Block versus longitudinal integrated clerkships: students’ views of rural clinical supervision

Context

Medical students undertaking longitudinal integrated clerkships (LIC s) train in multiple disciplines concurrently, compared with students in block rotations who typically address one medical discipline at a time. Current research suggests that LIC s afford students increased access to patients and continuity of clinical supervision. However, these factors are less of an issue in rural placements where there are fewer learners. The aim of this study was to compare rural LIC and rural block rotation students’ reported experiences of clinical supervision.

Methods

De‐identified data from the 2015 version of the Australian national rural clinical schools (RCS s) exit survey was used to compare students in LIC s with those in block rotations in relation to how they evaluate their clinical supervisors and how they rate their own clinical competence.

Results

Multivariate general linear modelling showed no association between placement type (LIC versus Block) and reported clinical supervision. The single independent predictor of positive perception of clinical supervisors was choosing an RCS as a first preference. There was also no association between placement type (LIC versus Block) and self‐rated clinical competence. Instead, the clinical supervision score and male gender predicted more positive self‐ratings of clinical competence.

Conclusions

The quality of clinical supervision in block placements and LIC programmes in rural Australian settings was reported by students as equivalent.

     

‘I feel like I sleep here’: how space and place influence medical student experiences

Context

Buildings and learning spaces contribute in crucial ways to people's experiences of these spaces. However, this aspect of context has been under‐researched in medical education. We addressed this gap in knowledge by using the conceptual notions of space and place as heuristic lenses through which to explore the impact of a new medical school building on student experiences.

Methods

We carried out an exploratory case study to explore the impact of a new medical school building on student experiences. Data were collected from archived documents (n = 50), interviews with key stakeholders (n = 17) and focus group discussions with students (n = 17 participants) to provide context and aid triangulation. Data coding and analysis were initially inductive and conducted using thematic analysis. After themes had emerged, we applied the concepts of boundary objects, liminal space and Foucault's panopticon to provide a framework for the data.

Results

There were specific visions and intentions for the place (the location) and space (the facilities) of the new medical school building (e.g. it was positioned to facilitate flow between educational and clinical settings). However, the unintentional consequences of the planning were that students felt disconnected from the wider university, trapped on the health care campus, and under pressure to behave not like students but in a manner they believed to be expected by clinical staff and patients.

Conclusions

Despite much effort and a focus on creating an idyllic space and place, the new medical school had both positive and (unintentionally) negative impacts on student experiences. These findings highlight the importance of reflecting on, and exploring, how space and place may influence and shape students’ learning experiences during the formative years of their development of a professional identity, a necessary consideration when planning new medical school learning spaces or changing these spaces.

     

Minding the gap between communication skills simulation and authentic experience

Context

Concurrent exposure to simulated and authentic experiences during undergraduate medical education is increasing. The impact of gaps or differences between contemporaneous experiences has not been adequately considered. We address two questions. How do new undergraduate medical students understand contemporaneous interactions with simulated and authentic patients? How and why do student perceptions of differences between simulated and authentic patient interactions shape their learning?

Methods

We conducted an interpretative thematic secondary analysis of research data comprising individual interviews (n = 23), focus groups (three groups, n = 16), and discussion groups (four groups, n = 26) with participants drawn from two different year cohorts of Year 1 medical students. These methods generated data from 48 different participants, of whom 17 provided longitudinal data. In addition, data from routinely collected written evaluations of three whole Year 1 cohorts (response rates ≥ 88%, n = 378) were incorporated into our secondary analysis dataset. The primary studies and our secondary analysis were conducted in a single UK medical school with an integrated curriculum.

Results

Our analysis identified that students generate knowledge and meaning from their simulated and authentic experiences relative to each other and that the resultant learning differs in quality according to meaning created by comparing and contrasting contemporaneous experiences. Three themes were identified that clarify how and why the contrasting of differences is an important process for learning outcomes. These are preparedness, responsibility for safety, and perceptions of a gap between theory and practice.

