Biomedical subjects

Henk G Schmidt

Publications and source records attributed to Henk G Schmidt.

26 records · Page 2Linked to original sources

PubMed2004

The structure of reflective practice in medicine.

BACKGROUND: The capability to reflect consciously upon one's professional practice is generally considered important for the development of expertise and, hence, for education. However, to our knowledge no empirical research has been conducted to date into the nature of reflective practice in medicine. PURPOSE: To study the structure of reflective practice in medicine. METHODS: A questionnaire based on the literature was developed and administered to a group of primary care doctors. The data were subjected to confirmatory factor analysis using structural equations modelling. RESULTS: A 5-factor model of reflective practice emerged. It consisted of the following factors: deliberate induction; deliberate deduction; testing and synthesising; openness for reflection, and meta-reasoning. The model fitted the data sufficiently. CONCLUSION: A multidimensional structure of reflective practice in medicine was brought to light by the study. Its components in terms of reasoning processes, behaviours and attitudes were identified and measured among doctors. Once conceptualised and measured, reflective practice can be studied to gain a better understanding of its relation to expertise development in medicine. In addition, training students to apply reflective practices may become a goal in medical education.

Attitude of Health Personnel↗

PubMed2004

The role of encapsulated knowledge in clinical case representations of medical students and family doctors.

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.

Clinical Competence↗

PubMed2004

Memory load and the cognitive pupillary response in aging.

The effect of memory load on the cognitive pupillary response among 16 young adults and 16 older adults was investigated. Mean pupil dilation and reaction time were measured during a Sternberg memory-search task, which involved six levels of memory load. A classic interaction pattern was obtained in which the reaction times of the elderly participants increased more as a function of memory load than the reaction times of the young participants. In the encoding phase of the experiment, mean dilation increased with memory load. No age differences were observed here. In the search phase of the experiment, however, mean pupil dilation was considerably greater in the young than in the elderly participants. Moreover, mean dilation of the older participants was not sensitive to memory load, whereas mean dilation increased as a function of memory load in the young participants. The results suggest that the usefulness of the pupillary response as a correlate of subtle fluctuations in memory load diminishes with old age.

Adult↗

PubMed2003

The efficiency of multimedia learning into old age.

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. AIMS: This study investigated the extent to which age and instructional format had an impact on training efficiency among both young and old adults. It was hypothesised that studying worked examples that are presented as a narrated animation (multimedia condition) is a more efficient means of complex skill training than studying visually presented worked examples (unimodal condition) and solving conventional problems. Furthermore, it was hypothesised that multimedia-based worked examples are especially helpful for elderly learners, who have to deal with a general decline of working-memory resources, because they address both mode-specific working-memory stores. SAMPLE: The sample consisted of 60 young (mean age = 15.98 years) and 60 old adults (mean age = 64.48 years). METHODS: Participants of both age groups were trained in either a conventional, a unimodal, or a multimedia condition. Subsequently, they had to solve a series of test problems. Dependent variables were perceived cognitive load during the training, performance on the test, and efficiency in terms of the ratio between these two variables. RESULTS: Results showed that for both age groups multimedia-based worked examples were more efficient than the other training formats in that less cognitive load led to at least an equal performance level. CONCLUSION: Although no difference in the beneficial effect of multimedia learning was found between the age groups, multimedia-based instructions seem promising for the elderly.

Adolescent↗

PubMed2002

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

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.

Brazil↗

PubMed2002

Long-term retention of a theatrical script by repertory actors: the role of context.

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.

Adult↗

PubMed2002

The impact of a community-oriented medical school on mental health services.

This paper discusses the impact of the community-based medical school on mental health services. The Gezira mental health programme represents a collaborative work involving the university, the community and the government. It aims at achieving specified objectives: (1) to modify community concepts, attitudes and practices concerning mental health, (2) to ensure community involvement and participation, (3) to extend mental health services, (4) to train PHC staff, and (5) to encourage research. The programme was implemented in three phases: preparatory, implementation, and evaluation. In the evaluation of the impact of the programme on changing community attitudes, the training of staff, the extension of mental health services, and on research, qualitative assessment, through interviews, focus group discussion, supervision visits, and review of reports are used. There is an overall agreement that the programme helped in raising public awareness regarding the concept of mental health, the care of the mentally ill and community participation. Members of the health team who received training as part of the programme reported a better understanding of mental health problems and an improvement in their handling of the mentally disturbed patients. Teachers reported an increased awareness of mental health problems in school children and a better collaboration with those involved in the handling of such problems. Social workers and psychologists updated their knowledge and skills and were well prepared to participate in the programme. Members of the different sectors involved reported a better standard of collaboration regarding mental health activities. These findings indicate that this programme, by providing a new model for health services in this field, has induced a large policy change within the Sudan. The community-based activities at the FMUG have resulted in a major change in the delivery of mental health services in Gezira State. The programme has resulted in a major shift in mental health services being provided by central hospitals to PHC settings. In addition it has stimulated research, thereby providing much original information that will help in preparing for future plans.

Journal Article↗

PubMed2002

The robustness of medical expertise: clinical case processing by medical experts and subexperts.

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.

Cardiology↗