Henk Schmidt is a professor of psychology at Erasmus University’s faculty of social sciences and founding dean of its problem-based psychology curriculum. Between 2009 and 2013, he was the Vice-Chancellor (“Rector Magnificus”) of Erasmus University Rotterdam. Previously, Schmidt held academic positions as professor of cognitive psychology, faculty of psychology, Maastricht University, and as professor of health professions education at the same university. His research areas of interest are learning and memory, and he has published on problem-based learning, long-term memory, and the development of expertise in medicine.
AUTHORS: Henk G. Schmidt, PhD, Jerome I. Rotgans, PhD, Preman Rajalingam, PhD, and Naomi Low- Bee... more AUTHORS: Henk G. Schmidt, PhD, Jerome I. Rotgans, PhD, Preman Rajalingam, PhD, and Naomi Low- Beer, MD
Although team-based learning is a popular instructional approach, little is known about its psychological foundation. In this Perspective, the authors propose a theoretical account of the psychological mechanisms through which team-based learning works. They suggest a knowledge reconsolidation hypothesis to explain how the distinct phases of team-based learning enable students to learn. Knowledge reconsolidation is the process whereby previously consolidated knowledge is retrieved from memory with the purpose of actively consolidating it again. Reconsolidation aims to preserve, strengthen, and adjust knowledge that is already stored in long-term memory. This process is generally considered an important reason why people who reactivate what they have previously learned many times develop knowledge structures that are extremely stable and easily retrieved. The authors propose that four psychological mechanisms enable knowledge reconsolidation, each of which is tied to a district phase of team-based learning: retrieval practice, peer elaboration, feedback, and transfer of learning. Before a team-based learning session, students engage in independent, self-directed learning that is often followed by at least one night of sleep. The latter is known to facilitate synaptic consolidation in the brain. During the actual team-based learning session, students are first tested individually on what they learned, then they discuss the answers to the test with a small group of peers, ask remaining “burning questions” to the teacher, and finally engage in a number of application exercises. This knowledge reconsolidation hypothesis may be considered a framework to guide future research into how team-based learning works and its outcomes.
Purpose. The objective of the present study was to determine the extent to which dual-process the... more Purpose. The objective of the present study was to determine the extent to which dual-process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored if neurological correlates of system-2 thinking could be located in the brain. It was hypothesised that system-2 thinking could be observed as the activation of the prefrontal cortex. Method. An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest x-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants’ prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. Results. The results revealed that participants’ diagnostic accuracy in the test phase was significantly higher for the trained cases as compared to the untrained cases F(1, 21) = 138.80, P < 0.001, η2 = 0.87. Also, their response time was significantly shorter for these cases F(1, 21) = 18.12, P < 0.001, η2 = 0.46. Finally, the results revealed that only for the untrained cases, a significant activation of the anterolateral prefrontal cortex could be observed F(1, 21) = 21.00, P < 0.01, η2 = 0.34. Conclusion. The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of dual-process theory are discussed.
(2018): Inducing System-1-type diagnostic reasoning in second-year medical students within 15 min... more (2018): Inducing System-1-type diagnostic reasoning in second-year medical students within 15 minutes, Medical Teacher, ABSTRACT Purpose: Diagnostic reasoning literature debates the significance of " dual-process theory " and the importance of its constituent types of thinking: System-1and System-2. This experimental study aimed to determine whether novice medical students could be trained to utilize System-1 thinking when making diagnoses based on chest X-rays. Method: Second-year medical students were recruited and presented with a series of eight online chest X-rays cases. Participants were shown half of the cases repeatedly during a training phase and the other half only twice. During the final test phase, they were shown all eight cases, providing a diagnosis as a free text answer. Dependent variables were diagnostic accuracy and response time. Results: Thirty-two students participated. During the test phase, students responses were significantly more accurate and faster for cases which had been seen repeatedly during the training phase (mean score ¼ 3.56/4, mean time ¼ 2.34 s) compared with cases which had been seen only twice (mean score ¼ 1.59/4, mean time ¼ 7.50 s). Conclusion: This study demonstrates that it is possible to induce in novice students the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. The full experimental design and the chest X-rays used may provide new opportunities to explore some of the issues surrounding dual-process theory.
