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

Abstract

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.

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

“…The ABEM Model of the Clinical Practice of Emergency Medicine categories for which a median of fewer than 10 patients were evaluated by EM residents included cardiovascular, endocrine/metabolic/nutritional, environmental, hematologic, immune system, musculoskeletal (nontrauma), and toxicologic. When contemplating EM resident education in PEM and progression toward unsupervised practice, one must consider the possibility of transfer of skill and knowledge from experience with the adult population 21–24 . For the categories of environmental, musculoskeletal (nontrauma), and toxicologic, there is likely transfer of knowledge obviating the need for additional exposure to large numbers of pediatric patients in these categories to learn how to effectively provide care for them.…”

“…When contemplating EM resident education in PEM and progression toward unsupervised practice, one must consider the possibility of transfer of skill and knowledge from experience with the adult population. [21][22][23][24] For the categories of environmental, musculoskeletal (nontrauma), and toxicologic, there is likely transfer of knowledge obviating the need for additional exposure to large numbers of pediatric patients in these categories to learn how to effectively provide care for them. However, cardiovascular (e.g., congenital heart disease), endocrine/metabolic/nutritional (e.g., inborn errors of metabolism), hematologic (e.g., childhood leukemia and sickle cell complications), and immune system (e.g., immune deficiency syndromes) categories are less likely to lend themselves to the same knowledge and skill transfer and should be explicitly addressed during curriculum planning.…”

Virtual Physiology: A Tool for the 21st Century

“…Procedural knowledge refers to the technique, process, or methodology that allow executing a task or procedure proficiently and is described as "knowing how". Finally, metacognition includes selfassessment ability and knowledge of various learning skills and techniques [23,29,30].…”

Adaptive Expertise in Continuing Pharmacy Professional Development

“…Conceptual knowledge underlies expertise development and skills transfer and refers to the generalizable principles that transcend specific contexts of a task. Conceptual knowledge is sometimes described as "knowing why" [9]. The training designed at adaptive expertise development requires that learners must be forming conceptual knowledge ("knowing why") while at the same time learning procedural efficiency ("knowing how").…”