Conclusions

We propose a conceptual framework generated by reframing common metaphors that refer to the concept of the gap to develop educational strategies that might maximise useful learning from perceived differences. Educators need to ‘mind’ gaps in collaboration with students if synergistic learning is to be constructed from contemporaneous exposure to simulated and authentic patient interactions. The strategies need to be tested in practice by teachers and learners for utility. Further research is needed to understand gaps in other contexts.

     

Resident hesitation in the operating room: does uncertainty equal incompetence?

Context

In postgraduate medical programmes, the progressive development of autonomy places residents in situations in which they must cope with uncertainty. We explored the phenomenon of hesitation, triggered by uncertainty, in the context of the operating room in order to understand the social behaviours surrounding supervision and progressive autonomy.

Methods

Nine surgical residents and their supervising surgeons at a Canadian medical school were selected. Each resident–supervisor pair was observed during a surgical procedure and subsequently participated in separate post‐observation, semi‐structured interviews. Constructivist grounded theory was used to guide the collection and analysis of data.

Results

Three hesitation‐related themes were identified: the principle of progress; the meaning of hesitation, and the judgement of competence. Supervisors and residents understood hesitation in the context of a core surgical principle we termed the ‘principle of progress’. This principle reflects the supervisors’ and residents’ shared norm that maintaining progress throughout a surgical procedure is of utmost importance. Resident hesitation was perceived as the first indication of a disruption to this principle and was therefore interpreted by supervisors and residents alike as a sign of incompetence. This interpretation influenced the teaching–learning process during these moments when residents were working at the edge of their abilities.

Conclusions

The principle of progress influences the meaning of hesitation which, in turn, shapes judgements of competence. This has important implications for teaching and learning in direct supervision settings such as surgery. Without efforts to change the perception that hesitation represents incompetence, these potential teaching–learning moments will not fully support progressive autonomy.

     

Implementation and impact of indigenous health curricula: a systematic review

Context

The effectiveness of cultural competency education in improving health practitioner proficiency and addressing health inequities for minoritised patient groups is uncertain. Identification of institutional factors that shape or constrain development of indigenous health curricula may provide insights into the impact of these factors on the broader cultural competency curricula.

Methods

We undertook a systematic review using actor–network theory to inform our interpretive synthesis of studies that reported indigenous health curricula evaluated within medical, nursing and allied health education. We searched the MEDLINE , OVID Nursing, Educational Resources Information Center (ERIC ), PsycINFO, EMBASE, Web of Science and PubMed databases to December 2017 using exploded MeSH terms ‘indigenous’ and ‘medical education’ and ‘educational professional’ and ‘health professional education’. We included studies involving undergraduate or postgraduate medical, nursing or allied health students or practitioners. Studies were eligible if they documented indigenous health learning outcomes, pedagogical practices and student evaluations.

Results

Twenty‐three studies were eligible for the review. In an interpretive synthesis informed by actor–network theory, three themes emerged from the data: indigenous health as an emerging curriculum (drivers of institutional change, increasing indigenous capacity and leadership, and addressing deficit discourse); institutional resource allocation to indigenous health curricula (placement within the core curriculum, time allocation, and resources constraining pedagogy), and impact of the curriculum on learners (acceptability of the curriculum, learner knowledge, and learner behaviour).

Conclusions

Systemic barriers acting on and within educational networks have limited the developmental capacity of indigenous health curricula, supported and sustained hidden curricula, and led to insufficient institutional investment to support a comprehensive curriculum. Future research in health professional education should explore these political and network intermediaries acting on cultural competence curricula and how they can be overcome to achieve cultural competency learning outcomes.

     

‘Oh my God,I can't handle this!’: trainees’ emotional responses to complex situations

Context

Dealing with emotions is critical for medical trainees’ professional development. Taking a sociocultural and narrative approach to understanding emotions, we studied complex clinical situations as a specific context in which emotions are evoked and influenced by the social environment. We sought to understand how medical trainees respond to emotions that arise in those situations.