The objective of the paper is to report findings of two studies that attempted to find answers to... more The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and-2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (b = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.
The extent to which a student experiences situational interest during a learning task is dependen... more The extent to which a student experiences situational interest during a learning task is dependent on at least two factors: (1) external stimuli in the learning environment that arouse interest and (2) internal dispositions, such as individual interest. The objective of the present study was to disentangle how both factors influence situational interest during task engagement. Two data sets were collected from primary school science (N D 186) and secondary school history students (N D 71). Path analysis was used to examine the influence of individual interest on seven situational interest measurements and knowledge acquisition. The results suggest that individual interest has only a significant influence on situational interest at the beginning of a task and then its influence fades. In addition, individual interest is not a significant predictor of learning. Only situational interest predicts knowledge acquisition. Implications of these findings for interest research are discussed.
Interest has become a central topic in the educational-psychology literature and Hidi and Renning... more Interest has become a central topic in the educational-psychology literature and Hidi and Renninger’s (2006) four-phase model of interest development is its most recent manifestation. However, this model presently enjoys only limited empirical support. To contribute to our understanding of how individual interest in a subject develops in learners, two studies were conducted with primary school science stu- dents. The first study (N = 187) tested the assumption that repeated arousal of situational interest affects the growth of individual interest. Latent growth curve modeling was applied and the results suggest that the arousal of situational interest has a positive effect on the development of individual interest and sig- nificantly influences its growth trajectory. The second study tested the assumption that engaging stu- dents with interest-provoking didactic stimuli, such as problems, is critical to triggering situational interest and increasing individual interest. To test this assumption, four classes of primary school stu- dents (N = 129) were randomly assigned to two conditions in a quasi-experimental setup. The treatment condition received four situational-interest-inducing science problems as part of a course whereas the control condition did not, all other things being equal. The results of latent growth curve modeling revealed that only the group receiving problems experienced repeated arousal of situational interest and its related growth in individual interest. Implications for, and amendments to, the four-phase model of interest development are proposed.
PURPOSE:
Studies suggest time pressure has negative effects on physicians' working conditions and... more PURPOSE: Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy. METHOD: In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored. RESULTS: The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants. CONCLUSIONS: Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.
The effect of memory load on the cognitive pupillary response among 16 young adults and 16 older ... more The effect of memory load on the cognitive pupillary response among 16 young adults and 16 older adults was investigated. Mean pupil dilation and reaction time were measured during a Sternberg memory-search task, which involved six levels of memory load. A classic interaction pattern was obtained in which the reaction times of the elderly participants increased more as a function of memory load than the reaction times of the young participants. In the encoding phase of the experiment, mean dilation increased with memory load. No age differences were observed here. In the search phase of the experiment, however, mean pupil dilation was considerably greater in the young than in the elderly participants. Moreover, mean dilation of the older participants was not sensitive to memory load, whereas mean dilation increased as a function of memory load in the young participants. The results suggest that the usefulness of the pupillary response as a correlate of subtle fluctuations in memory load diminishes with old age.
Page 1. Educational Gerontology, 26 : 503521, 2000 Copyright 2000 Taylor & Francis Ó 0360-12... more Page 1. Educational Gerontology, 26 : 503521, 2000 Copyright 2000 Taylor & Francis Ó 0360-1277/00 $12.00 1 .00 COGNITIVE LOAD THEORY AND THE ACQUISITION OF COMPLEX COGNITIVE SKILLS IN THE ELDERLY: TOWARDS AN INTEGRATIVE FRAMEWORK ...
