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To investigate the value of the physical Simbla Transurethral Resection of a Bladder Tumor (TURBT) simulator as an educational tool within urological residency training, by means of a training needs analysis (TNA) and assessment of its feasibility, acceptability, and face, content, and construct validity.To analyze the training needs for TURBT, procedural steps and pitfalls were identified and the TNA was completed during an expert consensus meeting. Participants (n = 76) were divided into three groups based on their experience in TURBT: novices, intermediates, and experts. Participants performed two standardized TURBT procedures on the simulator. Face validity and content validity, as well as feasibility and acceptability, were assessed with a quantitative survey. Construct validity was assessed by comparing the performance of novices, intermediates, and experts on resection time, quality of tumor resection, and overall performance.Of the 21 procedural steps and 17 pitfalls defined in TNA, 13 steps and 8 pitfalls were covered by the Simbla. Participants rated the Simbla's overall realism (face validity) with a score of 8 of 10 (range 6-9). The simulator was judged to be most useful (content validity) for learning eye-hand coordination: score 8 (6-10). All aspects regarding realism and usefulness were rated above the acceptability threshold of 6/10. Intermediates (100%) and experts (96%) considered the Simbla to be a useful educational tool within the urological curriculum. Resection time was longer for novices than for experts (p 0.05; construct validity). In addition, the overall performance of novices was rated lower compared with intermediates and experts, and novices showed more irradical resections and bladder perforations (all p 0.05).The Simbla TURBT simulator is a valid, feasible, and acceptable educational tool for training procedural skills and may be implemented in the urological curriculum to complement learning in clinical practice. TNA is valuable in defining training objectives and evaluating the educational value of a simulator.

Contains fulltext : 182286.pdf (Publisher’s version ) (Open Access) To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.

Item does not contain fulltext Although elaboration has been investigated frequently, there is little evidence for the beneficial effect of elaboration in problem-based learning. A controlled experiment tested the effect of elaboration during problem-based discussion on recall. Sixty-seven students observed a video-recorded, problem-based discussion. In one experimental condition, a tutor in the video encouraged participants to elaborate by asking elaborative questions. In a second condition, the tutor asked superficial questions. After the discussion, all participants studied a text with relevant new information. Elaborative questions had no significant effect on recall of idea units from the text, p = .39, eta(2) = .01. High-ability students outperformed low-ability students, p = .04, eta(2) = .07, but this effect did not interact with the experimental treatment, p = .22, eta(2) = .02. Suggestions for further research are presented.

Previous studies have generally found no relation between IQ and chess skill in chess experts. This lack of a relation could be due to the influence of practice being more important than IQ in chess expertise. An alternative explanation is that IQ is relatively high and might therefore be restricted in range in chess experts. The current study investigated the contribution of practice, IQ and motivation to chess performance prospectively in a group of young, novice chess players in which IQ restriction of range did not play a role. Children who entered their first chess course were asked to complete weekly diaries indicating the amount of practice and their enjoyment of the course. IQ and motivation were measured using standardized tests. Using pith analysis, we found that IQ and practice independently predicted chess performance on a chess test at the end of the course: Motivation influenced performance indirectly, by moderating the amount of practice that was undertaken. The results indicate that, at the early stages of expertise development, IQ and motivation influence chess performance.

When studying verbal materials, both adults and children are often poor at accurately monitoring their level of learning and regulating their subsequent restudy of materials, which leads to suboptimal test performance. The present experiment investigated how monitoring accuracy and regulation of study could be improved when learning idiomatic phrases. Elementary school children (fourth and sixth-graders) were instructed to predict their test performance by providing judgments of learning (JOLs). They provided JOLs immediately after studying each idiom, after studying all idioms, or after studying all idioms followed by generating sentences in which the idioms were used. Correlations between JOLs and test performance showed that delayed-JOLs and delayed-JOLs with sentence generation were more accurate than immediate JOLs. JOLs after sentence generation also improved regulation of study compared to delayed-JOLs only. Analyses of JOL reaction times suggest that delayed-JOLs led children to retrieve the literal meaning of the idiom, whereas JOLs after sentence generation led children to focus on connections between studied information, contextual information, and prior knowledge. Sentence generation presents a promising method to improve regulation of study, and thus idiom learning.

