Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

Schmidmaier, Ralf; Eiber, Stephan; Ebersbach, René; Schiller, Miriam; Hege, Inga; Holzer, Matthias; Fischer, Martin R.

doi:10.1186/1472-6920-13-28

Cited by 55 publications

(58 citation statements)

References 42 publications

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“…A coding scheme was established on the foundation of the knowledge type definitions [7, 10, 15]. The definition used in the coding scheme is illustrated in Table 2.…”

Section: Methodsmentioning

confidence: 99%

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Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

et al. 2016

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BackgroundClinical reasoning is a key competence in medicine. There is a lack of knowledge, how non-experts like medical students solve clinical problems. It is known that they have difficulties applying conceptual knowledge to clinical cases, that they lack metacognitive awareness and that higher level cognitive actions correlate with diagnostic accuracy. However, the role of conceptual, strategic, conditional, and metacognitive knowledge for clinical reasoning is unknown.MethodsMedical students (n = 21) were exposed to three different clinical cases and instructed to use the think-aloud method. The recorded sessions were transcribed and coded with regards to the four different categories of diagnostic knowledge (see above). The transcripts were coded using the frequencies and time-coding of the categories of knowledge. The relationship between the coded data and accuracy of diagnosis was investigated with inferential statistical methods.ResultsThe use of metacognitive knowledge is correlated with application of conceptual, but not with conditional and strategic knowledge. Furthermore, conceptual and strategic knowledge application is associated with longer time on task. However, in contrast to cognitive action levels the use of different categories of diagnostic knowledge was not associated with better diagnostic accuracy.ConclusionsThe longer case work and the more intense application of conceptual knowledge in individuals with high metacognitive activity may hint towards reduced premature closure as one of the major cognitive causes of errors in medicine. Additionally, for correct case solution the cognitive actions seem to be more important than the diagnostic knowledge categories.

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“…A coding scheme was established on the foundation of the knowledge type definitions [7, 10, 15]. The definition used in the coding scheme is illustrated in Table 2.…”

Section: Methodsmentioning

confidence: 99%

“…multiple choice tests, key feature problems, interviews, questions, stimulated recall) it has proven difficult to measure and observe metacognition in a realistic setting [7]. Since metacognition cannot be observed directly in students [12], self-report methods like questionnaires, rating scales and stimulated recall are used.…”

Section: Introductionmentioning

confidence: 99%

Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

et al. 2016

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“…However, teaching should be a process of creating learning activities that allow students to integrate knowledge within different contexts, rather than presenting it as a decontextualised set of abstractions [3]. There is therefore a trend towards focusing students’ attention on the interpretation of concepts and the relationships between them, which facilitates the development of procedural skills – an important attribute for success in the medical field [2, 4]. …”

Section: Introductionmentioning

confidence: 99%

Structured feedback on students’ concept maps: the proverbial path to learning?

et al. 2017

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BackgroundGood conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks.MethodsFifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning.ResultsThe inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P < 0.001) at the final evaluation (post-feedback). Changes in structural complexity of CMs appeared to be indicative of broader knowledge frameworks as assessed against the meaningful learning traits.ConclusionsFeedback on CM’s seemed to have contributed towards improving conceptual knowledge and correcting naive conceptions of related knowledge. Educators in medical education could therefore consider using CM’s to target individual student development.

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“…In contrast, procedural knowledge (“why” and “how” information) requires different skills: Students are encouraged to understand concepts and to gather information from various disciplines in order to apply their knowledge in a clinically-oriented context. Remarkably, prior clinical experience has been suggested to be a strong factor influencing students’ performance in procedural knowledge tasks [6, 7]. With the focus of teaching students to think critically, test items must require students to use a high level of cognitive processing [3].…”

Section: Introductionmentioning

confidence: 99%

Case-based learning and multiple choice questioning methods favored by students

et al. 2016

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BackgroundInvestigating and understanding how students learn on their own is essential to effective teaching, but studies are rarely conducted in this context. A major aim within medical education is to foster procedural knowledge. It is known that case-based questioning exercises drive the learning process, but the way students deal with these exercises is explored little.MethodsThis study examined how medical students deal with case-based questioning by evaluating 426 case-related questions created by 79 fourth-year medical students. The subjects covered by the questions, the level of the questions (equivalent to United States Medical Licensing Examination Steps 1 and 2), and the proportion of positively and negatively formulated questions were examined, as well as the number of right and wrong answer choices, in correlation to the formulation of the question.ResultsThe evaluated case-based questions’ level matched the United States Medical Licensing Examination Step 1 level. The students were more confident with items aiming on diagnosis, did not reject negatively formulated questions and tended to prefer handling with right content, while keeping wrong content to a minimum.ConclusionThese results should be taken into consideration for the formulation of case-based questioning exercises in the future and encourage the development of bedside teaching in order to foster the acquisition of associative and procedural knowledge, especially clinical reasoning and therapy-oriented thinking.

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Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

Cited by 55 publications

References 42 publications

Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities

Structured feedback on students’ concept maps: the proverbial path to learning?

Case-based learning and multiple choice questioning methods favored by students

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