van dergelijke verschillen in afwezigheid van een inhoudelijk onderscheid lijkt vooral te zijn gelegen in twee psychologische fenomenen. Ten eerste wordt verondersteld dat overdreven interpretaties van intrusies (samen te vatten in het concept thought-action fusion [taf]) leiden tot intensivering van obsessieve-compulsieve symptomen. Op de tweede plaats lijkt gedachtenonderdrukking (suppressie) te resulteren in meer, in plaats van minder, obsessieve-compulsieve symptomen. De potentiële interacties tussen taf en suppressie zijn nog niet in kaart gebracht. In het huidige onderzoek werd een poging ondernomen om te achterhalen of en op welke manier taf en suppressie samengaan in de ontwikkeling van obsessieve-compulsieve symptomen. Daartoe vulde een groep studenten (N = 173) verschillende vragenlijsten in. De data werden geanalyseerd met behulp van structural equation modelling. Uit de analyse volgde grosso modo dat taf aanleiding geeft tot suppressie, terwijl suppressie vervolgens leidt tot obsessieve-compulsieve symptomen.

Disgust sensitivity, trait anxiety, and anxiety disorders symptoms in normal children (Article)

1999-10-01T00:00:00Z

There is evidence to suggest that disgust sensitivity plays a role in the development of small animal fears and phobias. Recently, Phillips, Senior, Fahy, and David (1998) [Phillips, M. L., Senior, C., Fahy, T., and David, A. S. (1998). Disgust: the forgotten emotion of psychiatry. British Journal of Psychiatry, 172, 373–375.] suggested that disgust sensitivity is also involved in various other anxiety-based symptoms (e.g. obsessive–compulsive complaints, social phobia). The present study sought to test this suggestion in a large sample of normal school children (N=189). Children completed a measure of disgust sensitivity, the trait anxiety version of the Spielberger State-Trait Anxiety Inventory for Children and the Screen for Child Anxiety Related Emotional Disorders, an instrument that measures DSM-defined anxiety disorders symptoms. Disgust sensitivity was indeed found to be correlated with a broad range of anxiety disorders symptoms. However, results also indicated that these correlations were predominantly carried by trait anxiety. That is, when controlling for levels of trait anxiety, only specific phobia symptoms (including animal phobia, blood–injection–injury phobia and situational–environmental phobia) and separation anxiety disorder symptoms were significantly related to disgust sensitivity, although correlations were rather modest. Taken together, these findings cast doubts on the claim that disgust sensitivity is an unique and independent factor that contributes to a broad range of anxiety disorders.

The structure of specific phobia symptoms among children and adolescents (Article)

1999-09-01T00:00:00Z

Previous research [Frederikson, M., Annas, P., Fisher, H. and Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research and Therapy, 34, 33–39.] has shown that specific phobia symptoms of adults cluster into three subtypes: animal phobia, blood-injection-injury phobia and environmental–situational phobia. The present study examined whether these specific phobia subtypes can also be found in children. 996 children aged between 7 and 19 years completed a brief questionnaire regarding the frequency with which they experienced specific phobia symptoms. Confirmatory factor analysis was employed to examine the structure of these data. Results showed that childhood specific phobia symptoms indeed cluster into the three subtypes as described by Frederikson et al. and that these subtypes are either intercorrelated or the product of a single higher order factor. This structure appeared to be largely invariant across genders and age groups.

The explanation of medical concepts by expert physicians, clerks and advanced students (Article)

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.

The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): Factor structure in normal children (Article)

1999-01-01T00:00:00Z

The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R) is a self-report questionnaire that measures symptoms of DSM-IV linked anxiety disorders in children. The present study examined the factor structure of the SCARED-R in a sample of 674 normal Dutch school children aged 8 to 13 years. Exploratory factor analysis (principal components with oblimin rotation) clearly pointed in the direction of a 1-factor solution, suggesting that when applied to samples of normal children, the SCARED-R is a unidimensional measure. Additional exploratory and confirmatory factor analyses carried out on parts of the SCARED-R provided some support for the presence of the following factors: panic disorder, generalized anxiety disorder, separation anxiety disorder, school phobia, social phobia and three types of specific phobias. Implications of these findings for the use of the SCARED-R are briefly discussed.