This study set out to test whether relevant prior knowledge would moderate a positive effect on academic achievement of elaboration during small-group discussion. In a 2 × 2 experimental design, 66 undergraduate students observed a video showing a small-group problem-based discussion about thunder and lightning. In the video, a teacher asked questions to the observing participants. Participants either elaborated by responding to these questions, or did not elaborate, but completed a distraction task after each question. They received either relevant or irrelevant prior knowledge before the discussion. After the discussion, all participants studied a text about thunder and lighting and completed immediate and delayed-recall tests for this text. Elaboration had no main effect on recall, but there was a significant interaction effect between relevant prior knowledge and elaboration. The results suggest that elaboration is helpful for students with more prior knowledge, but harmful for students with less prior knowledge.

Lindsay Bank,1,2 Mariëlle Jippes,3 Jimmie Leppink,4 Albert JJA Scherpbier,4 Corry den Rooyen,5 Scheltus J van Luijk,6 Fedde Scheele1,2,7 1Department of Healthcare Education, OLVG Hospital, 2Faculty of Earth and Life Sciences, Athena Institute for Transdisciplinary Research, VU University, Amsterdam, 3Department of Plastic Surgery, Erasmus Medical Centre, Rotterdam, 4Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, 5Movation BV, Maarssen, 6Department of Healthcare Education, Maastricht University Medical Center+, Maastricht, 7School of Medical Sciences, Institute for Education and Training, VU University Medical Center, Amsterdam, the Netherlands Introduction: Curriculum change and innovation are inevitable parts of progress in postgraduate medical education (PGME). Although implementing change is known to be challenging, change management principles are rarely looked at for support. Change experts contend that organizational readiness for change (ORC) is a critical precursor for the successful implementation of change initiatives. Therefore, this study explores whether assessing ORC in clinical teaching teams could help to understand how curriculum change takes place in PGME.Methods: Clinical teaching teams in hospitals in the Netherlands were requested to complete the Specialty Training’s Organizational Readiness for curriculum Change, a questionnaire to measure ORC in clinical teaching teams. In addition, change-related behavior was measured by using the “behavioral support-for-change” measure. A two-way analysis of variance was performed for all response variables of interest. Results: In total, 836 clinical teaching team members were included in this study: 288 (34.4%) trainees, 307 (36.7%) clinical staff members, and 241 (28.8%) program directors. Overall, items regarding whether the program director has the authority to lead scored higher compared with the other items. At the other end, the subscales “management support and leadership,” “project resources,” and “implementation plan” had the lowest scores in all groups.Discussion: The study brought to light that program directors are clearly in the lead when it comes to the implementation of educational innovation. Clinical teaching teams tend to work together as a team, sharing responsibilities in the implementation process. However, the results also reinforce the need for change management support in change processes in PGME. Keywords: organizational readiness for change, postgraduate medical education, curriculum change, change management, questionnaire, innovation

The study investigated whether activation of inaccurate prior knowledge before study contributes to primary-school children’s commission errors and overconfidence in these errors when learning new concepts. Findings indicate that inaccurate prior knowledge affects children’s learning and calibration. The level of children’s judgments of learning for recall responses for which they would not receive credit was inappropriately high after activation of inaccurate prior knowledge. Moreover, results showed that activation of inaccurate prior knowledge was not only detrimental for monitoring judgments during learning, but also for calibration accuracy after test taking. When judging the quality of their recall responses on the posttest, children were more overconfident when they had activated inaccurate prior knowledge. Also, the children often discarded concepts from further study after activation of inaccurate prior knowledge. These results suggest that in order to improve self-regulated learning, it may be important to detect inaccuracies in children’s prior knowledge.

Learning from error is not just an individual endeavour. Organisations also learn from error. Hospitals provide many learning opportunities, which can be formal or informal. Informal learning from error in hospitals has not been researched in much depth so this narrative review focuses on five learning opportunities: morbidity and mortality conferences, incident reporting systems, patient claims and complaints, chart review and prospective risk analysis. For each of them we describe: (1) what can be learnt, categorised according to the seven CanMEDS competencies; (2) how it is possible to learn from them, analysed against a model of informal and incidental learning; and (3) how this learning can be enhanced. All CanMEDS competencies could be enhanced, but there was a particular focus on the roles of medical expert and manager. Informal learning occurred mostly through reflection and action and was often linked to the learning of others. Most important to enhance informal learning from these learning opportunities was the realisation of a climate of collaboration and trust. Possible new directions for future research on informal learning from error in hospitals might focus on ways to measure informal learning and the balance between formal and informal learning. Finally, 12 recommendations about how hospitals could enhance informal learning within their organisation are given.

