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Biomedical subjects

Henk G Schmidt

Publications and source records attributed to Henk G Schmidt.

At least 19 recordsLinked to original sources
PubMed2026

Premature closure underlies bias in medical diagnosis in students: A randomised controlled experiment.

OBJECTIVE: The purpose of the study reported in this article was to shed light on the cognitive mechanism mediating between biasing information and diagnostic error. The literature suggests at least two different hypotheses: premature closure leading biased participants to spend less time on diagnosis or increased competition between diagnostic hypotheses. The latter hypothesis predicts that biased participants would spend more time reaching a diagnosis. METHOD: Using the salient distracting findings (SDF) experimental paradigm, we biased 58 fourth-year medical students while diagnosing 12 clinical vignettes in a within-group incomplete block design under three conditions: cases presented without SDF, with SDF at the beginning and with SDF at the end. For each of these conditions, diagnostic accuracy, the number of SDF-related mistakes and time per word needed to process the case were recorded. The data were analysed using linear mixed modelling. Estimated marginal mean scores were reported. RESULTS: Participants confronted with salient distracting features (SDFs) at the beginning of a clinical case demonstrated significantly lower diagnostic accuracy (mean 0.11) compared with the No-SDF condition (0.27), representing a 61% reduction (F2,693&#x2009;=&#x2009;11.995, p&#x2009;<&#x2009;0.001), and made more SDF-related mistakes (F2, 693&#x2009;=&#x2009;16.395, p&#x2009;<&#x2009;0.001). When SDFs were presented at the end of the case, diagnostic accuracy was also reduced (mean 0.17; 36% reduction), but processing time did not differ from the No-SDF condition. Only early presentation of SDFs was associated with reduced processing time per word (F2,636&#x2009;=&#x2009;4.799, p&#x2009;<&#x2009;0.01), consistent with premature closure. CONCLUSION: These findings demonstrate that biasing information increases diagnostic error in medical students and that only early bias is associated with reduced information processing. The data do not support the competition hypothesis for early bias, as processing time did not increase under biasing conditions. Premature closure can therefore be directly observed rather than inferred, inviting further research.

Humans↗
PubMed2006

What do we know about cognitive and motivational effects of small group tutorials in problem-based learning?

Students collaborating in small groups is a characteristic of problem-based learning (PBL) that is receiving increased consideration in the literature. In this paper findings from studies in this area are synthesized and discussed. A distinction is made between studies focusing on cognitive effects of group learning and studies focusing on motivational effects of group learning. Studies concentrating on the cognitive effects of small-group PBL seem to demonstrate that activation of prior knowledge, recall of information, causal reasoning or theory building, cognitive conflicts leading to conceptual change and collaborative learning construction take place in the tutorial group. Studies focusing on the motivational effects of PBL demonstrate that group discussion positively influences students' intrinsic interest in the subject matter under discussion. The studies also demonstrate that a haphazard discussion in the tutorial group or a discussion that just scratches the surface, probably caused by students being less motivated, inhibits student learning. Several studies are reported providing suggestions on how to optimize group work in PBL. Although the studies demonstrate that group learning in PBL may have positive effects, much more research is needed to obtain more evidence and deeper insight in the cognitive and emotional effects of small group learning in PBL.

Cognition↗
PubMed2006

Students' conceptions of constructivist learning: a comparison between a traditional and a problem-based learning curriculum.

This study investigated students' conceptions of constructivist learning activities in a problem-based learning (PBL) and a traditional curriculum. We examined whether students who have chosen for a problem-based curriculum have different conceptions of constructivist assumptions compared to students who have chosen to be enrolled in a traditional, lecture-based curriculum when they enter university. Although constructivism represents an influential view of learning, studies investigating how students conceptualize this perspective have not been conducted before. A structural equation modelling approach was adopted to test the hypothesized model in both student populations and to calculate latent means. Results suggested that students in the PBL environment agree more on constructivist assumptions of cooperative learning and the use of authentic problems, while students in the traditional curriculum acknowledge the importance of motivation to learn more. It is discussed that conceptions of constructivist learning activities can act as an important moderator of PBL effects and should be considered in examining the effects of PBL and probably in all comparative education research.