Student assessment in community settings: a comprehensive approach (Article)

1998-05-06T00:00:00Z

Student assessment in community settings presents problems for medical teachers, e.g. difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0.77 and 0.92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.

The role of illness scripts in the development of medical diagnostic expertise: Results from an interview study (Article)

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.

A failure to reproduce the intermediate effect in clinical case recall (Article)

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.

Assessing students in community settings: the role of peer evaluation (Article)

1998-01-01T00:00:00Z

The assessment of students in community settings faces unique difficulties. Since students are usually posted in small groups in different community settings and since the learning (largely) takes place outside the classroom, assessing student performance becomes an intrinsically complex endeavor. In this article, the proposition is made and tested that peers may be used to accurately assess particular aspects of performance, in particular those which need extensive and close observation. Examples are: Effort displayed while working in a community, quality of the interaction with that community, display of leadership, and subject-matter contributions.

A review of problem-based learning: Perceptions of the students and tutors at the United Arab Emirates University (Article)

1998-01-01T00:00:00Z

Measuring knowledge and clinical reasoning skills in a problem-based curriculum (Article)

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.

Improving clinical education through evaluation (Article)

1997-01-01T00:00:00Z

Although clinical clerkships are an important and essential part of any medical training program, medical schools' policy makers seem to exert little control on the educational effectiveness of clerkships. However, educational quality of clerkships may be assured and improved by using information from evaluation. The success of the usefulness of evaluation results is clearly associated with the fulfilment of a number of conditions: willingness to adopt a critical attitude, willingness to analyse the existing situation, opportunities to discuss and carry on a dialogue, availability of a plan of action and continuous collection of evaluative data. This paper describes these conditions and the way in which they were translated in the context of clinical clerkships.

Drie factoren die verhinderen dat mensen zelfstandig leren kennis verwerven (Article)

1997-01-01T00:00:00Z

Problem based learning: Cognitive and metacognitive processes during problem analysis (Article)

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.

Effects of tutor expertise on student performance in relation to prior knowledge and level of curricular structure (Article)

1996-09-01T00:00:00Z

The influence of medical expertise, case typicality and illness script component on case processing and disease probability estimates (Article)

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.

The development of diagnostic competence: A comparison between a problem-based, an integrated, and a conventional medical curriculum (Article)

1996-01-01T00:00:00Z

Construeren van probleemtaken voor probleemgestuurd leren (Article)

1996-01-01T00:00:00Z

The advantages of problem-based curricula (Article)

1996-01-01T00:00:00Z

Inzichten over leren en implicaties voor het onderwijs (Article)

1996-01-01T00:00:00Z

Assessment and validation of diagnostic interviewing skills for mental health professions (Article)

1995-11-09T00:00:00Z

A behavioral test was developed to assess the quality of diagnostic interviewing skills of (future) mental health professionals. Two aspects of diagnostic interviewing ability are distinguished: process skills, reflecting the interpersonal and communication skills; and content skills, referring to the information-gathering ability of the interviewer. It was found that diagnostic interviewing can be reliably measured with respect to interrater reliability. However, interviewer performance on one case proved to be a poor predictor of performance on other cases. It was concluded that a large number of cases is required to obtain reliable scores of general diagnostic interviewing ability. Validity was supported by the correlational analyses. Process skills were strongly related to patient satisfaction, whereas content skills were related to the amount of relevant information given by the patient and the accuracy of the diagnostic formulation and treatment plan.

What makes a tutor effective? A structural equations modelling approach to learning in problem-based curricula (Article)

1995-01-01T00:00:00Z

Theory-Guided Design of a Rating Scale for Course Evaluation in Problem-Based Curricula (Article)

1995-01-01T00:00:00Z

Knowledge development and restructuring in the domain of medicine; the role of theory and practice (Article)

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.