Item does not contain fulltext AIM: There is growing pressure from the government and the public to define proficiency standards for surgical skills. Aim of this study was to estimate the reliability of the Program for Laparoscopic Urological Skills (PLUS) assessment and to set a certification standard for second-year urological residents. METHODS: Fifty participants were assessed on performance time and performance quality to investigate the reliability of the PLUS assessment. Generalisability coefficient of 0.8, on a scale of 0 to 1.0, was considered to indicate good reliability for assessment purposes. Pass/fail standards were based on laparoscopic experience: Novices, intermediates, and experts (>100 procedures). The pass/fail standards were investigated for the PLUS performances of 33 second-year urological residents. RESULTS: Fifteen novices, twenty-three intermediates and twelve experts were included. An inter-trial reliability of >0.80 was reached with two trials for each task. Inter-rater reliability of the quality measurements was 0.79 for two judges. Pass/fail scores were determined for the novice/intermediate boundary and the intermediate/expert boundary. Pass rates for second-year residents were 63.64% and 9.09%, respectively. CONCLUSION: The PLUS assessment is reliable for setting a certification standard for second-year urological residents that serves as a starting point for residents to proceed to the next level of laparoscopic competency.

Integrated curricula have been implemented in medical schools all over the world. However, among countries different relative numbers of schools with integrated curricula are found. This study aims to explore the possible correlation between the percentage of medical schools with integrated curricula in a country and that country’s cultural characteristics. Curricula were defined as not integrated if in the first 2 years of the program at least two out of the three monodisciplinary courses Anatomy, Physiology and Biochemistry were identified. Culture was defined using Hofstede’s dimensions Power distance, Uncertainty avoidance, Masculinity/Femininity, and Individualism/Collectivism. Consequently, this study had to be restricted to the 63 countries included in Hofstede’s studies which harbored 1,195 medical schools. From each country we randomly sampled a maximum of 15 schools yielding 484 schools to be investigated. In total 91% (446) of the curricula were found. Correlation of percent integrated curricula and each dimension of culture was determined by calculating Spearman’s Rho. A high score on the Power distance index and a high score on the Uncertainty avoidance index correlated with a low percent integrated curricula; a high score on the Individualism index correlated with a high percent integrated curricula. The percentage integrated curricula in a country did not correlate with its score on the Masculinity index. National culture is associated with the propensity of medical schools to adopt integrated medical curricula. Consequently, medical schools considering introduction of integrated and problem-based medical curricula should take into account dimensions of national culture which may hinder the innovation process.

In this article, we outline criteria for good assessment that include: (1) validity or coherence, (2) reproducibility or consistency, (3) equivalence, (4) feasibility, (5) educational effect, (6) catalytic effect, and (7) acceptability. Many of the criteria have been described before and we continue to support their importance here. However, we place particular emphasis on the catalytic effect of the assessment, which is whether the assessment provides results and feedback in a fashion that creates, enhances, and supports education. These criteria do not apply equally well to all situations. Consequently, we discuss how the purpose of the test (summative versus formative) and the perspectives of stakeholders (examinees, patients, teachers-educational institutions, healthcare system, and regulators) influence the importance of the criteria. Finally, we offer a series of practice points as well as next steps that should be taken with the criteria. Specifically, we recommend that the criteria be expanded or modified to take account of: (1) the perspectives of patients and the public, (2) the intimate relationship between assessment, feedback, and continued learning, (3) systems of assessment, and (4) accreditation systems.

Despite the popularity of peer assessment (PA), gaps in the literature make it difficult to describe exactly what constitutes effective PA. In a literature review, we divided PA into variables and then investigated their interrelatedness. We found that (a) PA's psychometric qualities are improved by the training and experience of peer assessors; (b) the development of domain-specific skills benefits from PA-based revision; (c) the development of PA skills benefits from training and is related to students' thinking style and academic achievement, and (d) student attitudes towards PA are positively influenced by training and experience. We conclude with recommendations for future research.