Problem-based curricula provide a learning environment in which competence is fostered not primar... more Problem-based curricula provide a learning environment in which competence is fostered not primarily by teaching to impart knowledge, but through encouraging an inquisitive style of learning. Preliminary discussion in small groups, contextual learning, integration of knowledge and an emphasis on patient problems, have several cognitive effects on student learning. These effects are increased retention of knowledge, enhancement of integration of
Previous studies have shown that with important decisions, unconscious thought has surprisingly l... more Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called 'deliberation-without-attention effect' in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that experienced physicians would outperform students as a result of their superior knowledge. The central question was whether unconscious thought in this task would lead to better performance in experts or novices, in line with the deliberation-without-attention effect. We created four fictitious male 60-year-old patients, each of whom with signs and symptoms related to likely prognosis, from 12 (Complex) or 4 (Simple) categories. This manipulation resulted in objectively different life expecta...
While the medical internship (MI) has evolved in some countries into competency-based training wi... more While the medical internship (MI) has evolved in some countries into competency-based training with innovative tools for assessment and feedback, the traditional MI is still the norm in many countries. To describe recent advances in the MI in several countries, to discuss the current MI situation in Saudi Arabia as an example of a country that applies a traditional MI, and to present a Framework for Medical Interns' Competencies (FMIC) implemented within the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Common electronic databases were searched for the years 1990 to 2008 under keywords related to medical internship education. Information on curricula designed for medical interns or junior doctors in selected countries was obtained by searching relevant websites. At the KSAU-HS, the FMIC was created by first building the case for the urgent need for revising the MI and adapting international approaches to the KSA's needs, followed by dialogue among faculty...
Contrary to what common sense makes us believe, deliberation without attention has recently been ... more Contrary to what common sense makes us believe, deliberation without attention has recently been suggested to produce better decisions in complex situations than deliberation with attention. Based on differences between cognitive processes of experts and novices, we hypothesized that experts make in fact better decisions after consciously thinking about complex problems whereas novices may benefit from deliberation-without-attention. These hypotheses were confirmed in a study among doctors and medical students. They diagnosed complex and routine problems under three conditions, an immediate-decision condition and two delayed conditions: conscious thought and deliberation-without-attention. Doctors did better with conscious deliberation when problems were complex, whereas reasoning mode did not matter in simple problems. In contrast, deliberation-without-attention improved novices' decisions, but only in simple problems. Experts benefit from consciously thinking about complex pro...
AUTHORS: Henk G. Schmidt, PhD, Jerome I. Rotgans, PhD, Preman Rajalingam, PhD, and Naomi Low- Bee... more AUTHORS: Henk G. Schmidt, PhD, Jerome I. Rotgans, PhD, Preman Rajalingam, PhD, and Naomi Low- Beer, MD
Although team-based learning is a popular instructional approach, little is known about its psychological foundation. In this Perspective, the authors propose a theoretical account of the psychological mechanisms through which team-based learning works. They suggest a knowledge reconsolidation hypothesis to explain how the distinct phases of team-based learning enable students to learn. Knowledge reconsolidation is the process whereby previously consolidated knowledge is retrieved from memory with the purpose of actively consolidating it again. Reconsolidation aims to preserve, strengthen, and adjust knowledge that is already stored in long-term memory. This process is generally considered an important reason why people who reactivate what they have previously learned many times develop knowledge structures that are extremely stable and easily retrieved. The authors propose that four psychological mechanisms enable knowledge reconsolidation, each of which is tied to a district phase of team-based learning: retrieval practice, peer elaboration, feedback, and transfer of learning. Before a team-based learning session, students engage in independent, self-directed learning that is often followed by at least one night of sleep. The latter is known to facilitate synaptic consolidation in the brain. During the actual team-based learning session, students are first tested individually on what they learned, then they discuss the answers to the test with a small group of peers, ask remaining “burning questions” to the teacher, and finally engage in a number of application exercises. This knowledge reconsolidation hypothesis may be considered a framework to guide future research into how team-based learning works and its outcomes.
