PubMed Health⌕ Search

Biomedical subjects

V L Patel

Publications and source records attributed to V L Patel.

At least 19 recordsLinked to original sources
PubMed1991

Effects of conventional and problem-based medical curricula on problem solving.

This study examined the reasoning processes of beginning, intermediate, and senior students in two medical schools with different curricular formats. One school had a conventional curriculum (CC) where basic science was taught one and a half years before the clinical training, and the other had a problem-based learning curriculum (PBLC) where basic science was taught in the context of clinical problems and general problem-solving heuristics were specifically taught. The students were asked to give diagnostic explanations of a clinical case, both before and after being exposed to relevant basic science information. Two distinct modes of reasoning were identified, each reflecting a curriculum type. A predominantly "backward-directed" hypothetico-deductive mode of reasoning was found in the explanations of the PBLC students, and a "more forward-directed" pattern of reasoning was found in the explanations of the CC students. Students in the PBLC produced extensive elaborations using relevant biomedical information, which was relatively absent from the CC students' explanations. However, these elaborations were accompanied by a tendency to generate errors. These results have important implications regarding the strengths and weaknesses of the two types of curricula.

Canada↗
PubMed1991

Developmental accounts of the transition from medical student to doctor: some problems and suggestions.

This paper is concerned with the difficulties in integrating the results of recent cognitive research on expert-novice in clinical reasoning. The focus is on the issue of stage theories as a means of achieving such integration. Objections to the use of such theories in developmental psychology are reviewed. In light of these objections, it is argued that it is important to distinguish between stage theories and stage-like phenomena. It is concluded that a stage theory is not likely to provide adequate integration. Some alternative explanations, which include both cognitive and non-cognitive factors, are discussed.

Clinical Competence↗
PubMed1990

Reasoning strategies and the use of biomedical knowledge by medical students.

This paper reports one of a series of studies conducted to investigate the role of biomedical knowledge in clinical reasoning. It was motivated by findings from our earlier studies that demonstrate that when specific basic science information is provided to medical students prior to solving a clinical case, they are unable to use this information in explaining the patient problem. An experiment was designed to investigate the use of biomedical information in the explanation of a clinical problem without any basic science information (spontaneous explanation) and where basic science information was provided after the clinical case (biomedically primed explanation). The results are discussed in the context of a two-stage model of diagnostic reasoning. The first stage is referred to as data-driven reasoning, and is characterized by the triggering of inferences from observations in the data to hypotheses. The second stage is designated as predictive reasoning, and is characterized by the generation of inferences driven by hypotheses. The results show that, with the exception of final-year medical students, the use of biomedical information interfered with the data-driven reasoning process. However, it did facilitate the process of predictive reasoning by the students. It is proposed that a sound disease classification scheme is necessary before biomedical knowledge can facilitate both data-driven and predictive reasoning during clinical problem-solving.

Clinical Competence↗
PubMed1990

Medical expertise as a function of task difficulty.

This paper is concerned with factors that disrupt the pattern of forward reasoning characteristic of experts with accurate performance. Two experiments are described. In the first, the performances of cardiologists, psychiatrists, and surgeons in diagnostic explanation of a clinical problem in cardiology were examined. In the second, the performances of cardiologists and endocrinologists in diagnostic explanation of clinical problems within and outside their domains of expertise were examined. The performances of researchers and practicing physicians are also compared. The results of Experiment 1 replicated earlier results regarding the relationship between forward reasoning and accurate diagnosis. There were no differences in recall as a function of expertise. Experts did not show any bias toward using specific knowledge from their own areas of expertise. The results of Experiment 2 showed that the breakdown of forward reasoning was related to the structure of the task. In particular, nonsalient cues induced some backward reasoning even in subjects with accurate diagnoses. Some differences were also found between the types of explanation used by researchers and practitioners. The practitioners referred more to clinical components in their explanations, whereas the researchers focused more on the biomedical components.

