Biomedical subjects

Silvia Mamede

Publications and source records attributed to Silvia Mamede.

4 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 = 11.995, p < 0.001), and made more SDF-related mistakes (F2, 693 = 16.395, p < 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 = 4.799, p < 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

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↗

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↗

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↗