Biomedical subjects

L Schuwirth

Publications and source records attributed to L Schuwirth.

7 recordsLinked to original sources

PubMed2006

The acquisition of tacit knowledge in medical education: learning by doing.

AIM: This study was designed to assess medical school teachers' tacit knowledge of basic pedagogic principles and to explore the specific character of the knowledge base. METHODS: We developed a 50-item, multiple-choice question test based on important pedagogic principles, and classified all questions as requiring either declarative or procedural knowledge. A total of 72 medical teachers representing 5 different groups of clinicians and educators agreed to sit the test. RESULTS: Teachers in all 5 groups performed well on the test of tacit pedagogic knowledge but those with advanced education degrees, or local recognition as experts, performed best. All test takers performed best on questions requiring procedural knowledge. CONCLUSION: Medical teachers possess tacit knowledge of basic pedagogic principles. Superior test performance on questions requiring procedural knowledge is consistent with their working in a clinical environment characterised by repeated procedural activities.

Education, Medical↗

PubMed2005

The role of a computerised case-based testing procedure in practice performance assessment.

INTRODUCTION: For postgraduate training of doctors there is a need for valid and reliable instruments to assess their daily performance. Various instruments have been suggested, some of which use incognito simulated patients (SPs). These methods are resource intensive. Computerised Case-based testing (CCT) is logistically simpler and may still predict performance well. The research question was to evaluate the predictive validity of CCT for performance. METHODS: Seventeen rheumatologists were each visited by eight incognito SPs presenting various rheumatological complaints, and scoring the performance of the rheumatologists using a predefined checklist. From this checklist a panel of experts identified essential items. In addition the rheumatologists sat a CCT test containing 55 cases with a total of 121 items. RESULTS: Negative correlations were found between the SP scores and the CCT scores. This was unexpected. Therefore, background variables on experience were used to compare both methods. The correlation between these and CCT were high and positive and with the SP scores high and negative. This pattern did not differ when using the essential items of the checklist. Reliabilities of the SP scores were markedly high. DISCUSSION: Although CCT was not predictive of SP scores, it was related to working experience. There are good reasons to assume that although SP-scores were more authentic, they were less valid than CCT scores, mainly because they focussed more on thoroughness than on efficiency in data gathering. The results underpin the assumption that for valid performance assessment the most important issue is what information about the candidate is collected and now how authentic the method is.

Clinical Competence↗

PubMed2005

The use of qualitative research criteria for portfolio assessment as an alternative to reliability evaluation: a case study.

AIM: Because it deals with qualitative information, portfolio assessment inevitably involves some degree of subjectivity. The use of stricter assessment criteria or more structured and prescribed content would improve interrater reliability, but would obliterate the essence of portfolio assessment in terms of flexibility, personal orientation and authenticity. We resolved this dilemma by using qualitative research criteria as opposed to reliability in the evaluation of portfolio assessment. METHODOLOGY/RESEARCH DESIGN: Five qualitative research strategies were used to achieve credibility and dependability of assessment: triangulation, prolonged engagement, member checking, audit trail and dependability audit. Mentors read portfolios at least twice during the year, providing feedback and guidance (prolonged engagement). Their recommendation for the end-of-year grade was discussed with the student (member checking) and submitted to a member of the portfolio committee. Information from different sources was combined (triangulation). Portfolios causing persistent disagreement were submitted to the full portfolio assessment committee. Quality assurance procedures with external auditors were used (dependability audit) and the assessment process was thoroughly documented (audit trail). RESULTS: A total of 233 portfolios were assessed. Students and mentors disagreed on 7 (3%) portfolios and 9 portfolios were submitted to the full committee. The final decision on 29 (12%) portfolios differed from the mentor's recommendation. CONCLUSION: We think we have devised an assessment procedure that safeguards the characteristics of portfolio assessment, with credibility and dependability of assessment built into the judgement procedure. Further support for credibility and dependability might be sought by means of a study involving different assessment committees.

Clinical Competence↗

PubMed2004

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Delphi Technique↗

PubMed2004

Physical activity as measured by accelerometry in children receiving growth hormone.

AIM: Parents of children treated with growth hormone (GH) frequently report to the paediatrician that their children have become more physically active. In the present study, activity patterns of GH-treated children were measured and compared to those of healthy controls. METHODS: Subjects were 25 children at the start of GH treatment (age 8.4 +/- 2.6 y) and 19 age- and gender-matched controls (age 8.8 +/- 3.2 y). Physical activity was assessed with a tri-axial accelerometer for movement registration over two separate 2-wk intervals, one before the start of GH treatment and one 2 wk after the start of treatment. GH-treated subjects were categorized as poor responders (change in height over 1 y <0.7 SDS, n = 15) or good responders (change in height over 1 y >0.7 SDS, n = 10). RESULTS: Before therapy, good responders showed a significantly lower physical activity compared to healthy controls, spending significantly less time on high-intensity activities. This difference disappeared 2 wk after the start of therapy. Physical activity in poor responders was not significantly different from controls before and after 2 wk of GH therapy. CONCLUSION: Children who respond well to GH therapy (change in height >0.7 SDS) showed a reduced amount of physical activity before therapy, which was normalized after 2 wk of GH therapy.

Arginine↗

PubMed1996

An international comparison of knowledge levels of medical students: the Maastricht Progress Test.

The increasing international mobility of medical students has inspired the search for an international assessment format. As one step along this line, kinetics of knowledge acquisition and final cognitive levels of students were compared among one Dutch, one German and four Italian medical faculties. For this comparison, the Maastricht Progress Test (MPT) was used. For four out of the six participating faculties, it was possible to compare the level of knowledge of sixth-year students. These data showed no significant differences on the test as a whole. On the other hand, as judged from cross-sectional data on students from all study years, the kinetics of knowledge acquisition showed different trends. In one school applying problem-based learning, acquisition of knowledge by students occurred almost linearly. In another school, over the first 2 years, acquisition of knowledge occurred only in the basic sciences but not in clinical or public health/behavioural sciences. In two other schools over that same period, students seemed to gain no knowledge at all. In some faculties, a marked boost in knowledge was noted with third- or fourth-year students. These findings may be explained by peculiarities of the respective curricula, selection of students during their studies, and national or local assessment procedures. It is preliminarily concluded that the different educational approaches and assessment systems in medical education in Europe seem to have only limited influence on the final level of knowledge of the graduates. On the other hand, these differences may influence the kinetics of knowledge acquisition, especially in distinct domains like basic or clinical sciences. Therefore, the MPT may not be suitabe to solve the problem of assessment of individual international exchange students, but it may be helpful in identifying corresponding cognitive levels on, for example, basic sciences for students in different curricula.

Clinical Competence↗

PubMed1990

Simultaneous dislocation of both interphalangeal joints in a finger.

Unlike dislocations of the distal or proximal interphalangeal joints, the simultaneous dislocation in a single finger of both seems to be a rare occurrence. Reduction and checking of the collateral ligament, extensor tendon, and volar plate, followed by 3 weeks of splinting in the intrinsic plus position seems to be the treatment of choice.

Female↗