In the collection, analysis and interpretation of any test data, psychometric properties, such as those reported here for the ANT, must be carefully considered.
Healthcare practice and education are highly emotional endeavors. While this is recognized by educators and researchers seeking to develop interventions aimed at improving wellness in health professionals and at providing them with skills to deal with emotional interpersonal situations, the field of health professions education has largely ignored the role that emotions play on cognitive processes. The purpose of this review is to provide an introduction to the broader field of emotions, with the goal of better understanding the integral relationship between emotions and cognitive processes. Individuals, at any given time, are in an emotional state. This emotional state influences how they perceive the world around them, what they recall from it, as well as the decisions they make. Rather than treating emotions as undesirable forces that wreak havoc on the rational being, the field of health professions education could be enriched by a greater understanding of how these emotions can shape cognitive processes in increasingly predictable ways.
There are many ways in which emotions may influence medical education. Researchers must further explore the implications of these findings to ensure that learning is not treated simply as a rational, mechanistic process but that trainees are effectively prepared to perform under a wide range of emotional conditions.
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.
PEs add a powerful real-life dimension to communication skills teaching and have been shown to be a valuable educational modality. Moreover, exposure to and reflection on video-based patient narratives are useful ways of teaching medical students about patients' lived experiences and promoting person-centered communication, both within and beyond IDD.
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