Purpose. The objective of the present study was to determine the extent to which dual-process the... more Purpose. The objective of the present study was to determine the extent to which dual-process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored if neurological correlates of system-2 thinking could be located in the brain. It was hypothesised that system-2 thinking could be observed as the activation of the prefrontal cortex. Method. An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest x-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants’ prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. Results. The results revealed that participants’ diagnostic accuracy in the test phase was significantly higher for the trained cases as compared to the untrained cases F(1, 21) = 138.80, P < 0.001, η2 = 0.87. Also, their response time was significantly shorter for these cases F(1, 21) = 18.12, P < 0.001, η2 = 0.46. Finally, the results revealed that only for the untrained cases, a significant activation of the anterolateral prefrontal cortex could be observed F(1, 21) = 21.00, P < 0.01, η2 = 0.34. Conclusion. The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of dual-process theory are discussed.
(2018): Inducing System-1-type diagnostic reasoning in second-year medical students within 15 min... more (2018): Inducing System-1-type diagnostic reasoning in second-year medical students within 15 minutes, Medical Teacher, ABSTRACT Purpose: Diagnostic reasoning literature debates the significance of " dual-process theory " and the importance of its constituent types of thinking: System-1and System-2. This experimental study aimed to determine whether novice medical students could be trained to utilize System-1 thinking when making diagnoses based on chest X-rays. Method: Second-year medical students were recruited and presented with a series of eight online chest X-rays cases. Participants were shown half of the cases repeatedly during a training phase and the other half only twice. During the final test phase, they were shown all eight cases, providing a diagnosis as a free text answer. Dependent variables were diagnostic accuracy and response time. Results: Thirty-two students participated. During the test phase, students responses were significantly more accurate and faster for cases which had been seen repeatedly during the training phase (mean score ¼ 3.56/4, mean time ¼ 2.34 s) compared with cases which had been seen only twice (mean score ¼ 1.59/4, mean time ¼ 7.50 s). Conclusion: This study demonstrates that it is possible to induce in novice students the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. The full experimental design and the chest X-rays used may provide new opportunities to explore some of the issues surrounding dual-process theory.
The objective of the paper is to report findings of two studies that attempted to find answers to... more The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and-2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (b = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.
The extent to which a student experiences situational interest during a learning task is dependen... more The extent to which a student experiences situational interest during a learning task is dependent on at least two factors: (1) external stimuli in the learning environment that arouse interest and (2) internal dispositions, such as individual interest. The objective of the present study was to disentangle how both factors influence situational interest during task engagement. Two data sets were collected from primary school science (N D 186) and secondary school history students (N D 71). Path analysis was used to examine the influence of individual interest on seven situational interest measurements and knowledge acquisition. The results suggest that individual interest has only a significant influence on situational interest at the beginning of a task and then its influence fades. In addition, individual interest is not a significant predictor of learning. Only situational interest predicts knowledge acquisition. Implications of these findings for interest research are discussed.
Interest has become a central topic in the educational-psychology literature and Hidi and Renning... more Interest has become a central topic in the educational-psychology literature and Hidi and Renninger’s (2006) four-phase model of interest development is its most recent manifestation. However, this model presently enjoys only limited empirical support. To contribute to our understanding of how individual interest in a subject develops in learners, two studies were conducted with primary school science stu- dents. The first study (N = 187) tested the assumption that repeated arousal of situational interest affects the growth of individual interest. Latent growth curve modeling was applied and the results suggest that the arousal of situational interest has a positive effect on the development of individual interest and sig- nificantly influences its growth trajectory. The second study tested the assumption that engaging stu- dents with interest-provoking didactic stimuli, such as problems, is critical to triggering situational interest and increasing individual interest. To test this assumption, four classes of primary school stu- dents (N = 129) were randomly assigned to two conditions in a quasi-experimental setup. The treatment condition received four situational-interest-inducing science problems as part of a course whereas the control condition did not, all other things being equal. The results of latent growth curve modeling revealed that only the group receiving problems experienced repeated arousal of situational interest and its related growth in individual interest. Implications for, and amendments to, the four-phase model of interest development are proposed.
