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PubMed1989

Problem-solving model in radiology for medical students.

Current undergraduate medical education is criticized for not preparing physicians to be independent thinkers. The rapid development of new imaging techniques and the problem of escalating medical costs call for efficient patient management. The development of algorithms in imaging work-up of patient problems is an excellent example of problem solving or medical decision making. The senior elective in radiology at our institution incorporates this type of problem-solving session. Small groups (15-25 students) with faculty guidance discuss 5-6 common patient problems to develop an investigative plan in imaging. Algorithms are thus developed by the group, but not presented for memorization. Small changes are then made in the case history so that the students are forced to make new hypotheses and generate a modified algorithm. Correlative costs are included. Flexibility and initiative in development of patient management algorithms are stressed.

Clinical Clerkship↗
PubMed1999

Brief problem-solving questions in medical school examinations: is it necessary for students to explain their answers?

OBJECTIVE: To compare outcomes when answers to objective type problem-solving questions are marked with and without consideration of students' explanations of their answers. DESIGN: Students answered six multiple-part problem-solving questions on the final examination for a course in clinical biochemistry. Each part required a choice from a list, a number or a few words, plus an explanation or justification. Scores were determined independently for the answers alone and for the answers plus explanations. The outcomes of the two marking methods were compared. SETTING: Department of Pathology, University of Otago Medical School, Dunedin, New Zealand. SUBJECTS: Final year preclinical medical students. RESULTS: Marks were slightly higher for answers alone than for answers plus explanations (overall mean, 82.1%; standard deviation, 9.8% vs. 77.1%; 9.3%; P < 0.001 by paired t-test). There was a very high correlation between scores derived from the two methods (r=0. 87). Consideration of the answers alone (without explanations) was about as good as answers plus explanations in identifying students who performed at different levels overall on the examination and in identifying the weakest students. CONCLUSIONS: The data suggest that when students arrived at the correct answers, their information and reasons were usually correct and that answers alone discriminate adequately among students with different levels of knowledge and ability. By dispensing with the requirement for explanations, we would be able to ask more questions and mark objectively, so competent students should not be disadvantaged by the lack of opportunity to explain their reasoning.

Education, Medical, Undergraduate↗
PubMed1995

Problem solving, stress, and coping in adolescent suicide attempts.

Twenty adolescents who had made suicide attempts were compared with 20 nonpsychiatric control subjects on measures of problem solving, stress, and coping. The suicidal group did not show evidence of "rigid" thinking or of deficits in the ability to generate solutions to standardized interpersonal problems. However, they did report recent histories of more severe life stress and had inaccurate appraisal of the extent to which stressful events could be controlled. Although suicidal patients were able to generate as many adaptive strategies as control subjects for coping with their own most severe recent real-life stressor, they actually used fewer. They were also more likely to identify maladaptive behaviors as ways of coping. These findings support a transactional model of adolescent suicidal behavior, whereby inaccuracies in the appraisal aspects of problem solving (but not in the solution-generation aspects) in the face of high life stress lead to a reduction in the use of adaptive efforts to cope.

Adaptation, Psychological↗
PubMed1998

Hope, problem-solving ability, and coping in a college student population: some implications for theory and practice.

The influence of high versus low hope on problem-solving ability and on coping with stressful academic and interpersonal situations was examined in 211 college students. Consistent with Snyder's (1995) model, high-hope students were found to have greater problem-solving abilities than low-hope students. High-hope students were also found to employ less disengagement strategies than low-hope students for coping with stressful academic situations. No difference was found in the strategies used by high- and low-hope students for coping with stressful interpersonal situations. Separate hierarchical regression analyses indicated that hope was an important predictor of both academic and interpersonal life satisfaction independent of coping activities. Implications of the present findings for both theory and practice are discussed.

Adaptation, Psychological↗
PubMed1997

Support, problem-solving/coping ability, and personal burden of younger and older caregivers of adults with mental retardation.

Relations between service and support utilization, problem-solving/coping strategies, level of personal burden experienced by younger and older caregivers were examined. Overall, there were no differences in the number of support services received. However, younger caregivers reported significantly more unmet service needs and rated significantly more of them as a critical or an emergency need. Both groups had highly developed effective problem-solving skills. However, older caregivers were more likely to seek spiritual support and the younger caregivers more apt to mobilize their families to acquire and accept help. Older caregivers experienced significantly less personal burden. Results suggest that younger caregivers are more predisposed toward seeking outside help and have higher expectations of the service system.

Adaptation, Psychological↗
PubMed1989

A test of medical problem-solving scored by nurses and doctors: the handicap of expertise.