Effects of quantity of instruction on time spent on learning and achievement (Article)

1995-01-01T00:00:00Z

Probleemgestuurd leren: een krachtige leeromgeving (Article)

1995-01-01T00:00:00Z

Problem-based learning: An introduction (Article)

1995-01-01T00:00:00Z

Peer versus staff tutoring in problem-based learning (Article)

1994-07-01T00:00:00Z

Effects of student versus staff tutoring on student learning in a problem-based, health sciences curriculum were studied. Academic achievement of 334 tutorial groups guided by staff tutors was compared with achievement of 400 groups guided by student tutors. In addition, students rated their tutor''s performance on four behaviors considered critical to facilitating student learning. Overall, students guided by a staff tutor achieved somewhat better. In terms of practical significance, the difference was, however, fairly small. Staff tutors were rated as more knowledgeable and their contributions as more relevant. In addition, they asked stimulating questions to a larger extent. However, an interaction effect was found between the ratings and the year of study: Peer tutors displayed the supportive behaviors more extensively in the first year, whereas staff tutors'' ratings were higher as the curriculum advanced. These results were interpreted in terms of the cognitive congruence framework.

Facilitating small-group learning: A comparison of student and staff tutors' behavior (Article)

1994-07-01T00:00:00Z

This study focused on students' observations of student and staff tutors' behavior during two academic courses, using a thirtynine-item rating scale. The study took place within an integrated problem-based law curriculum. Six major factors in tutors' behavior were identified. Differences between student and staff tutors' performance were investigated. The results showed that student tutors were better at understanding the nature of the problems students face in attempting to master the subject-matter. Student tutors were also more interested in students' daily lives, study experiences and personalities. In addition, student tutors referred to end-of-course examinations more frequently than staff tutors to direct student learning. Alternatively, staff tutors used their subject-matter expertise more often and displayed more authoritarian behavior than student tutors. No differences were found with respect to tutors' focus on cooperation among group members. The results are interpreted in terms of the nature of the knowledge and experiences of students and staff with regard to problem-based learning and its requirements.

The relationship between student-generated learning issues and self-study in problem-based learning (Article)

1994-07-01T00:00:00Z

A major assumption of problem-based learning (PBL) is that learning issues, generated by students while discussing a problem, are used as guides for self-directed learning activities. This assumption, though basic to PBL, has never been tested. At the University of Limburg, the Netherlands, two procedures have been developed that reflect the extent to which students are able to identify important learning issues given a particular problem, and whether subsequent, independent, learning corresponds with these learning issues. The focus of the present article will be on the relationship between the two. We have explored to what extent student-generated learning issues are a major factor influencing the nature of students' self-study, or whether other factors may be involved in decisions on what to study and how much time to spend on topics selected. First, the production of learning issues was studied and represented as the percentage of overlap between learning issues raised by students and pre-set faculty objectives for each problem. The second procedure consisted of the administration of a 'Topic Checklist' (TOC) which purports to measure students' actual self-directed learning activities. The TOC consists of a list of topics specifying the intended course content. Students were asked to indicate on a five-point Likert scale how much time they had spent studying each topic and to what degree they had mastered that topic. Third, learning issues and TOC topics were compared directly in a qualitative sense. Comparisons between the procedures revealed that a low proportion of variance of TOC scores could be predicted from the percentage of faculty objectives identified for each problem and the direct match between learning issues and TOC scores. It is concluded that scrutinizing student-generated learning issues and topics covered during self-study may provide information about what content is covered by students in tutorial groups. The discrepancy between the results of the measurements suggests, however, that learning issues produced during group discussion are not the sole source on which students base self-study decisions. Several other factors may be involved, such as tutor guidance, content already covered in previous units, issues raised during sessions with resource persons, and the nature of the learning resources available. Therefore, the relationship between learning issues and content covered during self-study is not as straightforward as is suggested.

Resolving inconsistencies in tutor expertise research: Does lack of structure cause students to seek tutor guidance? (Article)