PURPOSE:
Studies suggest time pressure has negative effects on physicians' working conditions and... more PURPOSE: Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy. METHOD: In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored. RESULTS: The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants. CONCLUSIONS: Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.
The effect of memory load on the cognitive pupillary response among 16 young adults and 16 older ... more The effect of memory load on the cognitive pupillary response among 16 young adults and 16 older adults was investigated. Mean pupil dilation and reaction time were measured during a Sternberg memory-search task, which involved six levels of memory load. A classic interaction pattern was obtained in which the reaction times of the elderly participants increased more as a function of memory load than the reaction times of the young participants. In the encoding phase of the experiment, mean dilation increased with memory load. No age differences were observed here. In the search phase of the experiment, however, mean pupil dilation was considerably greater in the young than in the elderly participants. Moreover, mean dilation of the older participants was not sensitive to memory load, whereas mean dilation increased as a function of memory load in the young participants. The results suggest that the usefulness of the pupillary response as a correlate of subtle fluctuations in memory load diminishes with old age.
Page 1. Educational Gerontology, 26 : 503521, 2000 Copyright 2000 Taylor & Francis Ó 0360-12... more Page 1. Educational Gerontology, 26 : 503521, 2000 Copyright 2000 Taylor & Francis Ó 0360-1277/00 $12.00 1 .00 COGNITIVE LOAD THEORY AND THE ACQUISITION OF COMPLEX COGNITIVE SKILLS IN THE ELDERLY: TOWARDS AN INTEGRATIVE FRAMEWORK ...
Problem-based curricula provide a learning environment in which competence is fostered not primar... more Problem-based curricula provide a learning environment in which competence is fostered not primarily by teaching to impart knowledge, but through encouraging an inquisitive style of learning. Preliminary discussion in small groups, contextual learning, integration of knowledge and an emphasis on patient problems, have several cognitive effects on student learning. These effects are increased retention of knowledge, enhancement of integration of
Previous studies have shown that with important decisions, unconscious thought has surprisingly l... more Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called 'deliberation-without-attention effect' in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that experienced physicians would outperform students as a result of their superior knowledge. The central question was whether unconscious thought in this task would lead to better performance in experts or novices, in line with the deliberation-without-attention effect. We created four fictitious male 60-year-old patients, each of whom with signs and symptoms related to likely prognosis, from 12 (Complex) or 4 (Simple) categories. This manipulation resulted in objectively different life expecta...
While the medical internship (MI) has evolved in some countries into competency-based training wi... more While the medical internship (MI) has evolved in some countries into competency-based training with innovative tools for assessment and feedback, the traditional MI is still the norm in many countries. To describe recent advances in the MI in several countries, to discuss the current MI situation in Saudi Arabia as an example of a country that applies a traditional MI, and to present a Framework for Medical Interns' Competencies (FMIC) implemented within the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Common electronic databases were searched for the years 1990 to 2008 under keywords related to medical internship education. Information on curricula designed for medical interns or junior doctors in selected countries was obtained by searching relevant websites. At the KSAU-HS, the FMIC was created by first building the case for the urgent need for revising the MI and adapting international approaches to the KSA's needs, followed by dialogue among faculty...