There is evidence that nurses fulfil the requirements of objective judgement better than doctors. Simulation of Initial Medical Problem-Solving (SIMP), a paper-and-pencil test for the assessment of medical problem-solving, consists of case histories, followed by an open-ended question. The scoring of open-ended questions is time-consuming and adds subjective bias to measurement error. In order to reduce scoring error, answers on SIMP are scored by means of scoring models in the form of check-lists with descriptions of elements of a correct answer. The reliability of the scoring was analysed in a study, with six nurses rating 500 answers. The overall interrater reliability was high, expressed by an intra-class correlation of 0.83. Selection of raters, and improvement of the scoring models, could increase the interrater reliability even further. In addition to the scoring by the nurses part of the material was scored again by two experienced doctors. The reliability of the scoring method on the whole was confirmed. Nevertheless, some evidence was found of misinterpretation of the scoring models by the nurses. Analysis at the item level revealed several instances in which both doctors agreed on a score for an element in an answer and all the nurses agreed on the opposite score. On the other hand, however, the two doctors were less consistent between themselves than the nurses. The disagreement between the doctors seems to be a consequence of differences in their own medical judgement of the case in question. The impact of the mistakes that are made by the nurses is much smaller than the loss of reliability caused by the inconsistency among the doctors.

Educational Measurement↗
PubMed1990

Assessment of procedural learning and problem solving in schizophrenic patients by Tower of Hanoi type tasks.

Two versions of the Tower of Hanoi task were used to investigate different components of learning and problem solving in schizophrenia. Prior studies have suggested that a three-disk version (Tower 3), which involves primarily problem-solving abilities and planning, is preferentially sensitive to frontal lobe lesions and that the more difficult four-disk version (Tower 4), which involves "learning by doing," is sensitive to basal ganglia disease. Schizophrenic patients performed significantly worse than normal subjects on Tower 3 and Tower 4. However, they performed at least as well relatively on Tower 4 as on Tower 3, indicating that level of difficulty per se does not account for their poor performance on these tasks. Moreover, they eventually attained perfect or near-perfect performance after four days of repeated administration. Their relatively stronger performance on Tower 4 may have reflected an ability to acquire a procedure and, as such, suggests greater preservation of basal ganglia function than of prefrontal function.

Adult↗
PubMed1992

Problem-solving behaviour in apomorphine-susceptible and unsusceptible rats.

Pharmacogenetically selected apomorphine-susceptible (APO-SUS) and apomorphine-unsusceptible (APO-UNSUS) rats were trained in a discrimination learning paradigm. After the initial discrimination task was solved, reinforcement contingencies were reversed. No differences between APO-SUS and APO-UNSUS animals were found in the rate of learning. However, negative transfer from the initial discrimination to its reversal was less for the APO-SUS rats than for the APO-UNSUS rats. Moreover, the APO-SUS rats responded more to the relevant dimension (light) than the APO-UNSUS rats in the last 100 trials before solving the initial problem as well as the reversal. During overtraining on the first problem, APO-SUS animals responded less to an irrelevant dimension (position of the lever) than APO-UNSUS animals. In the first 100 trials of the reversal APO-SUS rats responded more to another irrelevant dimension (noise) than APO-UNSUS rats. The data show that APO-SUS and APO-UNSUS rats used the various dimensions (visual, auditory, and spatial) differently in the chosen discrimination learning paradigm. It is concluded that the interline differences found are the consequences of the interline differences in the dopaminergic activity of the ventral and dorsal striatum.

Acoustic Stimulation↗
PubMedDate not supplied

Refinements in the dimensional analysis method of dose calculation problem-solving.

Although the dimensional analysis method for solving dose calculation problems is gaining acceptance with nurse educators, many inconsistencies in teaching methodologies remain that can be confusing to both students and practicing nurses. The author presents refinements to the dimensional analysis method which can improve speed and accuracy in dose calculations and will be universally applicable to all types of clinical dosage problems.

Drug Therapy↗
PubMed2003

Creative problem solving and social cooperation of effective physical therapy practice: a pioneer study and overview.

Action research (AR) has an important role to play in educating physical therapists. Increasing efforts should be encouraged to instigate AR programs in physical therapy practice and clinical education. Such programs commonly require considerable effort and understanding by clinical instructors, and require adoption of new educational methods. AR programs can lead physical therapists and clinicians to be more questioning and reflective in evaluating practical questions regarding patient therapy and education. The purpose of this article is to educate the readers on the importance of AR and to provide a few relevant references on that topic. A specific study is described in this paper in which physical therapy clinical instructors participated in a structured workshop designed to demonstrate the values of AR and how such values can be incorporated in teaching their students. AR can lead to improved therapist-patient interaction and help solve specific practical problems arising during therapy sessions.

Cooperative Behavior↗
PubMed1989

A second look at consequences for medical education of problem solving in science and medicine.

This article reports that most freshman and senior medical students in one medical school were not able to solve a written problem case, concerning back pain, that required the examinee to recognize that foot drop was a key physical finding. The students' responses were not influenced by the fact that half of the examinations listed the foot drop finding first and the other half listed it seventh in a list of eight physical findings. The authors conclude that the outcome of this sample problem hints at a fault in medical education: the failure of medical students to learn the skill of formulating overall hypotheses and subhypotheses before choosing treatment options.

Adult↗
PubMed2004

Priming problem solving with conceptual processing of relevant objects.