1994-01-01T00:00:00Z

Purpose. To investigate under what conditions tutors' subject-matter expertise influences student achievement. Method. Data were analyzed from 1,800 University of Limburg Faculty of Health Sciences students who in 1989- 90 participated in tutorial groups led by content-expert staff tutors, non- expert staff tutors, or student tutors. Each student participated in an average of 4.1 tutorial groups. Overall, 4,111 data records were available for analysis. The basic analyses were of (1) students' achievement scores as a function of tutors' levels of subject-matter expertise and students' prior knowledge; (2) students' achievement scores as a function of tutors' levels of subject-matter expertise and educational units' levels of structure; and (3) differences in achievement between students guided by tutors of different levels of expertise in either high- or low-structure units. Statistical methods included analyses of variance. Results. The level of subject-matter expertise of tutors had a positive influence on student achievement. Similar results were found for the students' prior knowledge and the levels of structure of the units; the more prior knowledge students had the better were their performances on the end-of-unit test; and the higher the level of structure of the unit, the better the achievement. More important, interactions were found between tutor expertise on the one hand and prior knowledge and unit structure on the other, tutor expertise being mainly important if the unit was poorly structured or students reported lack of prior knowledge. Conclusion. The results suggest that students need a minimum level of structure in order to profit from problem-based instruction. This structure can be internally provided through prior knowledge available for understanding the new subjects, or offered by the environment in the form of cues of what is relevant and what should be the focus of the activities. If prior knowledge falls short, or if the environment lacks structure, students will turn to their tutors for help and direction. Under those conditions, students who are guided by a subject-matter expert tutor may benefit more than students guided by a non-expert staff tutor or by a student tutor. These findings may explain the widely divergent results of tutor-expertise research.

Effects of staff and student tutors on student achievement (Article)

1994-01-01T00:00:00Z

A brief narrative description of the journal article, document, or resource. A study at the University of Maastricht (Netherlands) law school found that students (n=200) tutored by other students showed improved academic achievement as high as those (n=207) taught by staff tutors. Data were gathered from overall assessment of essay question responses and a more elaborate propositional analysis of a sample of responses.

A rating scale for tutor evaluation in a problem-based curriculum: Validity and reliability (Article)

1994-01-01T00:00:00Z

An instrument has been developed to assess tutor performance in problem-based tutorial groups. This tutor evaluation questionnaire consists of 13 statements reflecting the tutor's behaviour. The statements are based on a description of the tasks set for the tutor. This study reports results on the validity and reliability of the instrument. Confirmatory factor analysis showed that a three-factor model fitted the data reasonably well. The three factors are: (1) guiding students through the learning process, (2) content knowledge input, and (3) commitment to the group's learning. Generalizability studies indicated that the rating scales provide reliable information with student responses of existing tutorial group sizes. It is concluded that the tutor evaluation questionnaire is a fairly valid and reliable instrument that can be used in staff development programmes.

What drives the student in problem-based learning? (Article)

1994-01-01T00:00:00Z

In problem-based learning, the development of self-directed learning skills is encouraged through confronting students with (professional) problems. However, several other elements of a problem-based curriculum, such as general teaching objectives, lectures and tutors, may have an impact on students' actual learning activities. The present study focuses on the extent to which various elements of a problem-based curriculum influence students' decisions on what to study. First, interviews were conducted to obtain qualitative data about what actually takes place when students initiate learning activities during self-study. Based on the findings of these interviews, a questionnaire was developed, consisting of statements describing elements of the learning process and their influence on student learning. Elements included in the questionnaire were: the discussion in the tutorial group, content tested, course objectives, lectures, the tutor and reference literature. The students reported that all these elements may have an impact on decisions on what to study. Moreover, first-year students tend to rely more on the literature cited in the references list and content covered in lectures and tests than students in the other three curriculum years. In general, the influence of these elements showed a decrease over the four curriculum years. The influence of the discussion in the tutorial group, on the contrary, tended to increase over the four curriculum years. These findings suggest that students in a problem-based curriculum become more accomplished self-directed learners over the four curriculum years, even although they are provided with many clues which may play a role in their decisions on what to study.

Use of student-generated learning issuses to evaluate problems in a problem-based curriculum (Article)

1994-01-01T00:00:00Z

Course content coverage as a measure of instructional quality (Article)

1993-12-03T00:00:00Z

In order to measure instructional quality, several methods have been proposed in the literature, among them student performance on achievement tests and student ratings of the quality of instruction. Both methods have in common that they tend to ignore course content coverage, although this is an important determinant of instructional quality. In this article a procedure is described which is used to assess students' actual learning activities. This procedure, the Topic Checklist, makes use of student ratings. Reliability, validity, and utility studies were conducted. The results suggest that the Topic Checklist is a reliable and fairly valid procedure to evaluate course content coverage and to detect problem areas in a course, providing feedback useful for carrying out improvements.