Background In postgraduate medical education (PGME), programs have been restructured according to competency-based frameworks. The scale and implications of these adjustments justify a comprehensive implementation plan. Organizational Readiness for Change (ORC) is seen as a critical precursor for a successful implementation of change initiatives. Though, ORC in health care settings is mostly assessed in small scale settings and in relation to new policies and practices rather than educational change. Therefore our aim with this work was to develop an instrument to asses Specialty Training’s Organizational Readiness for curriculum Change (STORC). Methods A Delphi procedure was conducted to examine the applicability of a preliminary questionnaire in PGME, which was based on existing instruments designed for business and health care organizations. The 41 panellists (19 trainees and 22 supervisors from 6 specialties) from four different countries who were confronted with an apparent curriculum change, or would be in the near future, were asked to rate the relevance of a 89-item web-based questionnaire with regard to changes in specialty training on a 5-point Likert scale. Furthermore, they were invited to make qualitative comments on the items. Results In two rounds the 89-item preliminary questionnaire was reduced to 44 items. Items were either removed, kept, adapted or added based on individual item scores and qualitative comments. In the absence of a gold standard, this Delphi procedure was considered complete when the overall questionnaire rating exceeded 4.0 (scale 0–5). The overall item score reached 4.1 in the second round, meeting our criteria for completion of this Delphi procedure. Conclusions This Delphi study describes the initial validating step in the development of an instrument to asses Specialty Training’s Organisational Readiness for curriculum Change (STORC). Since ORC is measured on various subscales and presented as such, its strength lies in analysing these subscales. The latter makes it possible for educational leaders to identify and anticipate on hurdles in the implementation process and subsequently optimize efforts for successful curriculum change. Electronic supplementary material The online version of this article (doi:10.1186/s12909-015-0408-0) contains supplementary material, which is available to authorized users.

Contains fulltext : 138308.pdf (Publisher’s version ) (Open Access) BACKGROUND: Hospital clerkships are considered crucial for acquiring competencies such as diagnostic reasoning and clinical skills. The actual learning process in the hospital remains poorly understood. This study investigates how students learn clinical skills in workplaces and factors affecting this. METHODS: Six focus group sessions with 32 students in Internal Medicine rotation (4-9 students per group; sessions 80-90 minutes). Verbatim transcripts were analysed by emerging themes and coded independently by three researchers followed by constant comparison and axial coding. RESULTS: Students report to learn the systematics of the physical examination, gain agility and become able to recognise pathological signs. The learning process combines working alongside others and working independently with increasing responsibility for patient care. Helpful behaviour includes making findings explicit through patient files or during observation, feedback by abnormal findings and taking initiative. Factors affecting the process negatively include lack of supervision, uncertainty about tasks and expectations, and social context such as hierarchy of learners and perceived learning environment. CONCLUSION: Although individual student experiences vary greatly between different hospitals, it seems that proactivity and participation are central drivers for learning. These results can improve the quality of existing programmes and help design new ways to learn physical examination skills.

INTRODUCTION: The increasing demands for effective and efficient health care delivery systems worldwide have resulted in an expansion of the desired competencies that physicians need to possess upon graduation. Presently, medical residents require additional professional competencies that can prepare them to practice adequately in a continuously changing health care environment. Recent studies show that despite the importance of competency-based training, the development and evaluation of management competencies in residents during residency training is inadequate. The aim of this literature review was to find out which assessment methods are currently being used to evaluate trainees' management competencies and which, if any, of these methods make use of valid and reliable instruments.METHODS: In September 2012, a thorough search of the literature was performed using the PubMed, Cochrane, Embase®, MEDLINE®, and ERIC databases. Additional searches included scanning the references of relevant articles and sifting through the "related topics" displayed by the databases.RESULTS: A total of 25 out of 178 articles were selected for final review. Four broad categories emerged after analysis that best reflected their content: 1) measurement tools used to evaluate the effect of implemented curricular interventions; 2) measurement tools based on recommendations from consensus surveys or conventions; 3) measurement tools for assessing general competencies, which included care-management; and 4) measurement tools focusing exclusively on care-management competencies.CONCLUSION: Little information was found about (validated) assessment tools being used to measure care-management competence in practice. Our findings suggest that a combination of assessment tools should be used when evaluating residents' care-management competencies.