Attention↗
PubMed1989

Understanding instructions for oral rehydration therapy.

Oral rehydration mixtures are readily available in rural Kenya, but the instructions that accompany them are not always clear. Mothers will understand such instructions more readily if they explain the principles of oral rehydration and describe in a logical way the sequence of procedures to be followed.

Female↗
PubMed1988

Causal reasoning and the treatment of diarrhoeal disease by mothers in Kenya.

A study of reasoning about the cause and treatment of childhood diarrhoea by Maasai schooled and unschooled mothers was carried out in Kenya, using a method of analysis developed within cognitive psychology. A dramatic difference in the conceptual structures of mothers' reasoning about both the cause and treatment of diarrhoea was found between the unschooled and schooled group. The unschooled mothers' explanation of diarrhoea was in terms of illness, resulting from social and moral factors. The knowledge structures generated showed global coherence. The schooled mothers explained diarrhoea with a series of quasi-biomedical facts about the disease with little or no connections between facts. The role of understanding the underlying disease processes for learning in health education is discussed in the context of Kenyan culture.

Adult↗
PubMed1988

Biomedical knowledge in explanations of clinical problems by medical students.

This paper was motivated by a controversy concerning the role of basic sciences in medical education. A problem underlying this issue is that it is unknown how basic science is used in clinical reasoning. The experiment was designed to address this issue. Three texts were constructed dealing with basic science knowledge relevant to a clinical problem. Subjects were asked to read and recall the texts. Next, the subjects were required to read and recall the clinical text describing a patient problem. Finally, they were asked to provide a diagnosis and an explanation of the underlying pathophysiology. Subjects were first-, second- and fourth-year medical students. Detailed analysis of subjects' protocols are presented. In general, the results show that when basic science information is given before the clinical problem, the basic science knowledge is used either incorrectly or inconsistently in explaining the clinical problem by all subjects. The authors interpret these results to indicate that the basic sciences and the more practical clinical knowledge form two separate domains with their own individual structures and the clinical information cannot be embedded into the basic science knowledge structure.

Biology↗
PubMed1988

Expertise in the clinical interview: a cognitive analysis.

The present study evaluates differences between subjects at three levels of expertise in acquiring and using information obtained from a patient during the clinical review. The results of the study suggest that the selective acquisition and the efficient utilization of information are hallmarks of expertise in the clinical review.

Computer-Assisted Instruction↗
PubMed1987

Uses of formal and informal knowledge in the comprehension of instructions for oral rehydration therapy in Kenya.

Information for using pre-mixed oral rehydration salt solutions, which have been made widely available in rural Kenya, is normally obtained from what is printed on the packets in English and either read or explained to the purchaser. Consequently, the comprehension can be improved with simple changes in the printed text, particularly those that reinforce appropriate modern or indigenous medical knowledge. However, the knowledge involved in effectively using oral rehydration therapy is not merely an awareness of its benefits, but an understanding of the environmental and biological causes of diarrhoeal diseases and an ability to explain the course of treatment that secondary schooling seems to develop.

Child, Preschool↗
PubMed1987

Comparing the effects of problem-based and conventional curricula in an international sample.

In this article, the authors review 15 studies that compare various educational outcomes of problem-based, community-oriented medical curricula with those of conventional programs. The data suggest that problem-based curricula provide a student-centered learning environment and encourage an inquisitive style of learning in their students as opposed to the rote memorization and short-term learning strategies induced by conventional medical education. In addition, community-oriented schools appear to influence the career preferences of their students. The few data available show that significantly larger proportions of graduates from these schools seek careers in primary care. Some of the studies reviewed suggest that students in conventional programs perform somewhat better on traditional measures of academic achievement than do students in problem-based curricula. However, these differences, if any, tend to be very small. Data with respect to performance on instruments measuring clinical competence are inconclusive. Finally, the authors discuss the difficulties involved in carrying out comparative research at the curriculum level.