On acquiring expertise in medicine (Article)

1993-09-01T00:00:00Z

Foundations of problem-based learning: Some explanatory notes (Article)

1993-09-01T00:00:00Z

The present article elaborates on cognitive effects of problem-based learning put forward by Schmidt, De Volder, De Grave, Moust & Patel (1989) and Norman & Schmidt (1992). Its purpose is to discuss, in some detail, the theoretical premises of this approach to learning and instruction. It is argued that problem-based learning, above all, promotes the activation of prior knowledge and its elaboration. Evidence is reviewed demonstrating that these processes actually occur in small-group tutorials and that the processing of new information is indeed facilitated by discussion of a relevant problem. These effects must be attributed to a reorganization taking place in the knowledge structures of students as a result of problem-oriented study. In addition, a cognitive process called epistemic curiosity (or intrinsic interest) is enabled. Some directions for further research are outlined. The contribution starts, however, with a discussion of the philosophical and pedagogical roots of problem-based learning.

On the origin of intermediate effects in clinical case recall (Article)

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.

De ontwikkeling van expertise in verschillende domeinen: inleiding (Article)

1993-01-01T00:00:00Z

Kennisencapsulatie (Article)

1993-01-01T00:00:00Z

Influence of tutors' subject-matter expertise on student effort and achievement in problem-based learning (Article)

1993-01-01T00:00:00Z

Purpose. To investigate the effects of tutors' subject-matter expertise on students' levels of academic achievement and study effort in a problem-based health sciences curriculum. Also, to study differences in turors' behaviors and the influences of these differences on students' performances. Method. Data were analyzed from 336 staff-led tutorial groups involving student participants in seven four-year undergraduate programs at the University of Limburg Faculty of Health Sciences in 1989-90. Overall, 1,925 data records were studied, with each student participating in an average of 1.7 groups led by either content experts or non-experts. The basic analyses were of (1) students' achievement scores as a function of tutors' expertise levels and students' curriculum year; (2) students' estimates of self-study time as a function of tutors' expertise levels and students' curriculum year; and (3) the average ratings of the tutors' behaviors as a function of tutors' expertise levels. Statistical methods included analysis of variance and Pearson correlations. Results. The students guided by subject-matter experts were shown to spend more time on self-directed study, and they achieved somewhat better than did the students guided by non-expert tutors. The effect of subject-matter expertise on achievement was strongest in the first curriculum year, suggesting that novice students are more dependent on their tutors' expertise than are more advanced students. Also, the content-expert tutors made more extensive use of their subject-matter knowledge to guide students. However, in addition to the tutors' knowledge-related behaviors, the tutors' process-facilitation skills affected student achievement. Moreover, these two sets of behaviors were correlated, indicating that both are necessary conditions for effective tutoring. Conclusion. The results indicate that, at least for the curriculum studied, the assumption in the literature that tutors do not necessarily need content knowledge so long as they are skilled in the tutoring process is not entirely justified: the students who were guided by content experts achieved somewhat better and spent more time on self-directed learning. More important, tutoring skill and content knowledge seemed to be necessary and closely related conditions for effective tutoring.

Effects of Mobilising Prior Knowledge on Information Processing: Studies of Free Recall and Allocation of Study Time (Article)

1993-01-01T00:00:00Z

Problem effectiveness in a course using problem-based learning (Article)