When studying verbal materials, both adults and children are often poor at accurately monitoring their level of learning and regulating their subsequent restudy of materials, which leads to suboptimal test performance. The present experiment investigated how monitoring accuracy and regulation of study could be improved when learning idiomatic phrases. Elementary school children (fourth and sixth-graders) were instructed to predict their test performance by providing judgments of learning (JOLs). They provided JOLs immediately after studying each idiom, after studying all idioms, or after studying all idioms followed by generating sentences in which the idioms were used. Correlations between JOLs and test performance showed that delayed-JOLs and delayed-JOLs with sentence generation were more accurate than immediate JOLs. JOLs after sentence generation also improved regulation of study compared to delayed-JOLs only. Analyses of JOL reaction times suggest that delayed-JOLs led children to retrieve the literal meaning of the idiom, whereas JOLs after sentence generation led children to focus on connections between studied information, contextual information, and prior knowledge. Sentence generation presents a promising method to improve regulation of study, and thus idiom learning. This chapter has been published as: Van Loon, M.H., De Bruin, A. B. H., Van Gog, T., & Van Merrienboer, J. J. G. (2013). The effect of delayed-JOLs and sentence generation on children’s monitoring accuracy and regulation of idiom study. Metacognition and Learning, 8, 173-191. doi: 10.1007/s11409-013-9100-0

In his response to criticisms Ericsson argues that conclusions about expertise development cannot be drawn from studies in the general population, and that it is possible that, in chess, intelligence and expertise are uniformly related across development. We respond here that if we want to study the development of expertise across the lifespan, research needs to take into account samples from the general population, such as novices. Moreover, studies in the general population are needed to study a factor that might have troubled previous research in the field and therefore might have implications for current theories of expertise development, which is a possible restriction of range in crucial variables such as intelligence. We argue for a longitudinal, multifaceted approach to study expertise development, starting with unselected samples of novices and taking into account practice, intelligence and motivation simultaneously, to prevent restriction of range and allow for further and stronger conclusions on the relation between intelligence and chess expertise.

Objective Contextual factors are known to influence the acquisition and application of communication skills in clinical settings. Little is known about residents’ perceptions of these factors. This article aims to explore residents’ perceptions of contextual factors affecting the acquisition and application of communication skills in the medical workplace. Method We conducted an exploratory study comprising seven focus groups with residents in two different specialities: general practice (n = 23) and surgery (n = 18). Results Residents perceive the use of summative assessment checklists that reduce communication skills to behavioural components as impeding the learning of their communication skills. Residents perceive encouragement to deliberately practise in an environment in which the value of communication skills is recognised and support is institutionalised with appropriate feedback from role models as the most important enhancing factors in communication skills learning. Conclusion To gradually realise a clinical working environment in which the above results are incorporated, we propose to use transformative learning theory to guide further studies. Practical implications Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.

Item does not contain fulltext OBJECTIVE: In order to reduce the inconsistencies of findings and the apparent low transfer of communication skills from training to medical practice, this narrative review identifies some main gaps in research on medical communication skills training and presents insights from theories on learning and transfer to broaden the view for future research. METHODS: Relevant literature was identified using Pubmed, GoogleScholar, Cochrane database, and Web of Science; and analyzed using an iterative procedure. RESULTS: Research findings on the effectiveness of medical communication training still show inconsistencies and variability. Contemporary theories on learning based on a constructivist paradigm offer the following insights: acquisition of knowledge and skills should be viewed as an ongoing process of exchange between the learner and his environment, so called lifelong learning. This process can neither be atomized nor separated from the context in which it occurs. Four contemporary approaches are presented as examples. CONCLUSION: The following shift in focus for future research is proposed: beyond isolated single factor effectiveness studies toward constructivist, non-reductionistic studies integrating the context. PRACTICE IMPLICATIONS: Future research should investigate how constructivist approaches can be used in the medical context to increase effective learning and transition of communication skills.

Background Incident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions. Methods The aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier “Incident type”, described as odds ratios (OR) and proportional similarity indices (PSI). Results A total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32) and from IRS and retrospective chart review (PSI = 0.31) were mainly attributable to behaviour (OR = 6.08), clinical administration (OR = 5.14), clinical process (OR = 6.73) and resources (OR = 2.06). Conclusions IRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.

Animations are more and more often used in instruction materials. Segmentation, presenting animations in parts with short breaks in between instead of one continuous stream of information, is one way of optimizing instructive animations for learning. The studies described in this dissertation investigated why segmentation positively influences the learning process and learning outcomes. It was found that the breaks are important for the positive effects, but that showing how the information can be segmented into meaningful parts may also play a role in these effects. Furthermore it was found that segmentation of animations is only favourable for beginning learners.