Adult↗
PubMed2006

Innovations in problem-based learning: what can we learn from recent studies?

This article aims at discussing the six papers included in this special issue on innovations in Problem-based learning (PBL). The papers address different aspects related to the implementation and the development of PBL. This discussion article highlights the relevance of the theme explored by each of the papers, the contributions emerging from the study to what is already known about that topic, and its limitations, particularly those that suggest directions for future research. Emphasis is given to new insights brought by the papers for better understanding tutorial group processes and self-study phase in PBL. The contributions provided by the papers are discussed in the light of pertinent literature and also in relation to their companion articles in this issue when indicated.

Cooperative Behavior↗
PubMed2006

Clinical competence: general ability or case-specific?

BACKGROUND: 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." PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Clinical Clerkship↗
PubMed2006

Effectiveness of a training programme for primary care physicians directed at the enhancement of their psychiatric knowledge in Saudi Arabia.

OBJECTIVE: A substantial number of patients with psychiatric disorders consult primary care physicians for comprehensive health care; however, the diagnosis and effective treatment of psychiatric disorders are deficient in primary health care. The aim of this intervention study is to assess the pre- and post-psychiatric training knowledge of primary care physicians. METHOD: The setting of this study was Buraidah Mental Health Hospital. The research design consisted of a pre- and post-test comparison of physicians' responses (n = 70) with a control group (n = 40). The instrument includes a Knowledge Test comprised of 50 questions on primary care psychiatry. RESULTS: There were no significant differences between the intervention and control groups with regard to several confounding sociodemographic variables, but physicians' age and duration of medical practice were significantly higher in the control group. There were significant differences between knowledge of intervention and controls prior to psychiatric training and this difference was further highly significant post-psychiatric training. The gain in knowledge of intervention group post-psychiatric training was highly significant as compared to pre-test knowledge but there was no difference in the knowledge of the control group. CONCLUSION: Psychiatric training courses can enhance physicians' knowledge in clinical psychiatry with possible psychiatric implications, including early diagnosis and better treatment of primary care patients with psychiatric problems.

Adult↗
PubMed2006

Influence of clerkship experiences on clinical competence.

BACKGROUND: Clerkship experiences are considered crucial for the development of clinical competence. Yet whether there is a direct relationship between the nature and volume of patient encounters and learning outcomes is far from clear. Some evidence in the literature points towards the importance of clinical supervision on student learning, but the relationship between clinical supervision, patient encounters and student competence remains unclear. OBJECTIVES: This study aimed firstly to determine the variation in students' clinical experiences within and across sites; secondly, to identify the causes of this variation, and thirdly, to investigate the consequences of this variation on students' competence. METHODS: Clerkship students at 12 hospital sites recorded their patient encounters in logbooks. Site characteristics that might influence the variation in patient encounters were collected. Student competence was determined by 3 independent indicators: a practical end-of-clerkship examination; a theoretical end-of-clerkship examination, and an evaluation of professional performance. A model was developed to test the available clerkship data using structural equation modelling (SEM) software. RESULTS: Analysis of the logbooks revealed a large variation in the number of patients encountered by students. The average length of patient stay, number of patients admitted, and quality of supervision accounted partly for this variation. An increased number of patient encounters did not directly lead to improved competence. Quality of supervision turned out to be crucially important because it directly impacted student learning and also positively influenced the number of patient encounters. CONCLUSION: Monitoring the effectiveness of clerkship by merely asking students to keep a tally of the problems and diseases they encounter, without paying attention to the quality of supervision, does not contribute towards improving student learning.

Clinical Clerkship↗
PubMed2006

Longterm effects of problem-based learning: a comparison of competencies acquired by graduates of a problem-based and a conventional medical school.

BACKGROUND: Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. PURPOSE: To study the longterm effects of problem-based medical training on the professional competencies of graduates. METHODS: A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. RESULTS: The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. CONCLUSION: The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice.

Adult↗
PubMed2005

Correlates of reflective practice in medicine.

