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The influence of problem-based learning (PBL) and open-book tests on long-term knowledge retention is unclear and subject of discussion. Hypotheses were that PBL as well as open-book tests positively affect long-term knowledge retention. Four progress test results of fifth and sixth-year medical students (n = 1,648) of three medical schools were analyzed. Two schools had PBL driven curricula, and the third one had a traditional curriculum (TC). One of the PBL schools (PBLob) used a combination of open-book (assessing backup knowledge) and closed-book tests (assessing core knowledge); the other two schools (TC and PBLcb) only used closed-book tests. The items of the progress tests were divided into core and backup knowledge. T tests (with Bonferroni correction) were used to analyze differences between curricula. PBL students performed significantly better than TC students on core knowledge (average effect size (av ES) = 0.37-0.74) and PBL students tested with open-book tests scored somewhat higher than PBL students tested without such tests (av ES = 0.23-0.30). Concerning backup knowledge, no differences were found between the scores of the three curricula. Students of the two PBL curricula showed a substantially better long-term knowledge retention than TC students. PBLob students performed somewhat better on core knowledge than PBLcb students. These outcomes suggest that a problem-based instructional approach in particular can stimulate long-term knowledge retention. Distinguishing knowledge into core and backup knowledge and using open-book tests alongside closed-book tests could enhance long-term core knowledge retention.

Objectives: To determine whether self-directed learning about (electronic) patient records during a PBL (problem-based learning) block, dealing with the content of disciplines concerned with the diagnosis and therapy of diseases of the abdomen, increased the knowledge of the students with respect to the patient records., Methods: At the beginning and at the end of the ten-week block the same questionnaire was offered to the students (180). Cohen's d for effect size was used to determine the increase in knowledge., Results: For those students that answered the questionnaire twice (53), a Cohen's d of 0.94 was obtained., Conclusions: The knowledge of the students concerning the advantages and limitations of (electronic) patient records increased significantly. The corresponding effect size was large.

Objective: To investigate whether adding a brief video case instead of an equivalent written text improves the cognitive and metacognitive processes (data exploration, theory building, theory evaluation and metareasoning) of residents in problem-based learning., Subjects: Paediatric residents., Setting: Department of Paediatrics, Arhus University Hospital, Skejby, Denmark., Methods: Eleven residents were each assigned to 1 of 2 groups. Both groups analysed an identical vignette of a patient case. Immediately after this, 1 group watched a 2.5-minute video recording and the other group read a description of the same video recording. The groups then reanalysed the case. Thinking processes were tapped by recording and analysing the verbal group interaction. The frequencies of clause categories were calculated and compared using chi-square tests., Results: The verbal interaction showed statistically significant improvements in data exploration, theory building and theory evaluation after the video case., Conclusions: The greater improvement in clause frequency after the video case compared with the equivalent text suggests an improvement in data exploration, theory building and theory evaluation. The use of patient video recordings may be a valuable supplement to postgraduate paediatric training, particularly pertaining to movement disorders.

Objective To test hypotheses regarding the longitudinal effects of problem-based learning (PBL) and conventional learning relating to students’ appreciation of the curriculum, self-assessment of general competencies, summative assessment of clinical competence and indicators of career development. Methods The study group included 2 complete cohorts of graduates who were admitted to the medical curriculum in 1992 (conventional curriculum, n = 175) and 1993 (PBL curriculum, n = 169) at the Faculty of Medicine, University of Groningen, the Netherlands. Data were obtained from student records, graduates’ self-ratings and a literature search. Gender and secondary school grade point average (GPA) scores were included as moderator variables. Data were analysed by a stepwise multiple and logistic regression analysis. Results Graduates of the PBL curriculum scored higher on self-rated competencies. Contrary to expectations, graduates of the PBL curriculum did not show more appreciation of their curriculum than graduates of the conventional curriculum and no differences were found on clinical competence. Graduates of the conventional curriculum needed less time to find a postgraduate training place. No differences were found for scientific activities such as reading scientific articles and publishing in peer- reviewed journals. Women performed better on clinical competence than did men. Grade point average did not affect any of the variables. Conclusions The results suggest that PBL affects self-rated competencies. These outcomes confirm earlier findings. However, clinical competence measures did not support this finding. [ABSTRACT FROM AUTHOR]