1993-01-01T00:00:00Z

Background. Problem-based learning (PBL) emphasizes active generation of learning issues by students. Both students and reachers, however, tend to worry that not all important knowledge will be acquired. To explore this question, problem effectiveness (i.e., for each problem, the degree of correspondence between student-generated learning issues and preset faculty objectives) was examined in three interdependent studies. Method. The three studies used the same participants: about 120 second-year students and 12 faculty tutors in a six-week course on normal pregnancy, delivery, and child development at the medical school of the University of Limburg in The Netherlands, 1990-91. The participants were randomly assigned to 12 tutorial groups that were each given the same 12 problems; the problems were based on 51 faculty objectives; the tutors were asked to record all learning issues generated by their groups. Study 1 addressed this question: To what degree are faculty objectives reflected by student-generated learning issues? Study 2: To what extent do students miss certain objectives, and are these objectives classifiable? Study 3: Do students generate learning issues not expected by the faculty, and are these issues relevant to course content, and finally, why do students generate these issues? To help answer these questions, the studies employed expert raters and a teacher familiar with the course content. Results. Study 1: For the set of 12 problems, the average overlap between learning issues and faculty objectives was 64.2%, with the percentages for individual problems ranging from 27.7% to 100%. Study 2: Of the 51 objectives, 30 were not identified by at least one tutorial group; these objectives were grouped into three categories; on average, each group failed to identify 7.4 objectives (15%). Study 3: Of 520 learning issues, 32 (6%) were unexpected; 15 of these were judged to be at least fairly relevant to course content; they were grouped into four categories. Conclusions. The students' learning activities covered an average of 64% of the intended course content; in addition, the students generated learning issues not expected by the faculty, and half of these issues were judged relevant to the course content. Thus, PBL seems to permit students to adapt learning activities to their own needs and interests.

Kennisontwikkeling en onderwijs in de geneeskunde: een subtiel evenwicht (Article)

1993-01-01T00:00:00Z

Kennisstructuur en hypothesevorming; verschillen tussen beginners en experts in de geneeskunde (Article)

1993-01-01T00:00:00Z

Investeren in instructietijd: spaarzaamheid loont de moeite (Article)

1993-01-01T00:00:00Z

Het verwerven van expertise in complexe domeinen: Accountancy, geneeskunde en psychiatrische diagnostiek (In Book)

1993-01-01T00:00:00Z

Optimalisering van het onderwijsleerproces in probleemgestuurd onderwijs (In Book)

1993-01-01T00:00:00Z

Comparing problem-based with conventional education: A review of the University of Limburg medical school experiment (Article)

1992-01-01T00:00:00Z

The psychological basis of problem-based learning: A review of the evidence (Article)

1992-01-01T00:00:00Z

On the Role of Biomedical Knowledge in Clinical Reasoning by Experts, Intermediates and Novices (Article)

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.

Network of community-oriented educational institutions for the health sciences for the health sciences (Article)

1991-01-01T00:00:00Z

Ontwikkeling van een vaardigheidstoets voor het anamnestisch interview in de geestelijke gezondheidszorg (In Book)

1991-01-01T00:00:00Z

A Cognitive Perspective on Medical Expertise: Theory and Implications (Article)

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.

Clinical inquiry and scientific inquiry (Article)

1990-01-01T00:00:00Z

Effectiever leren door het activeren van voorkennis (Article)

1990-01-01T00:00:00Z

Innovative and conventional curricula compared: What can be said about their effects? (In Book)

1990-01-01T00:00:00Z

Development and Evaluation of a Causal Model of Problem-Based Learning (In Book)

1990-01-01T00:00:00Z

Perceived workload as an indicator for the quality of instruction, the case of Maastricht (In Book)

1990-01-01T00:00:00Z

Construction of problems for problem-based learning (In Book)

1990-01-01T00:00:00Z

Activatie van voorkennis en tekstverwerking (In Book)

1990-01-01T00:00:00Z

Biomedical knowledge and clinical expertise (In Book)

1990-01-01T00:00:00Z

Over het verwerven van medische expertise (In Book)

1990-01-01T00:00:00Z

Explanatory models in the processing of science text: The role of prior knowledge activation through small-group discussion (Article)

1989-01-01T00:00:00Z

Two experiments assessed effects of activation of prior knowledge through small-group discussion. Subjects were given a description of natural phenomena and were asked to elaborate on possible explanations for them. In Experiment 1, small groups of subjects were presented with a problem describing the behavior of a blood cell in pure water and in a salt solution. No additional text was studied. The experimental subjects produced more than twice as many propositions about osmosis (i.e. the biological process explaining the blood cell's behavior) as a control group produced. Experiment 2 investigated effects of problem analysis on subsequent text processing for subjects with imprecise prior knowledge (novices) and subjects with precise knowledge (experts). Recall of the text showed considerable facilitative effects of problem analysis. Results are explained in terms of faster accessibility of prior knowledge and better integration of new information into explanatory models that may exist before, or are actively constructed during, problem analysis.