Models of expertise differences in radiology often do not take into account visual differences between diseases. This study investigates the bottom-up effects of three types of images on viewing patterns of students, residents and radiologists: focal diseases (localized abnormality), diffuse diseases (distributed abnormality) and images showing no abnormalities (normal). Participants inspected conventional chest radiographs while their eye movements were recorded. Regardless of expertise, in focal diseases, participants fixated relatively long at specific locations, whereas in diffuse diseases, fixations were more dispersed and shorter. Moreover, for students, dispersion of fixations was higher on diffuse compared with normal images, whereas for residents and radiologists, dispersion was highest on normal images. Despite this difference, students showed relatively high performance on normal images but low performance on focal and diffuse images. Viewing patterns were strongly influenced by bottom-up stimulus effects. Although viewing behavior of students was similar to that of radiologists, they lack knowledge that helps them diagnose the disease correctly.

Two ways to improve worked examples are investigated: presenting them in a segmented format (i.e., in pieces separated by blank lines) and instructing students to segment them actively (i.e., students must divide the examples in pieces). Segmented examples are expected to support learning because they show which information elements belong together. Learners might also be encouraged to think about which information elements belong together when they are instructed to actively segment, but on the negative side, this is an additional task that might impose extra cognitive load without facilitating learning. Results showed that students in the actively segmenting condition invested more effort in learning than students in the other conditions without performing better. Furthermore, studying segmented examples required less effort to achieve equal learning outcomes than studying nonsegmented ones. So, presenting learners with segmented examples improved the efficiency of the learning process, whereas instructing them to actively segment decreased this efficiency.

Item does not contain fulltext OBJECTIVE: To develop and evaluate a program for laparoscopic urologic skills (PLUS) to determine the face, content, and construct validation to achieve uniformity and standardization in training residents in urology. METHODS: The PLUS consists of 5 basic laparoscopic tasks. Three tasks were abstracted from the Fundamentals of Laparoscopic Surgery program, and 2 additional tasks were developed under continuous evaluation by expert urologists. Fifty participants were recruited from different hospitals and performed the final PLUS training. They all completed a questionnaire after performance. Three outcome parameters were measured: performance quality, time, and dropped objects. The relationship between laparoscopic experience and the outcome parameters was investigated. RESULTS: Of the 50 participants, 13 were students, 20 were residents, and 17 were urologists. Double-log linear regression analysis for all 5 tasks showed a significant effect (effect size range 0.53-0.82; P < .0005) for laparoscopic experience on performance time. Substantial correlations were found between experience and quality ratings (log-linear regression effect size 0.37; P = .012) and the number of dropped objects (Spearman correlation effect size 0.49; P < .01). The usefulness of the PLUS model as a training tool for basic laparoscopic skills was rated 4.55 on a scale from 1 (not useful) to 5 (useful) (standard deviation 0.58; range 3-5). CONCLUSION: The results of the present study indicated the face, content, and construct validity for the PLUS. The training is considered appropriate for use as a primary training tool for an entry test or as part of a step-wise training program in which basic and procedural laparoscopic skills are integrated. 01 april 2012

Item does not contain fulltext Most studies of simulator-based surgical skills training have focused on the acquisition of psychomotor skills, but surgical procedures are complex tasks requiring both psychomotor and cognitive skills. As skills training is modelled on expert performance consisting partly of unconscious automatic processes that experts are not always able to explicate, simulator developers should collaborate with educational experts and physicians in developing efficient and effective training programmes. This article presents an approach to designing simulator-based skill training comprising cognitive task analysis integrated with instructional design according to the four-component/instructional design model. This theory-driven approach is illustrated by a description of how it was used in the development of simulator-based training for the nephrostomy procedure.

