Objective-To assess how much adults with congenital heart disease understand about their heart defect, its treatment, and the preventive measures necessary to avoid complications. Design-Descriptive, cross sectional study. Setting-Adult congenital heart disease programme in one tertiary care centre in Belgium. Patients-62 adults with congenital heart disease (47 men; 15 women), median age 23 years. Main outcome measures-Patients' knowledge was assessed during an outpatient visit using the Leuven knowledge questionnaire for congenital heart diseases, a 33 item instrument developed for this study. Results-Patients had adequate knowledge (> 80% correct answers) about their treatment, frequency of follow up, dental practices, occupational choices, appropriateness of oral contraceptives, and the risks of pregnancy. Knowledge about the name and anatomy of the heart defect, the possibility of recurrent episodes of endocarditis during their lifetime, and the appropriateness of diVerent physical activities was moderate (50-80% correct answers). There was poor understanding (< 50% correct answers) about the reasons for follow up, the symptoms of deterioration of the heart disease, the definition, characteristics, and risk factors of endocarditis, the impact of smoking and alcohol on the heart disease, the hereditary nature of the condition, and the suitability of intrauterine devices as contraceptives. Conclusions-Adults with congenital heart disease have important gaps in their knowledge about their condition. The results of this study can be used as a basis for developing or optimising structured educational interventions to enhance patients' health behaviour. (Heart 2001;86:74-80)

Promoting students' critical thinking (CT) has been an essential goal of higher education. However, despite the various attempts to make CT a primary focus of higher education, there is little agreement regarding the conditions under which instruction could result in greater CT outcomes. In this review, we systematically examined current empirical evidence and attempted to explain why some instructional interventions result in greater CT gains than others. Thirty three empirical studies were included in the review and features of the interventions of those individual studies were analyzed. Emphasis was given to the study features related to CT instructional approach, teaching strategy, student and teacher related characteristics, and CT measurement. The findings revealed that effectiveness of CT instruction is influenced by conditions in the instructional environment comprising the instructional variables (teaching strategies and CT instructional approaches), and to some extent by student-related variables (year level and prior academic performance). Moreover, the type of CT measures adopted (standardized vs. non-standardized) appear to influence evaluation of the effectiveness of CT interventions. The findings overall indicated that there is a shift towards embedding CT instruction within academic disciplines, but failed to support effectiveness of particular instructional strategies in fostering acquisition and transfer of CT skills. The main limitation in the current empirical evidence is the lack of systematic design of instructional interventions that are in line with empirically valid instructional design principles.

Although the development of critical thinking (CT) is a major goal of science education, adequate emphasis has not been given to the measurement of CT skills in specific science domains such as physics. Recognizing that adequately assessing CT implies the assessment of both domain-specific and domain-general CT skills, this study reports on the development and validation of a test designed to measure students' acquisition of CT skills in electricity and magnetism (CTEM). The CTEM items were designed to mirror the structural components of items identified in an existing standardized domain-general CT test, and targeted content from an introductory Electricity and Magnetism (E&M) course. A preliminary version of the CTEM test was initially piloted on three groups of samples: interviews with physics experts (N = 3), student cognitive interviews (N = 6), and small-scale paper and pencil administration (N = 19). Modifications were made afterwards and the test was administered to a different group of second-year students whose major was mechanical engineering (N = 45). The results showed that the internal consistency (Cronbach's α = .72) and inter-rater reliability (Cohen's kappa = .83) of the CTEM test are acceptable. The findings overall suggest that the CTEM test can be used to measure the acquisition of domain-specific CT skills in E&M, and a good basis for future empirical research that focuses on the integration of CT skills within specific subject matter instruction. A broader CT assessment

This contribution explores the relationship between teacher-centred and student-centred learning environments from a student's perspective. Three different views with respect to this relationship can be retrieved. The balance view suggests that the more teacher-centred a learning environment is, the less student-centred it is and vice versa. The transactional view stresses the continuous renegotiation of teacher-and student-roles. The independent view argues that teacher-and studentcentredness are independent features of learning environments. Results from three survey studies of higher education students' conceptions of quality education are discussed. While the practiceoriented literature regularly seems to adopt a balance view, factor analyses did not reveal evidence for the balance view in any of these studies. In students' minds student-centredness and teachercentredness seem to be mutually reinforcing features of high quality education. From a curricular point of view, and especially with regard to teacher training, the results warrant to argue for the development of so-called powerful learning environments rather than for the transition from teacher-centred towards student-centred learning environments.

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pointers to exemplary work that has implications for research in educational communications and technology. This part of the Handbook consists of seven chapters covering: (1) historical foundations, (2) theoretical foundations, (3) complexity theory, (4) experiential perspectives, (5) empirical perspectives, (6) contextualistic perspectives, and (7) philosophical perspectives.

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