In the present study, the author explored the effect of processing relevant information on producing solutions to brief insight problems. She hypothesized that the conceptual processing of objects relevant to the target solution would facilitate that solution relative to unrelated objects or the shallow processing of words. The author also explored the effect of knowledge of the relationship between the initial object-processing task and the problem-solving task. The results showed that participants who conceptually processed objects related to the target solution (Experiment 1), but not those who shallowly processed words related to the target solution (Experiment 2), were more likely to produce the solution relative to the control; and knowledge of the relationship between objects and solutions made no difference in the frequency of target solutions produced. The results of Experiment 3 showed that conceptual processing of an object could prime a nondominant solution for an ambiguously worded problem. Taken together, the results of the studies supported the effect of conceptual processing on facilitating insight in problem solving.

Adult↗
PubMed2005

Age differences in everyday problem-solving and decision-making effectiveness: a meta-analytic review.

The authors report a meta-analysis of age differences in everyday problem-solving/decision-making effectiveness (EPSE). Effect sizes were calculated to reflect 3 age group comparisons: old versus young, young versus middle-aged, and middle-aged versus old. Findings from the meta-analysis of 28 separate studies with an aggregate of 4,482 participants do not support theories of preserved EPSE in late adulthood. Although significant age differences of moderate magnitude persisted across methodological and theoretical domains, rating criteria (experimenter vs. participant) emerged as a significant moderator of the effect magnitude and direction. In addition, EPSE in older adults was bolstered when problem content was interpersonal and when samples were highly educated. Finally, the current results support the conceptual integration of findings from the everyday problem-solving and everyday decision-making literatures.

Adult↗
PubMed1994

Evaluating problem solving based on the use of history findings in a standardized-patient examination.

PURPOSE: To evaluate a novel item format for assessing clinical problem solving in a standardized-patient examination (SPE). METHOD: In 1992-93 a key-findings item format was included in two versions of three stations in an SPE (given in the style of an objective structured clinical examination) that was taken by 198 third-year students at the end of their three-month internal medicine clerkship at the University of Texas Medical Branch at Galveston. Each of the stations involved an extended matching question that listed ten to 12 findings. The students were told to select as many or as few findings as they wished that were key in leading them to their diagnosis of the standardized patient's (SP's) problem. The findings fell into three categories: (1) key to the diagnosis, (2) provided by the SP but not key to the diagnosis, and (3) not provided by the SP. RESULTS: A total of 169 students (85%) identified at least one of the findings determined to be key in each of the stations. Correctly identifying key findings was related to correctly diagnosing the SP's problem. A total of 145 students (73%) indicated at least one finding across the three cases as key to their diagnosis but not given by the SP. Selecting nonexistent findings as key to diagnosis was not found to be related to performance on the SPE. It was hypothesized that once a diagnosis was made, the students had difficulty differentiating key findings that had led them to the diagnosis from other key features of their cognitive model of illness. CONCLUSION: The students were generally able to obtain and recognize at least some of the key information they needed to formulate appropriate differential diagnoses, and the ability to identify key findings was shown to be related to identifying the most appropriate diagnosis. The key-findings item format has potential both in assessment and for gaining a better understanding of the clinical problem-solving process.

Clinical Competence↗
PubMed1987

Developing audiovisuals for problem solving in physical therapy education.

This article describes the design and development of an audiovisual training program in problem-solving skills for physical therapy students. A model showing the physical therapy problem-solving process serves as the basis for the audiovisuals. The audiovisuals are videotaped physical therapy case histories. These case histories are structured at three different levels to foster the integrated development of students' knowledge, skills, and attitudes at the three levels of physical therapy programs in the Netherlands. Initial experience using this audiovisual approach seems to indicate its effectiveness as a tool for physical therapy education.

Audiovisual Aids↗
PubMed1993

Database access and problem solving in the basic sciences.

This study examined the potential contribution that access to a database of biomedical information may offer in support of problem-solving exercises when personal knowledge is inadequate. Thirty-six medical students were assessed over four occasions and three domains in the basic sciences: bacteriology, pharmacology, and toxicology. Each assessment consisted of a two-pass protocol in which students were first assessed for their personal knowledge of a domain with a short-answer problem set. Then, for a sample of problems they had missed, they were asked to use a database, INQUIRER, to respond to questions which they had been unable to address with their personal knowledge. Results indicate that for a domain in which the database is well-integrated in course activities, useful retrieval of information which augmented personal knowledge increased over three assessment occasions, even continuing to increase several months after course exposure and experience with the database. For all domains, even at assessments prior to course exposure, students were able to moderately extend their ability to solve problems through access to the INQUIRER database.

Bacteriology↗
PubMed1989

Evaluating preclinical medical students by using computer-based problem-solving examinations.

A study was designed to determine the feasibility of creating and administering computer-based problem-solving examinations for evaluating second-year medical students in immunology and to determine how students would perform on these tests relative to their performances on concurrently administered objective and essay examinations. The results indicate that problem-solving questions of uniform difficulty can be created and that correct solution of the problems correlates with the early selection of the most relevant data. The mean scores on the three types of tests were not significantly different. The scores on the essay and objective examinations were most highly correlated, those on the computer-based and objective examinations were minimally correlated, and those on the computer-based and essay examinations were not correlated.

Allergy and Immunology↗