BACKGROUND: The ability of physicians to critically reflect on their professional practice has been increasingly valued. Previous research brought to light the multidimensional structure of reflective practice in medicine. It comprises at least five sets of behaviours in response to complex medical problems encountered in professional practice. Factors associated to reflective practice among physicians have, as far as we know, not yet been explored by empirical study. PURPOSE: To study factors correlated to reflective practice among physicians. METHODS: A questionnaire exploring characteristics of professional practice and educational experiences was administered to primary health care physicians. Measurements were related to scores on a reflective practice measuring instrument developed previously. Associations between variables were examined by statistical analysis with tests of correlation and analysis of variance. RESULTS: Reflective practice is negatively correlated to physician's age and number of years of clinical practice. Working mainly in hospitals and attendance to medical residency programmes in some specialties apparently have a positive effect on reflective practice. CONCLUSION: Reflective practice tends to decrease with experience. Findings are consistent with the literature on medical expertise that shows a decline of analytical reasoning in proportion to the increase in experience. Some specialty programmes seems to enhance concerns with the scientific basis to professional practice, thereby favouring reflective approaches. Local features of primary health care settings probably explain their negative effect on reflective practice. Strategies to develop reflective practice among physicians should be explored by further research.

Adult↗
PubMed2005

Limitations to the spacing effect: demonstration of an inverted u-shaped relationship between interrepetition spacing and free recall.

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 learn 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 intentional-learning 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 two-factor model of spacing effects in free-recall tasks.

Humans↗
PubMed2005

The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.

PURPOSE: To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning. METHOD: In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning. RESULTS: Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately. CONCLUSION: The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Clinical Competence↗
PubMed2005

The role of biomedical knowledge in clinical reasoning: a lexical decision study.

PURPOSE: To investigate the role of biomedical and diagnostic inferences in clinical reasoning of advanced medical students and experienced family physicians using a lexical decision task. METHOD: In 2002, 15 family physicians and 20 fourth-year medical students at Maastricht University medical school in The Netherlands were instructed to carefully study 60 short clinical texts consisting of signs and symptoms associated with a particular disease. Participants read the texts on a computer screen and responded using a computer keyboard. Each text was followed by a target item (i.e., biomedical item, diagnostic item, or a nonword). Participants had to decide as quickly and accurately as possible whether the presented target item was a word or a nonword. For both groups, mean response time and mean error rate for all levels of item type were analyzed. RESULTS: Findings indicate that both physicians and medical students judged diagnostic target items faster and more accurately than biomedical target items. However, physicians were considerably faster than were students on judging biomedical and diagnostic target items. CONCLUSIONS: These findings are largely in line with knowledge encapsulation in that biomedical knowledge still plays a prominent role in the physician's clinical reasoning.

Adult↗
PubMed2005

Inducing expertise effects in clinical case recall.

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 OME 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.

Clinical Competence↗
PubMed2005

The effects of prior knowledge on study-time allocation and free recall: investigating the discrepancy reduction model.

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.

Cognition↗
PubMed2005

Retrieval-induced forgetting in implicit memory tests: the role of test awareness.

Retrieval practice with particular items in memory may result in decreased recall of different, semantically related, items. This retrieval-induced forgetting effect has been demonstrated in studies using explicit memory tests. Anderson and Spellman (1995) have attributed retrieval-induced forgetting to inhibitory mechanisms. This hypothesis predicts similar effects in implicit memory tasks. In our first experiment, using Anderson and Spellman's original paradigm, retrieval-induced forgetting was found using an explicit memory test with independent extralist retrieval cues. In our second experiment, using the same materials, retrieval-induced forgetting was also found using an implicit memory test with independent extralist retrieval cues, but only for participants who were aware of the relationship between the study and practice phase on the one hand, and the test phase of the experiment on the other. Thus, test awareness seems to mediate retrieval-induced forgetting in implicit memory tasks.

Awareness↗
PubMed2004

Detrimental influence of contextual change on spacing effects in free recall.

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.

Humans↗
PubMed2004

Case representation by medical experts, intermediates and novices for laboratory data presented with or without a clinical context.

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.

Clinical Competence↗