The Development of Expertise in Dermatology

Norman, Geoffrey R.; Rosenthal, Donald; Brooks, Lee R.; Allen, Scott W.; Muzzin, Linda

doi:10.1001/archderm.1989.01670200039005

Cited by 163 publications

(88 citation statements)

References 11 publications

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“…These results are also consistent with previous research showing that physicians' take more time to provide a dermatological diagnosis when their eventual diagnosis is incorrect relative to when it is correct (Norman et al 1989) and with the response changing literature which suggests that the decision to change responses is sensitive to the presence of initial errors (e.g., Ferguson et al 2002). A second major finding in the current study is that our measures of self-monitoring were modulated by the ability of the examinees.…”

Section: Discussionsupporting

confidence: 92%

Self-monitoring and its relationship to medical knowledge

McConnell

Regehr

Wood

et al. 2011

Adv in Health Sci Educ

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In the domain of self-assessment, researchers have begun to draw distinctions between summative self-assessment activities (i.e., making an overall judgment of one's ability in a particular domain) and self-monitoring processes (i.e., an "in the moment" awareness of whether one has the necessary knowledge or skills to address a specific problem with which one is faced). Indeed, previous research has shown that, when responding to both short answer and multiple choice questions, individuals are able to assess the likelihood of answering questions correctly on a moment-by-moment basis, even though they are not able to generate an accurate self-assessment of overall performance on the test. These studies, however, were conducted in the context of low-stakes tests of general "trivia". The purpose of the present study was to further this line of research by investigating the relationship between self-monitoring and performance in the context of a high stakes test assessing medical knowledge. Using a recent administration of the Medical Council of Canada Qualifying Examination Part I, we examined three measures intended to capture self-monitoring: (1) the time taken to respond to each question, (2) the number of questions a candidate flagged as needing to be considered further, and (3) the likelihood of changing one's initial answer. Differences in these measures as a function of the accuracy of the candidate's response were treated as indices of each candidate's ability to judge his or her likelihood of responding correctly. The three self-monitoring indices were compared for candidates at three different levels of overall performance on the exam. Relative to correct responses, when examinees initially responded incorrectly, they spent more time answering the question, were more likely to flag the question for future consideration, and were more likely to change their answer before committing to a final answer. These measures of self-monitoring were modulated by candidate performance in that high performing examinees showed greater differences on these indices relative to poor performing examinees. Furthermore, reliability analyses suggest that these difference measures hold promise for reliably differentiating self-monitoring at the level of individuals, at least within a given content area. The results suggest that examinees were self-monitoring their knowledge and skills on a question by question basis and altering their behavior appropriately in the moment. High performing individuals showed stronger evidence of accurate self-monitoring than did low performing individuals and the reliability of these measures suggests that they have the potential to differentiate between individuals. How these findings relate to performance in actual clinical settings remains to be seen.

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Section: Discussionsupporting

confidence: 92%

Self-monitoring and its relationship to medical knowledge

McConnell

Regehr

Wood

et al. 2011

Adv in Health Sci Educ

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“…and 1 Kaposi sarcoma). Of the 380 specimens submit¬ ted by nondermatologists as nevi, 12 (3.2%) proved to be malignant tumors (8 basal cell carcinomas, 2 squa¬ mous cell carcinomas, and 2 melanomas).…”

Section: Afh)mentioning

confidence: 99%

The Diagnostic Yield of Histologic Examination of Seborrheic Keratoses

Eads

Hood²,

Chuang³

et al. 1997

Arch Dermatol

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“…12 In these studies, experts and novices are encouraged to diagnose a series of visual stimuli, and note is taken of accuracy and response times.…”

Section: Studies Of Medical Reasoning Using Psychological Methodologymentioning

confidence: 99%

Reliability and construct validity of some cognitive measures of clinical reasoning

Norman

1989

Teaching and Learning in Medicine

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The past few years have seen a growing interest in understanding clinical reasoning processes by using the research methods of cognitive psychology. Nevertheless, a gap remains between the basic research methods and the application of these methods as evaluative instruments. The present research applied standard psychometric "yardsticks"-reliability and construct validity-to several cognitive measures of recall and perception used in previous studies. The cognitive measures were compared to measures of clinical performance derived from encounters with simulated patients and to conventional measures of knowledge based on multiple-choice questions and modified essay questions.The cognitive measures demonstrated reliability comparable to that of the conventional tests and considerably exceeding that of the clinical performance measures. Validity coefficients were comparable for all the measures. A calculation of reliability per unit of testing time indicated that the cognitive measures were more efficient than the other measures. These results provide at least a preliminary indication that the gap between cognitive measures and conventional measures of clinical performance can be narrowed.

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The Development of Expertise in Dermatology

Cited by 163 publications

References 11 publications

Self-monitoring and its relationship to medical knowledge

Self-monitoring and its relationship to medical knowledge

The Diagnostic Yield of Histologic Examination of Seborrheic Keratoses

Reliability and construct validity of some cognitive measures of clinical reasoning

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