Cause and Effect

Kulasegaram, Kulamakan; Manzone, Julian; Ku, Cheryl; Skye, Aimee; Wadey, Veronica; Woods, Nicole N.

doi:10.1097/acm.0000000000000896

Cited by 47 publications

(26 citation statements)

References 29 publications

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“…28 By comparing why content Integrated for Causation versus why content Integrated in Sequence, we show that teaching that explicitly promotes cognitive integration appears to help participants further mobilize their conceptual knowledge, which then enhances how well they transfer their learning. 24 There are three key implications for educators who want to design education that promotes transfer of learning: (1) they need to consider trainees' level of conceptual knowledge; (2) the content they choose to teach matters and should include conceptual knowledge that explains the Bwhy^; and (3) how they expose the relationships between the how and why content matters.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] In studying how expertise develops, researchers have found that trainees learning to make clinical diagnoses have better diagnostic skill retention and transfer when teaching involves integrating basic science and clinical knowledge. [14][15][16][17][18][19][20][21][22][23][24][25][26] Hence, identifying and selecting the relevant conceptual and procedural knowledge appears to be a key decision point when educators choose which content to teach.…”

Section: Introductionmentioning

confidence: 99%

“…A series of studies demonstrate that integrating conceptual and procedural knowledge using Bscience-based causal explanations^led to superior diagnostic skill retention and transfer compared to teaching that merely presented these two types of content in close spatial and temporal proximity. 20,24,25 That is, teaching material helped trainees achieve improved outcomes when it explicitly integrated conceptual and procedural knowledge in a way that encouraged them to make causal connections between the two, a process referred to as cognitive integration. 27 Hence, evidence has accrued to show that how educators organize procedural knowledge (i.e., how content) and conceptual knowledge (i.e., why content) matters for trainees' outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer

et al. 2019

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BACKGROUND: Curricular constraints require being selective about the type of content trainees practice in their formal training. Teaching trainees procedural knowledge about Bhow^to perform steps of a skill along with conceptual knowledge about Bwhy^each step is performed can support skill retention and transfer (i.e., the ability to adapt knowledge to novel problems). However, how best to organize how and why content for procedural skills training is unknown. OBJECTIVES: We examined the impact of different approaches to integrating why and how content on trainees' skill retention and transfer of simulation-based lumbar puncture (LP). DESIGN AND PARTICIPANTS: We randomized medical students (N = 66) to practice LP for 1 h using one of three videos. One video presented only the how content for LP (Procedural Only). Two other videos presented how and why content (e.g., anatomy) in two ways: Integrated in Sequence, with why content followed by how content, or Integrated for Causation, with how and why content integrated throughout. MAIN MEASURES: Pairs of blinded raters scored participants' retention and transfer LP performances on a global rating scale (GRS), and written tests assessed participants' procedural and conceptual knowledge. KEY RESULTS: Simple mediation regression analyses showed that participants receiving an integrated instructional video performed significantly better on transfer through their intervention's positive impact on conceptual knowledge (all p < 0.01). Further, the Integrated for Causation group performed significantly better on transfer than the Integrated in Sequence group (p < 0.01), again mediated by improved conceptual knowledge. We observed no mediation of participants' skill retention (all p > 0.01). CONCLUSIONS: When teaching supports cognitive integration of how and why content, trainees are able to transfer learning to new problems because of their improved conceptual understanding. Instructional designs for procedural skills that integrate how and why content can help educators optimize what trainees learn from each repetition of practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer

et al. 2019

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“…These links between basic sciences and clinical content should be strong within the minds of individual learners (27,28) for cognitive integration to happen (2). Studies have also reported that cognitive integration of knowledge, which helps in the application of basic science knowledge to clinical contexts, would not happen spontaneously (15,16) just by exposing students to an integrated curriculum (15). Our study confirms the above finding that implementing an integrated curriculum alone would not be sufficient enough to prepare medical students for long-term retention and application of basic science knowledge.…”

Section: Discussionmentioning

confidence: 99%

Assessment for learning: a needs analysis study using formative assessment to evaluate the need for curriculum reform in basic sciences

Abraham

Alele

Kamath

et al. 2018

Advances in Physiology Education

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A needs analysis study for curriculum reform in basic sciences was conducted at Melaka Manipal Medical College, India, by means of a formative assessment method, namely Basic Science Retention Examination (BSRE). Students participated in a BSRE, which comprised recall and clinical multiple-choice questions in six discipline areas. They also rated the clinical relevance of each question and provided responses to three open-text questions about the exam. Pass rates were determined; clinical relevance ratings and performance scores were compared between recall type and clinical questions to test students' level of clinical application of basic science knowledge. Text comments were thematically analyzed to identify recurring themes. Only one-third of students passed the BSRE (32.2%). Students performed better in recall questions compared with clinical questions in anatomy (51.0 vs. 40.2%), pathology (45.1 vs. 38.1%), pharmacology (41.8 vs. 31.7%), and biochemistry (43.5 vs. 26.9%). In physiology, students performed better in clinical questions compared with the recall type (56.2 vs. 45.8%). Students' response to BSRE was positive. The findings imply that transfer of basic science knowledge was poor, and that assessment methods should emphasize clinical application of basic science knowledge.

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“…Cognitive integration is defined as "conceptual, cognitive connections between different types of knowledge," occurring within the mind of the learner [1]. Previous studies suggest novices' cognitive integration of basic science and clinical concepts leads to improved diagnostic performance in this early stage of training [2][3][4][5][6][7][8][9][10]. Because cognitive integration is not directly observable, demonstrating evidence of successful cognitive integration remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

Medical Students’ Clinical Reasoning During a Simulated Viral Pandemic: Evidence of Cognitive Integration and Insights on Novices’ Approach to Diagnostic Reasoning

2020

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Introduction Cognitive integration from multiple disciplines is essential to clinical problem-solving. Because it is not directly observable, demonstrating evidence of learners' cognitive integration remains a challenge. In addition, little is known about preclinical medical students' approach to diagnostic reasoning despite widespread implementation of clinical reasoning curricula for these early learners. The objectives of this study were to characterize how first-year medical students integrated knowledge to problem-solve during a simulated viral pandemic and to characterize students' diagnostic reasoning approach to this clinical scenario. Materials and Methods Student teams analyzed clinical data to formulate hypotheses for the pandemic's source and submitted reports justifying their hypotheses and treatment recommendations. A content analysis on students' reports identified codes and themes characterizing the learning content integrated and students' approaches to diagnostic reasoning tasks. Results Sixteen problem-solving codes were identified, demonstrating integration of new and previously encountered content from multiple disciplines. A compare-contrast analytical approach was the most commonly employed diagnostic reasoning approach (100%), with a smaller subset of teams also using a causal approach (20%). Discussion Content analysis of preclinical students' diagnostic justification tasks provided insights into their approach to diagnostic reasoning, which was most consistent with the search-inference framework rather than a causal approach, likely due to limited pathophysiological knowledge at that point in training. Conclusions Evidence of cognitive integration can be made explicit through learners' narrative justification of diagnostic reasoning tasks. Preclinical students' diagnostic reasoning development has implications for curricular design and implementation for this learner group.

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Cause and Effect

Cited by 47 publications

References 29 publications

Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer

Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer

Assessment for learning: a needs analysis study using formative assessment to evaluate the need for curriculum reform in basic sciences

Medical Students’ Clinical Reasoning During a Simulated Viral Pandemic: Evidence of Cognitive Integration and Insights on Novices’ Approach to Diagnostic Reasoning

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