Achievement↗
PubMed1987

Processing of critical information by physicians and medical students.

In the study reported here, differences between physicians and medical students in their recall of information from clinical problems were investigated. The focus of the study was on the recognition and recall of critical cues within cases as a function of problem difficulty and the organization of clinical information. Two clinical cases in two structural forms (typical and random) were designed, and the participants' written recall of the cases was analyzed using the techniques of discourse analysis. The results show that the physicians recalled significantly more critical cues than the medical students. However, when the case had a temporally ordered, underlying disease process, the random structure of the text disrupted both the physicians' ability to recall critical cues and the accuracy of their diagnoses. The medical students were unaffected by problem type or structural form in the amount of information they recalled. The results show that the physicians and medical students formulate the information from clinical problems differently, and this difference is due to the fact that the physicians recognize patterns of familiar problems with respect to critical cues but the students do not.

Clinical Competence↗
PubMed1987

Contextual factors in the activation of first diagnostic hypotheses: expert-novice differences.

According to Feltovich & Barrows (1984), the general frame used by medical experts to construct a mental representation of a particular patient problem contains a component part for those illness features that are associated with the acquisition of the illness. These 'enabling conditions' are related in several ways to the patient's disease. Examples are conditions like sex and age, or risk factors originating from work, behaviour and hereditary taint. Because of the sequential nature by which patient data become available during a clinical interview, contextual information is expected to play an important role in the generation of initial diagnostic hypotheses. To investigate the hypothesis that experienced doctors better utilize this kind of information, a group of 18 experts and 17 novices was confronted with 32 short case histories each presented on three slides: a portrait of the patient, the patient chart containing previous disease history, and a slide with the presenting complaint. It was hypothesized that differences in the number of correct diagnoses would emerge between the two groups, because the experts would use the contextual information, implicitly provided by picture and patient chart, in a more extensive way. If so, this would show in the amount of information that is explicitly recalled later. The data confirmed these predictions. The experts produced almost 50% more correct hypotheses as compared to the novices and were able to reproduce a larger amount of contextual information in particular information that was directly relevant to the patient's problem. Only the expert group showed a high correlation between accuracy of diagnoses and recall measures.

Adult↗
PubMed1986

Differences between medical students and doctors in memory for clinical cases.

Many studies dealing with differences between students' and doctors' memory for clinical cases have yielded puzzling results. In this paper it is claimed that these are due to the use of inadequate techniques for isolating chunks inherent in the stimuli and the data. The purpose of this paper is to investigate whether the techniques of propositional analysis yield a clearer picture. Using this technique, the analysis of two sets of data is presented. The results show a clear difference between doctors and students when relevant clinical information is isolated from irrelevant information. This supports the notion that the process involved in the memory for clinical cases is far more complex and involves the ability to make inferences from a highly developed knowledge base.

Clinical Competence↗
PubMed1985

The clinical learning environments in medicine, paediatrics and surgery clerkships.

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.

Clinical Clerkship↗
PubMed1985

Medical problem-solving: some questionable assumptions.

This paper questions the idea that expert doctors use the hypothetico-deductive method when developing diagnoses of routine clinical cases. Up to now, this has not been justified by empirical evidence but by two indirect arguments. The first is that it is the standard procedure of scientific method. The second is that it is supported by research in cognitive psychology comparing the problem-solving behaviour of experts and novices. It is argued in this paper that both areas have been misinterpreted. In particular, the evidence from research in cognitive psychology on expert-novice comparisons indicates that the use of the hypothetico-deductive method is a characteristic of novices rather than experts. Experts use what are called strong methods, which are dependent on a highly elaborated and structured knowledge base. It is concluded that a considerable amount of research on the nature of such strong methods in expert clinical reasoning is needed before any confident claims can be made regarding the use of the hypothetico-deductive or any other method.

Cognition↗