Methods

In an international constructivist grounded theory study, 29 trainees drew two rich pictures of complex clinical situations, one exciting and one frustrating. Rich pictures are visual representations that capture participants’ perceptions about the people, situations and factors that create clinical complexity. These pictures were used to guide semi‐structured, individual interviews. We analysed visual materials and interviews in an integrated way, starting with looking at the drawings, doing a ‘gallery walk’, and using the interviews to inform the aesthetic analysis.

Results

Participants’ drawings depicted a range of personal emotions in response to complexity, and disclosed unsettling feelings and behaviours that might be considered unprofessional. When trainees felt confident, they were actively participating, engaged in creative problem‐solving strategies, and emphasised their personal involvement. When trainees felt the situation was beyond their control, they described how they were running away from the situation, hiding themselves behind others or distancing themselves from patients or families.

Conclusions

A sense of control seems to be a key factor influencing trainees’ emotional and behavioural responses to complexity. This is problematic, as complex situations are by their nature emergent and dynamic, which limits possibilities for control. Following a social performative approach to emotions, we should help students understand that feeling out of control is an inherent property of participating in complex clinical situations, and, by extension, that it is not something they will ‘grow out of’ with expertise.

     

Medical communication: the views of simulated patients

Context

Simulated patients (SP s) are extensively used in the teaching of medical communication, both for students and doctors. They occupy a unique middle ground between patients and physicians: although free from the prejudices that medical training brings, they work closely with clinical tutors to promote the principles of patient‐centred consulting. Despite this, there is relatively little research around their views on what makes for good communication practice. This study aims to address this gap in the literature through a qualitative analysis of SP s’ opinions, especially in the context of medical student communication.

Methods

Eighteen SP s from two medical schools, Hull York Medical School and Durham, were interviewed, using an in‐depth, one‐to‐one, semi‐structured approach. Data, transcribed verbatim, were thematically analysed.

Results

Three global themes were identified: (i) listening and empathy and showing it, (ii) continual human connection and (iii) information flow from the patient. These three themes, termed the communication triad, form a type of virtuous circle, each facilitating the other. Listening and empathy were facilitated through attributes, including attentive non‐verbal communication, and through responding to cues, including making effective empathetic statements. Continual human connection was facilitated through successful beginnings, including preferring open questions to ‘robotic’ tick‐list questions and allowing patients time to have their say. Mirroring, professional appearance, appropriate physical contact and a human approach were amongst other factors facilitating connection with patients. Information flow was encouraged by factors including showing an interest in the patient and use of silence; flow was curtailed by undesirable attributes, including interrupting, dismissive communication and making assumptions about aspects such as sexuality.

Conclusion

This first in‐depth study of SP s’ views on medical consulting identifies a communication triad that both affirms and builds on the current literature base. Five novel teaching points emerge, with clear relevance for best practice communication teaching and curricula design.

     

The supervisory encounter and the senior GP trainee: managing for,through and with

Objective

Help‐seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP ) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs.

Methods

This is an analysis of data from a multi‐case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post‐encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses.

Results

The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled ‘managing for’, ‘managing through’ and ‘managing with’. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement.

Conclusions

For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter.

     

Availability of cookies during an academic course session affects evaluation of teaching

Objectives

Results from end‐of‐course student evaluations of teaching (SET s) are taken seriously by faculties and form part of a decision base for the recruitment of academic staff, the distribution of funds and changes to curricula. However, there is some doubt as to whether these evaluation instruments accurately measure the quality of course content, teaching and knowledge transfer. We investigated whether the provision of chocolate cookies as a content‐unrelated intervention influences SET results.

Methods

We performed a randomised controlled trial in the setting of a curricular emergency medicine course. Participants were 118 third‐year medical students. Participants were randomly allocated into 20 groups, 10 of which had free access to 500 g of chocolate cookies during an emergency medicine course session (cookie group) and 10 of which did not (control group). All groups were taught by the same teachers. Educational content and course material were the same for both groups. After the course, all students were asked to complete a 38‐question evaluation form.

