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There has been much debate surrounding diagnostic strategies and the most appropriate training models for novices in oral radiology. It has been argued that an analytic approach, using a step-by-step analysis of the radiographic features of an abnormality, is ideal. Alternative research suggests that novices can successfully employ non-analytic reasoning. Many of these studies do not take instructional methodology into account. This study evaluated the effectiveness of non-analytic and analytic strategies in radiographic interpretation and explored the relationship between instructional methodology and diagnostic strategy. Second-year dental and dental hygiene students were taught four radiographic abnormalities using basic science instructions or a step-by-step algorithm. The students were tested on diagnostic accuracy and memory immediately after learning and one week later. A total of seventy-three students completed both immediate and delayed sessions and were included in the analysis. Students were randomly divided into two instructional conditions: one group provided a diagnostic hypothesis for the image and then identified specific features to support it, while the other group first identified features and then provided a diagnosis. Participants in the diagnosis-first condition (non-analytic reasoning) had higher diagnostic accuracy then those in the features-first condition (analytic reasoning), regardless of their learning condition. No main effect of learning condition or interaction with diagnostic strategy was observed. Educators should be mindful of the potential influence of analytic and non-analytic approaches on the effectiveness of the instructional method.

Context In health professions education, tests have traditionally been used to assess the skills and knowledge of learners. More recently, research in psychology and education has shown that tests can also be used to enhance student memory; a phenomenon called the ‘testing effect’. Much of the research in this domain has focused on enhancing rote memory of simple facts, and not on the deeper comprehension and application of complex theoretical knowledge necessary to diagnose and manage patients. The purpose of this study was to examine the effects of testing on students' comprehension of the basic science mechanisms and diagnostic accuracy. Methods Undergraduate dental and dental hygiene students (n = 112) were taught the radiographic features and pathophysiology underlying four intrabony abnormalities. Participants were divided into two groups: the test-enhanced (TE) condition and the study (ST) condition. Following the learning phase, the TE condition group completed an interventional test that tested the basic science mechanisms and the ST condition group was given additional study passages without being tested. Participants in both groups then completed a diagnostic test and a memory test immediately after the learning phase and 1 week later. Results A main effect of testing condition was found. The participants in the TE condition group outperformed those in the ST condition group on immediate and delayed testing. Unlike the diagnostic test, the memory test showed no difference between the groups. Conclusion The inclusion of the basic science test appears to have improved the students' understanding of the underlying disease mechanisms learned and also improved their performance on a test of diagnostic accuracy.

Educational research suggests that cognitive processing in diagnostic radiology requires a solid foundation in the basic sciences and knowledge of the radiological changes associated with disease. Although it is generally assumed that dental students must acquire both sets of knowledge, little is known about the most effective way to teach them. Currently, the basic and clinical sciences are taught separately. This study was conducted to compare the diagnostic accuracy of students when taught basic sciences segregated or integrated with clinical features. Predoctoral dental students (n=51) were taught four confusable intrabony abnormalities using basic science descriptions integrated with the radiographic features or taught segregated from the radiographic features. The students were tested with diagnostic images, and memory tests were performed immediately after learning and one week later. On immediate and delayed testing, participants in the integrated basic science group outperformed those from the segregated group. A main effect of learning condition was found to be significant (p

Medical Education 2012: 46: 409–416 Context Video-based observational practice can extend simulation-based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills. Methods Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre-test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self-assessed their individual pre-test and contrasted their self-assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self-assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer-to-peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet-mediated network. After 2 weeks, participants returned for post-tests and transfer tests. Results The pre-test–post-test analyses revealed significant interactions (global rating scale: F(2,22) = 4.00 [p = 0.033]; checklist: F(2,22) = 4.31 [p = 0.026]), which indicated that post-test performance in the ESPO group was significantly better than pre-test performance. The transfer analyses revealed main effects for both the global rating scale (F(2,23) = 6.73; p = 0.005) and validated checklist (F(2,23) = 7.04; p = 0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group. Conclusions The results suggest that video-based observational practice can be effective in extending simulation-based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners’ specific needs.