Item does not contain fulltext Lack of published studies on students' practice behaviour of physical examination skills outside timetabled training sessions inspired this study into what activities medical students undertake to improve their skills and factors influencing this. Six focus groups of a total of 52 students from Years 1-3 using a pre-established interview guide. Interviews were recorded, transcribed and analyzed using qualitative methods. The interview guide was based on questionnaire results; overall response rate for Years 1-3 was 90% (n = 875). Students report a variety of activities to improve their physical examination skills. On average, students devote 20% of self-study time to skill training with Year 1 students practising significantly more than Year 3 students. Practice patterns shift from just-in-time learning to a longitudinal selfdirected approach. Factors influencing this change are assessment methods and simulated/real patients. Learning resources used include textbooks, examination guidelines, scientific articles, the Internet, videos/DVDs and scoring forms from previous OSCEs. Practising skills on fellow students happens at university rooms or at home. Also family and friends were mentioned to help. Simulated/real patients stimulated students to practise of physical examination skills, initially causing confusion and anxiety about skill performance but leading to increased feelings of competence. Difficult or enjoyable skills stimulate students to practise. The strategies students adopt to master physical examination skills outside timetabled training sessions are self-directed. OSCE assessment does have influence, but learning takes place also when there is no upcoming assessment. Simulated and real patients provide strong incentives to work on skills. Early patient contacts make students feel more prepared for clinical practice. 01 augustus 2012

Background: Patient safety has become an important topic over the last decade and has also been increasingly implemented in the undergraduate curriculum. However, the best timing and method of teaching still remains to be decided. Aims: To develop and evaluate a patient safety course for final-year students. The course is based on reflective learning and personal experiences to improve the transfer of theory into practice. Methods: We performed a mixed method evaluation study of the course. An evaluation questionnaire and the number of completed incident report cards were analyzed using descriptive statistics. Focus groups, organized two and four weeks after the course, were analyzed using template analysis; the Theory of Planned Behaviour (TPB) was used to interpret the results. Results: Students found the course overall instructive and reacted positively towards many elements of the course. Focus group analysis showed that an increase in knowledge about patient safety topics resulted in a change of attitudes towards these subjects and in an increase in awareness of patient safety. This influenced students' behavioral intention and their behavior. Conclusions: A course based on students' personal experiences enables them to transfer theory on patient safety issues into their own practice and has an effect on their awareness, attitudes and behavior. This could have a large impact on their future role as resident.

This article reviews studies investigating segmentation of dynamic visualizations (i.e., showing dynamic visualizations in pieces with pauses in between) and discusses two not mutually exclusive processes that might underlie the effectiveness of segmentation. First, cognitive activities needed for dealing with the transience of dynamic visualizations impose extraneous cognitive load, which may hinder learning. Segmentation may reduce the negative effect of this load by dividing animations into smaller units of information and providing pauses between segments that give students time for the necessary cognitive activities after each of those units of information. Second, event segmentation theory states that people mentally segment dynamic visualizations during perception (i.e., divide the information shown in pieces). Segmentation of dynamic visualisation could cue relevant segments to students, which may aid them in perceiving the structure underlying the process or procedure shown.

Objective: To examine the hypothesis that the “natural” combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use. Methods: In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions. Results: Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need. Conclusions: The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory–delusional syndrome.

Comparison learning is a promising approach for learning complex real-life visual tasks. When medical students study radiological appearances of diseases, comparison of images showing diseases with images showing no abnormalities could help them learn to discriminate relevant, disease-related information. Medical students studied 12 diseases on chest x-ray images. They were randomly assigned to a group (n = 31) that compared radiographs of diseases with normal images and a group (n = 30) that only studied radiographs of diseases. On a visual diagnosis test, students who compared with normal images during study were better able to diagnose focal diseases (i.e., lesions at one location) than students who could not compare, but for the diagnosis of diffuse diseases (i.e., involving both lungs) there was no significant difference between groups. Results show that comparison with normal images made it easier to discriminate relevant information for focal diseases.

Background The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training. Methods Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results. Results 875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1. Conclusions The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.

Within Problem-Based Learning successful learning depends on the quality of cognitive, social and motivational contributions students make to the tutorial group. But at the same time, not all students in PBL automatically contribute in a high quality manner, which might impede successful group functioning. This study investigated whether peer process feedback combined with goal setting can be used to improve the quality of students' individual contributions. A mixed-methods explanatory design, in which 74 second-year Health Sciences students participated, combined a pre- and posttest with a focus group. The results indicated that the quality of the contributions only increased for students with a below average score on the pre-test. The qualitative data confirmed that the impact of the feedback could be increased by combining individual reflection by means of goal setting with face-to-face discussion. Another suggestion is to investigate whether midterm peer process feedback is more effective for first year students, because they are still developing their tutorial behavior, as opposed to second year students.