Results

A total of 112 students completed the evaluation form. The cookie group evaluated teachers significantly better than the control group (113.4 ± 4.9 versus 109.2 ± 7.3; p = 0.001, effect size 0.68). Course material was considered better (10.1 ± 2.3 versus 8.4 ± 2.8; p = 0.001, effect size 0.66) and summation scores evaluating the course overall were significantly higher (224.5 ± 12.5 versus 217.2 ± 16.1; p = 0.008, effect size 0.51) in the cookie group.

Conclusions

The provision of chocolate cookies had a significant effect on course evaluation. These findings question the validity of SET s and their use in making widespread decisions within a faculty.

     

How can systems engineering inform the methods of programme evaluation in health professions education?

Context

We evaluate programmes in health professions education (HPE ) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a ‘holistic programme evaluation’ aiming to better describe and understand the implications of ‘emergent processes and outcomes’.

Framework

We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE . We demonstrate how the abstract decomposition space (ADS ), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements.

Methods

We translate the ADS tool to use education‐oriented language, and describe how evaluators can use it to create a programme‐specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme.

Conclusion

Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of ‘emergence’ in HPE research.

     

Chart stalking,list making,and physicians’ efforts to track patients’ outcomes after transitioning responsibility

Context

Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians’ activities in practice as they sought follow‐up information about patients.

Methods

Using a constructivist grounded theory approach, semi‐structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants’ strategies when deliberately conducting follow‐up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT ) to explore interactions among the social, cultural and material influences related to follow‐up.

Results

The authors identified three themes related to follow‐up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow‐up. Analysis of participants' follow‐up processes as an activity system highlighted key tensions in the system and participants’ work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients’ outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients’ health information (rules) led to rule‐breaking or abandoning activities of locating information. Finding time to conduct desired follow‐up produced tension between this and other activity systems.

Conclusion

In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow‐up. The authors offer four recommendations to address the tensions identified through AT : (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians’ skill development in developing and maintaining tracking systems for follow‐up; (iii) dedicate time in physicians’ work schedules for conducting follow‐up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians’ learning and respect patients’ privacy.

     

A critical narrative review of transfer of basic science knowledge in health professions education

Context

‘Transfer’ is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE ) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies.

Methods

A systematic search of the literature was conducted. Articles related to basic science teaching at the undergraduate level in HPE were analysed using a ‘transfer out’/’transfer in’ conceptual framework. ‘Transfer out’ refers to the application of knowledge developed in one learning situation to the solving of a new problem. ‘Transfer in’ refers to the use of previously acquired knowledge to learn from new problems or learning situations.

Results

Of 9803 articles initially identified, 627 studies were retrieved for full text evaluation; 15 were included in the literature review. A total of 93% explored ‘transfer out’ to clinical reasoning and 7% (one article) explored ‘transfer in’. Measures of ‘transfer out’ fostered by basic science knowledge included diagnostic accuracy over time and in new clinical cases. Basic science knowledge supported learning – ‘transfer in’ – of new related content and ultimately the ‘transfer out’ to diagnostic reasoning. Successful teaching strategies included the making of connections between basic and clinical sciences, the use of commonsense analogies, and the study of multiple clinical problems in multiple contexts. Performance on recall tests did not reflect the transfer of basic science knowledge to clinical reasoning.

Conclusions

Transfer of basic science knowledge to clinical reasoning is an essential component of HPE that requires further development for implementation and scholarship.

     

Unravelling residents’ and supervisors’ workplace interactions: an intersubjectivity study

Context

Successful engagement between residents and supervisors lies at the core of workplace learning, a process that is not exempt from challenge. Clinical encounters have unique learning potential as they offer opportunities to achieve a shared understanding between the resident and supervisor of how to accomplish a common goal. How residents and supervisors develop such a mutual understanding is an issue that has received limited attention in the literature. We used the ‘intersubjectivity’ concept as a novel conceptual framework to analyse this issue.