Contrary to what common sense makes us believe, deliberation without attention has recently been ... more Contrary to what common sense makes us believe, deliberation without attention has recently been suggested to produce better decisions in complex situations than deliberation with attention. Based on differences between cognitive processes of experts and novices, we hypothesized that experts make in fact better decisions after consciously thinking about complex problems whereas novices may benefit from deliberation-without-attention. These hypotheses were confirmed in a study among doctors and medical students. They diagnosed complex and routine problems under three conditions, an immediate-decision condition and two delayed conditions: conscious thought and deliberation-without-attention. Doctors did better with conscious deliberation when problems were complex, whereas reasoning mode did not matter in simple problems. In contrast, deliberation-without-attention improved novices' decisions, but only in simple problems. Experts benefit from consciously thinking about complex pro...
Previous research indicated that physically disabled children have a low self-efficacy and percei... more Previous research indicated that physically disabled children have a low self-efficacy and perceive less control over their own performance than other children. Problem-based learning (PBL) is an educational approach that emphasizes interpersonal skills, self-directed learning and problem-solving skills. Acquiring these skills has been demonstrated to increase self-efficacy. This study examined whether the use of PBL would increase self-efficacy and school-related attitudes in physically disabled teenagers. In a quasi-experimental design, 29 physically disabled teenagers received a 9-week geography course in PBL format or their usual geography education. Contrary to our hypothesis, no positive effects of PBL were found and the PBL group even showed a significant decrease in learning-related self-esteem, as compared with the controls. A possible explanation is that the PBL course was too short and not integrated in the whole curriculum. The results emphasize the importance of experimentally testing the effects of new educational methods for use in other populations then the population for which positive results have been reported (university students). This seems particularly true in special populations such as physically disabled children. Additionally,
The Willey Handbook of Problem-Based Learning, 2019
Rotgans, J.I. & Schmidt, H.G. (2019). Effects of problem-based learning on motivation, interest, ... more Rotgans, J.I. & Schmidt, H.G. (2019). Effects of problem-based learning on motivation, interest, and learning. In: M. Moallem, W. Hung & N. Dabbagh (Eds.) The Willey Handbook of Problem-Based Learning. pp.157-181.
" My students don't seem interested in what I teach and I can hardly get them to focus on the tas... more " My students don't seem interested in what I teach and I can hardly get them to focus on the tasks in class. What can I do to make them more interested so that they engage more and learn more? " This is a common cry for help by many teachers and has been considered an increasingly severe problem facing education worldwide (e.g. see " Motivating the academically unmotivated: A critical issue for the 21 st Century "). Although it may not be directly obvious, problem-based learning as an instructional approach can help remedy the problem in three important ways. First, it has largely been assumed that the problem, which represents a puzzle or controversial issue describing something unexpected or novel, startles students' curiosity and interest. Further, if students are interested they engage more in discussions with their peers and come up with tentative explanations for the problem. Working with peers in teams is a second expected motivator. Rather than engaging in a question and answer discourse with a teacher, students engage in discussions with peers who are generally of similar mindsets and proficiency. This is expected to result in a feeling of equality and is less threatening. Lastly, in problem-based learning students perceive that they have a choice on what they want to study, i.e. they identify their own learning goals. According to self-determination theory, having this choice results in a feeling of autonomy and empowerment, which in turn is expected to have a motivating effect on students' learning. The above explanations appeal to intuitive logic. However, surprisingly little research has been conducted in problem-based learning to investigate whether these assumptions are correct. The objective of this chapter is to provide more insights in this issue.
The objective of this chapter is to illuminate the role of interest in knowledge acquisition. In ... more The objective of this chapter is to illuminate the role of interest in knowledge acquisition. In this chapter, we make a distinction between situational interest and individual interest and explain how both are related to knowledge. We will argue that the relations between these three concepts are at the heart of the education endeavor. We present empirical findings showing that situational interest is a causal factor in the acquisition of knowledge. Individual interest is shown to be a byproduct of knowledge and a causal factor in the emergence of situational interest. In the concluding paragraphs, we will propose a model that integrates our findings and present directions for future research.