brydges r., carnahan h., rose d. & dubrowski a. (2010) Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. Journal of Advanced Nursing 66(8), 1832–1844. Abstract Title. Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. Aim. In this paper, we tested the over-arching hypothesis that progressive self-guided learning offers equivalent learning benefit vs. proficiency-based training while limiting the need to set proficiency standards. Background. We have shown that self-guided learning is enhanced when students learn on simulators that progressively increase in fidelity during practice. Proficiency-based training, a current gold-standard training approach, requires achievement of a criterion score before students advance to the next learning level. Methods. Baccalaureate nursing students (n = 15/group) practised intravenous catheterization using simulators that differed in fidelity (i.e. students’ perceived realism). Data were collected in 2008. Proficiency-based students advanced from low- to mid- to high-fidelity after achieving a proficiency criterion at each level. Progressive students self-guided their progression from low- to mid- to high-fidelity. Yoked control students followed an experimenter-defined progressive practice schedule. Open-ended students moved freely between the simulators. One week after practice, blinded experts evaluated students’ skill transfer on a standardized patient simulation. Group differences were examined using analyses of variance. Results. Proficiency-based students scored highest on the high-fidelity post-test (effect size = 1·22). An interaction effect showed that the Progressive and Open-ended groups maintained their performance from post-test to transfer test, whereas the Proficiency-based and Yoked control groups experienced a significant decrease (P

1 Kluger AN, Van Dijk D. Feedback, the various tasks of the doctor and the feedforward alternative. Med Educ 2010;44:1166–74. 2 Higgins ET. Promotion and prevention: regulatory focus as a motivational principle. In: Zanna MP, ed. Advances in Experimental Social Psychology. San Diego, CA: Academic Press 1998;1–46. 3 Akre V, Falkum E, Hoftvedt BO, Aasland OG. The communication atmosphere between physician colleagues: competitive perfectionism or supportive dialogue? A Norwegian study. Soc Sci Med 1997;44:519–26. 4 Overeem K, Wollersheim HC, Driessen E, Lombarts K, van de Ven G, Grol R, Arah O. Doctors’ perceptions of why 360-degree feedback does (not) work. Med Educ 2009;43:874–82. 5 Mitchell M, Srinivasan M, West DC et al. Factors affecting resident performance: development of a theoretical model and a focused literature review. Acad Med 2005;80:376–89. 6 Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organisational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev 2007;32:203–12. 7 Donohue SK. Health care quality information liability and privilege. Ann Health Law 2002;11: 147–58. 8 Sargeant J, Mann K, Sinclair D, van der Vleuten C, Metsemakers J. Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Adv Health Sci Educ Theory Pract 2008;13:275–88. 9 Overeem K, Driessen EW, Arah OA, Lombarts MJMH, Wollersheim HC, Grol RPTM. Peer-mentoring in doctor performance assessments. Strategies, obstacles and benefits. Med Educ 2010;44:140–7. 10 Galbraith RM, Hawkins RE, Holmboe ES. Making self-assessment more effective. J Contin Educ Health Prof 2008;28:20–4. 11 Eva KW, Regehr G. ‘I’ll never play professional football’ and other fallacies of self-assessment. J Contin Educ Health Prof 2008;28:14–9. 12 Keroack MA, Youngberg BJ, Cerese JL, Krsek C, Prellwitz LW, Trevelyan EW. Organisational factors associated with high performance in quality and safety in academic medical centres. Acad Med 2007;82:1178–86.

This study investigated the strategies used by individuals when the locomotor and prehensile motor systems are used simultaneously. Subjects were required to perform five tasks: to walk normally, walk and pick up a small object, walk and pick up a large object, and finally pick up small and large objects from a standing position. The general organization and control of lower limb movements was largely unaffected by the introduction of reaching movements. However, arm movements were generated faster when subjects were walking (both when walking and reaching together, and walking alone), suggesting that the discrete reach is superimposed upon the normal swing of the arms during walking. Recordings of muscle activity of the upper limb confirmed this observation. The stability of gait while grasping indicates that the motor control system may be organized such that the stability of gait is maintained over variations in the control of grasping.