Context We addressed the assessment of professional behaviour in tutorial groups by investigating students' perceptions of the frequency and impact of critical incidents that impede this assessment and 5 factors underlying these critical incidents. Methods A questionnaire asking students to rate the frequency and impact of 40 critical incidents relating to effective assessment of professional behaviour on a 5-point Likert scale was developed and sent to all undergraduate medical students in Years 2–4 of a 6-year undergraduate curriculum. Results The response rate was 70% ( n = 393). Important factors underlying critical incidents are: lack of effective interaction; lack of thoroughness; tutors' failure to confront students with unprofessional behaviour; lack of effort to find solutions, and lack of student motivation. Confirmatory factor analysis showed a good model fit. Because the relationship between frequency of occurrence and degree of impediment varies, the best information about the true impact of critical incidents and the underlying factors is provided by the product of frequency and degree of impediment. Frequency of occurrence remains stable and degree of impediment increases in Years 2–4. Conclusions The results of this study can be used to design and improve faculty development programmes aimed at improving assessment of professional behaviour. Training programmes should motivate tutors by providing background information as to why and how sound assessment of professional behaviour is to be performed and encourage tutors to confront students with and discuss all aspects of professional behaviour, as well as provide appropriate feedback. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. Methods A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. Results The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. Conclusions Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning. [ABSTRACT FROM AUTHOR]

Introduction An earlier study showed that an Angoff procedure with ≥ 10 recently graduated students as judges can be used to estimate the passing score of a progress test. As the acceptability and feasibility of this approach are questionable, we conducted an Angoff procedure with test item writers as judges. This paper reports on thereliability and credibility of this procedure and compares the standards set by the two different panels. Methods Fourteen item writers judged 146 test items. Recently graduated students had assessed these items in a previous study. Generalizability was investigated as a function of the number of items and judges. Credibility was judged by comparing the pass/fail rates associated with the Angoff standard, a relative standard and a fixed standard. The Angoff standards obtained by item writers and graduates were compared. Results The variance associated with consistent variability of item writers across items was 1·5% and for graduate students it was 0·4%. An acceptable error score required 39 judges. Item-Angoff estimates of the two panels and item P -values correlated highly. Failure rates of 57%, 55% and 7% were associated with the item writers' standard, the fixed standard and the graduates' standard, respectively. Conclusion The graduates' and the item writers' standards differed substantially, as did the associated failure rates. A panel of 39 item writers is not feasible. The item writers' passing score appears to be less credible. The credibility of the graduates' standard needs further evaluation. The acceptability and feasibility of a panel consisting of both students and item writers may be worth investigating. [ABSTRACT FROM AUTHOR]

Background: This research focuses on the relation between individual study and group discussion. In a problem-based curriculum, it is expected that the way students prepare themselves during individual study (i.e., search and prepare the literature) will influence the quality of the reporting phase. Purpose: To investigate whether searching for different literature resources and preparing the literature (by making summaries to explain the literature) affects the quality of the reporting phase. Method : A 23-item questionnaire was developed, reflecting 2 factors of the search phase and 1 factor of the preparing phase of the individual study. Two factors (breadth and depth of the discussion) reflected the reporting phase. Participants were 1st-year students (N = 195, 90%) at the Medical School of the Maastricht University in the Netherlands during the academic year 1997-1998. Results: Regression analyses show that the search phase and the preparing phase explained 29% of the variance of the breadth and 38% of the depth of the reporting phase. Conclusions: Searching different literature resources has a small and negative impact on the quality of the reporting phase. However, preparing extensively for the next tutorial meeting is very important, especially for the depth of the reporting phase. Therefore, when new knowledge must be integrated in the tutorial group, students must be taught to prepare themselves by making summaries that are useful and effective during the discussion. [ABSTRACT FROM AUTHOR]