Methods

We conducted a constructivist grounded theory study in an anaesthesiology department in Bogota, Colombia, using focus groups and field observations. Eleven residents of different training levels and 18 supervisors with varying years of teaching experience participated in the study. Through iterative data analysis, collection and constant comparison, we constructed the final results.

Results

We found that residents and supervisors achieved a shared understanding by adapting to one another in the process of providing patient care. Continuous changes in the composition of resident–supervisor dyads exposed them to many procedural variations, to which they responded by engaging in various adaptation patterns that included compliance by residents with supervisors’ directions, negotiation by residents of supervisors’ preferences, and the sharing of decision making. In the process, the resident played an increasingly key role as a member of the supervisory dyad. Additionally, experiencing these adaptation patterns repeatedly resulted in the creation of a working repertoire: an attuned working code used by the members of each supervisory dyad to work together as a team.

Conclusions

The development of shared understanding between residents and supervisors entailed experiencing diverse adaptation patterns which resulted in the creation of working repertoires. Seeing supervisory interactions as adaptation processes has essential theoretical and practical implications regarding workplace learning in postgraduate settings. Our findings call for further exploration to understand learning in postgraduate education as a social process.

     

What advice is given to newly qualified doctors on Twitter? An analysis of #TipsForNewDocs tweets

Context

Twitter is a social media platform on which users post very brief messages that can be rapidly communicated across wide geographical areas and audiences. Many doctors use Twitter for personal as well as professional communications and networking. The #TipsForNewDocs hashtag is used on Twitter to give advice to newly qualified doctors as they commence their careers. This study explores the nature and focus of such advice.

Methods

An analysis of Twitter activity containing the #TipsForNewDocs hashtag was performed using Symplur health care analytics software. Tweets sent during a peak 48‐hour period in 2016 (immediately preceding the first day of work for newly qualified UK doctors) were studied. The geographical locations and professional backgrounds of participants were categorised and the content of tweets was subjected to thematic analysis. During 1 and 2 August 2016, 661 unique #TipsForNewDocs tweets were posted. A total of 621 (94.0%) were posted by people in the UK ; 522 (79.0%) were posted by doctors, and the remainder by allied health care professionals and patients.

Results

The majority of included tweets focused on aspects of professional development, improving personal or professional knowledge, particularly tacit knowledge, and developing ‘know‐how’. These aspects of professional knowledge have previously been described as fundamental to professional education and training. However, a significant subset of tweets focused on accelerating socialisation into the profession, an essential step in joining a professional community. The tweets relating to socialisation were often humorous and colloquial in nature.

Conclusions

Despite their brief and often jocular nature, #TipsForNewDocs tweets provided meaningful advice for newcomers to the profession, often focusing on tacit learning and professional socialisation. Hashtag‐driven enquiries can be a valuable and time‐efficient way of accessing and sharing tacitly held knowledge. Social media content analysis can provide valuable insights into key educational issues.

     

Emotions and assessment: considerations for rater‐based judgements of entrustment

Context

Assessment is subject to increasing scrutiny as medical education transitions towards a competency‐based medical education (CBME ) model. Traditional perspectives on the roles of assessment emphasise high‐stakes, summative assessment, whereas CBME argues for formative assessment. Revisiting conceptualisations about the roles and formats of assessment in medical education provides opportunities to examine understandings and expectations of the assessment of learners. The act of the rater generating scores might be considered as an exclusively cognitive exercise; however, current literature has drawn attention to the notion of raters as measurement instruments, thereby attributing additional factors to their decision‐making processes, such as social considerations and intuition. However, the literature has not comprehensively examined the influence of raters’ emotions during assessment. In this narrative review, we explore the influence of raters’ emotions in the assessment of learners.