Theoretische en empirische grondslagen van probleemgestuurd onderwijs (In Book)

1989-01-01T00:00:00Z

Opsporen van misconcepties bij middelbare scholieren (Article)

1988-01-01T00:00:00Z

The relationship between the development of medical knowledge and the solving of problems (Article)

1988-01-01T00:00:00Z

Medical education (Letter To Editor)

1988-01-01T00:00:00Z

De invloed van ervaring op diagnostische prestaties van huisartsen (Article)

1988-01-01T00:00:00Z

Comparing the effects of problem-based and conventional curricula in an international sample (Article)

1987-01-01T00:00:00Z

Educational outcomes of innovative versus conventional medical curricula: a review (Article)

1987-01-01T00:00:00Z

Waarom zijn studievaardigheidscursussen zo weinig effectief (Article)

1987-01-01T00:00:00Z

Contextual factors in the activation of first diagnostic hypotheses: Expert-novice differences (Article)

1987-01-01T00:00:00Z

Effects of verbal participation in small-group discussion on learning (In Book)

1987-01-01T00:00:00Z

Effecten van verschil in verbale deelname aan de discussie in kleine groepen op leerprestaties (In Book)

1987-01-01T00:00:00Z

Sturing van het onderwijsleerproces door middel van problemen: een veldexperiment (Book)

1986-01-01T00:00:00Z

Problem-based-learning and intrinsic motivation (In Book)

1986-01-01T00:00:00Z

Hoe betrouwbaar is de redactie van De Psycholoog (Article)

1985-01-01T00:00:00Z

Wat bewijst Wilbrink eigenlijk (Article)

1985-01-01T00:00:00Z

Een positief verband tussen studiejaar en tentamenresultaat, en de rol van toenemende voorkennis (Article)

1984-01-01T00:00:00Z

Problem-based learning: rationale and description (Article)

1983-01-01T00:00:00Z

Problem-based learning is an instructional method that is said to provide students with knowledge suitable for problem solving. In order to test this assertion the process of problem-based learning is described and measured against three principles of learning: activation of prior knowledge, elaboration and encoding specificity. Some empirical evidence regarding the approach is presented.

Intrinsieke motivatie en studieprestatie: enkele verkennende onderzoekingen (Article)

1983-01-01T00:00:00Z

Problem-based learning in the Maastricht medical curriculum (In Proceedings)

1983-01-01T00:00:00Z

Leren oplossen van problemen in de 'exacte' vakken (Article)

1983-01-01T00:00:00Z

Klinisch denken: oefening baart kunst (Article)

1983-01-01T00:00:00Z

Activatie van voorkennis, intrinsieke motivatie en de verwerking van tekst (Doctoral Thesis)

1982-10-28T00:00:00Z

Een training in het werken in taakgerichte groepen (Article)

1982-01-01T00:00:00Z

Persoonlijke Psychologie (Article)

1982-01-01T00:00:00Z

Medical education in action: Community-based experience and service in Nigeria (Article)

1982-01-01T00:00:00Z

Studiebeleving van Maastrichtse medische studenten (Article)

1982-01-01T00:00:00Z

Maastrichtse medische studenten blijken alleszins tevreden met het onderwijs dat zij genieten. De mogelijkheid veelsoortige praktische ervaring op te doen is aan dat gunstige oordeel niet vreemd. H. G. Schmidt en J. H. C. Moust van de capaciteitsgroep Onderwijsontwikkeling en Onderwijsresearch aan de Rijksuniversiteit Limburg geven een aanvulling op eerder aan een conventionele medische faculteit verricht onderzoek naar de ervaringen van studenten.

Activation and restructuring of prior knowledge and their effects on text processing (In Book)

1982-01-01T00:00:00Z

Tutor: inhoudsdeskundige of procesbegeleider (In Book)

1982-01-01T00:00:00Z

De trekkentheorie is terug van weggeweest (Article)

1980-01-01T00:00:00Z

Training in empathie, een gedragsanalytische benadering (Article)

1979-01-01T00:00:00Z

Opnieuw de arts-patiënt-relatie (Article)

1977-01-01T00:00:00Z

Gevalsbeschrijving bij Sigmund Freud (Article)

1976-01-01T00:00:00Z

An individualised learning system for interviewing techniques (Miscellaneous)

1976-01-01T00:00:00Z