Given the data available, there does not appear to be sufficient evidence for exclusively using CBE or OBE. As such, a combined approach could become a more significant part of testing protocols as licensing bodies seek ways to assess competencies other than the maintenance of medical knowledge.

The influence of one teacher's scaffolding moves on children's performance in free-flowing child-led small-group discussions was investigated. Three moves were examined: prompting for and praising the use of evidence, asking for clarification, and challenging. Lag sequential analysis was applied to a corpus of over 5,300 speaking turns during 30 discussions to identify recurrent turn-by-turn patterns of teacher-child and child-child talk initiated by the teacher's moves. A complex system of influence among discussion participants was documented in which the teacher's moves had delayed effects as well as immediate effects, indirect as well as direct effects, and reciprocal instead of unidirectional effects. Some children appropriated scaffolding moves of the teacher and began to spontaneously employ the moves in later discussions.

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Medical students' perceptions of the learning environment are related, in predictable ways, to their use of self-regulated learning behaviors; these perceptions seem to change across medical school.

ObjectivesThe primary objectives of this study were to examine the regulatory processes of medical students as they completed a diagnostic reasoning task and to examine whether the strategic quality of these regulatory processes were related to short-term and longer-term medical education outcomes.MethodsA self-regulated learning (SRL) microanalytic assessment was administered to 71 second-year medical students while they read a clinical case and worked to formulate the most probable diagnosis. Verbal responses to open-ended questions targeting forethought and performance phase processes of a cyclical model of SRL were recorded verbatim and subsequently coded using a framework from prior research. Descriptive statistics and hierarchical linear regression models were used to examine the relationships between the SRL processes and several outcomes.ResultsMost participants (90%) reported focusing on specific diagnostic reasoning strategies during the task (metacognitive monitoring), but only about one-third of students referenced these strategies (e.g. identifying symptoms, integration) in relation to their task goals and plans for completing the task. After accounting for prior undergraduate achievement and verbal reasoning ability, strategic planning explained significant additional variance in course grade (ΔR2 = 0.15, p < 0.01), second-year grade point average (ΔR2 = 0.14, p < 0.01), United States Medical Licensing Examination Step 1 score (ΔR2 = 0.08, p < 0.05) and National Board of Medical Examiner subject examination score in internal medicine (ΔR2 = 0.10, p < 0.05).ConclusionsThese findings suggest that most students in the formative stages of learning diagnostic reasoning skills are aware of and think about at least one key diagnostic reasoning process or strategy while solving a clinical case, but a substantially smaller percentage set goals or develop plans that incorporate such strategies. Given that students who developed more strategic plans achieved better outcomes, the potential importance of forethought regulatory processes is underscored.