Methods

We summarise existing literature that describes the role of emotions in assessment broadly, and rater‐based assessment specifically, across a variety of fields. The literature related to emotions and assessment is examined from different perspectives, including those of educational context, decision making and rater cognition. We use the concept of entrustable professional activities (EPA s) to contextualise a discussion of the ways in which raters’ emotions may have meaningful impacts on the decisions they make in clinical settings. This review summarises findings from different perspectives and identifies areas for consideration for the role of emotion in rater‐based assessment, and areas for future research.

Conclusions

We identify and discuss three different interpretations of the influence of raters’ emotions during assessments: (i) emotions lead to biased decision making; (ii) emotions contribute random noise to assessment, and (iii) emotions constitute legitimate sources of information that contribute to assessment decisions. We discuss these three interpretations in terms of areas for future research and implications for assessment.

     

Validity as a social imperative for assessment in health professions education: a concept analysis

Context

Assessment can have far‐reaching consequences for future health care professionals and for society. Thus, it is essential to establish the quality of assessment. Few modern approaches to validity are well situated to ensure the quality of complex assessment approaches, such as authentic and programmatic assessments. Here, we explore and delineate the concept of validity as a social imperative in the context of assessment in health professions education (HPE ) as a potential framework for examining the quality of complex and programmatic assessment approaches.

Methods

We conducted a concept analysis using Rodgers’ evolutionary method to describe the concept of validity as a social imperative in the context of assessment in HPE . Supported by an academic librarian, we developed and executed a search strategy across several databases for literature published between 1995 and 2016. From a total of 321 citations, we identified 67 articles that met our inclusion criteria. Two team members analysed the texts using a specified approach to qualitative data analysis. Consensus was achieved through full team discussions.

Results

Attributes that characterise the concept were: (i) demonstration of the use of evidence considered credible by society to document the quality of assessment; (ii) validation embedded through the assessment process and score interpretation; (iii) documented validity evidence supporting the interpretation of the combination of assessment findings, and (iv) demonstration of a justified use of a variety of evidence (quantitative and qualitative) to document the quality of assessment strategies.

Conclusions

The emerging concept of validity as a social imperative highlights some areas of focus in traditional validation frameworks, whereas some characteristics appear unique to HPE and move beyond traditional frameworks. The study reflects the importance of embedding consideration for society and societal concerns throughout the assessment and validation process, and may represent a potential lens through which to examine the quality of complex and programmatic assessment approaches.

     

Retrieval practice enhances the ability to evaluate complex physiology information

Objective

Many investigations have shown that retrieval practice enhances the recall of different types of information, including both medical and physiological, but the effects of the strategy on higher‐order thinking, such as evaluation, are less clear. The primary aim of this study was to compare how effectively retrieval practice and repeated studying (i.e. reading) strategies facilitated the evaluation of two research articles that advocated dissimilar conclusions. A secondary aim was to determine if that comparison was affected by using those same strategies to first learn important contextual information about the articles.

Methods

Participants were randomly assigned to learn three texts that provided background information about the research articles either by studying them four consecutive times (Text‐S) or by studying and then retrieving them two consecutive times (Text‐R). Half of both the Text‐S and Text‐R groups were then randomly assigned to learn two physiology research articles by studying them four consecutive times (Article‐S) and the other half learned them by studying and then retrieving them two consecutive times (Article‐R). Participants then completed two assessments: the first tested their ability to critique the research articles and the second tested their recall of the background texts.

Results

On the article critique assessment, the Article‐R groups’ mean scores of 33.7 ± 4.7% and 35.4 ± 4.5% (Text‐R then Article‐R group and Text‐S then Article‐R group, respectively) were both significantly (p < 0.05) higher than the two Article‐S mean scores of 19.5 ± 4.4% and 21.7 ± 2.9% (Text‐S then Article‐S group and Text‐R then Article‐S group, respectively). There was no difference between the two Article‐R groups on the article critique assessment, indicating those scores weren't affected by the different contextual learning strategies.

Conclusion

Retrieval practice promoted superior critical evaluation of the research articles, and the results also indicated the strategy enhanced the recall of background information.