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Although team-based learning is a popular instructional approach, little is known about its psychological foundation. In this Perspective, the authors propose a theoretical account of the psychological mechanisms through which team-based learning works. They suggest a knowledge reconsolidation hypothesis to explain how the distinct phases of team-based learning enable students to learn. Knowledge reconsolidation is the process whereby previously consolidated knowledge is retrieved from memory with the purpose of actively consolidating it again. Reconsolidation aims to preserve, strengthen, and adjust knowledge that is already stored in long-term memory. This process is generally considered an important reason why people who reactivate what they have previously learned many times develop knowledge structures that are extremely stable and easily retrieved.
The authors propose that four psychological mechanisms enable knowledge reconsolidation, each of which is tied to a district phase of team-based learning: retrieval practice, peer elaboration, feedback, and transfer of learning. Before a team-based learning session, students engage in independent, self-directed learning that is often followed by at least one night of sleep. The latter is known to facilitate synaptic consolidation in the brain. During the actual team-based learning session, students are first tested individually on what they learned, then they discuss the answers to the test with a small group of peers, ask remaining “burning questions” to the teacher, and finally engage in a number of application exercises.
This knowledge reconsolidation hypothesis may be considered a framework to guide future research into how team-based learning works and its outcomes.
Method. An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest x-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants’ prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators.
Results. The results revealed that participants’ diagnostic accuracy in the test phase was significantly higher for the trained cases as compared to the untrained cases F(1, 21) = 138.80, P < 0.001, η2 = 0.87. Also, their response time was significantly shorter for these cases F(1, 21) = 18.12, P < 0.001, η2 = 0.46. Finally, the results revealed that only for the untrained cases, a significant activation of the anterolateral prefrontal cortex could be observed F(1, 21) = 21.00, P < 0.01, η2 = 0.34.
Conclusion. The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of dual-process theory are discussed.
Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy.
METHOD:
In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored.
RESULTS:
The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants.
CONCLUSIONS:
Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.
Although team-based learning is a popular instructional approach, little is known about its psychological foundation. In this Perspective, the authors propose a theoretical account of the psychological mechanisms through which team-based learning works. They suggest a knowledge reconsolidation hypothesis to explain how the distinct phases of team-based learning enable students to learn. Knowledge reconsolidation is the process whereby previously consolidated knowledge is retrieved from memory with the purpose of actively consolidating it again. Reconsolidation aims to preserve, strengthen, and adjust knowledge that is already stored in long-term memory. This process is generally considered an important reason why people who reactivate what they have previously learned many times develop knowledge structures that are extremely stable and easily retrieved.
The authors propose that four psychological mechanisms enable knowledge reconsolidation, each of which is tied to a district phase of team-based learning: retrieval practice, peer elaboration, feedback, and transfer of learning. Before a team-based learning session, students engage in independent, self-directed learning that is often followed by at least one night of sleep. The latter is known to facilitate synaptic consolidation in the brain. During the actual team-based learning session, students are first tested individually on what they learned, then they discuss the answers to the test with a small group of peers, ask remaining “burning questions” to the teacher, and finally engage in a number of application exercises.
This knowledge reconsolidation hypothesis may be considered a framework to guide future research into how team-based learning works and its outcomes.
Method. An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest x-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants’ prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators.
Results. The results revealed that participants’ diagnostic accuracy in the test phase was significantly higher for the trained cases as compared to the untrained cases F(1, 21) = 138.80, P < 0.001, η2 = 0.87. Also, their response time was significantly shorter for these cases F(1, 21) = 18.12, P < 0.001, η2 = 0.46. Finally, the results revealed that only for the untrained cases, a significant activation of the anterolateral prefrontal cortex could be observed F(1, 21) = 21.00, P < 0.01, η2 = 0.34.
Conclusion. The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of dual-process theory are discussed.
Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy.
METHOD:
In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored.
RESULTS:
The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants.
CONCLUSIONS:
Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.