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Objectives: Teaching of ECG interpretation frequently relies on visual schemas. However, subsequent student ECG interpretation skills are often poor. Expertise research shows that expert looking patterns frequently deviate from the steps taught in schema learning. The present study made a cardiology expert’s gaze interpreting ECGs visible – through eye-tracking videos with cued retrospective reporting (CRR) – and investigated the potential as an additional expert-driven route to improve medical students’ ECG interpretation skills.Methods: =91 Medical students participated in the RCT of an ECG e-learning session aimed at medical students’ ECG interpretation skills gain, either receiving the newly developed eye-tracking video with CRR audio commentary materials (=47) or studying via four clinical cases only (=44). Three outcome scores relating to different aspects of ECG interpretation skills were derived from pre-post MCQ ECG tests. The effect of the EYE-ECG training and additional characteristics (e.g., prior experience, interest) on student ECG interpretation skills were evaluated using t-tests and multivariate linear regression.Results: A small, non-significant advantage of the EYE-ECG training signifying a tendency for greater knowledge gain was observed, compared to training as usual. In multivariate regression models, the predictive value of clinical case 1 was an unexpected finding warranting further exploration.Conclusion: Additional gains after an only 9-minute intervention using videos of expert’s real-time gaze pattern in combination with hearing their thought processes during ECG interpretation is a promising finding. Furthermore, a number of specific performance characteristics enabling students to best benefit from ECG training were identified and possible modifications to the learning intervention suggested.

Background: Due to SARS-CoV-2, the Bavarian Ministry of Health decided in April 2020 to postpone the second national board examination in human medicine and to bring forward the start of the practical year (in German: Praktisches Jahr, further abbreviated with PJ) from May to April 2020. The different tertial times made it necessary for affected students to reorganise the PJ and rendered the preparation for the national board examination that had already taken place obsolete. As a result, students had to prepare for it again after the PJ and take it together with the third national board examination.Research question: How do students affected by the early PJ differ in their perception of the practical year and in their psychological well-being from the comparison groups with a regular PJ schedule?Methodology: The study is based on quantitative data from the Dean of Studies Office of the Medical Faculty of Ludwig-Maximilians-Universität München (LMU) and an online survey. The sample consists of LMU students who started the early PJ in April 2020 (=86) and two comparison groups: The cohort of LMU students who started their PJ regularly in May 2019 (=50), and students from other German universities who started their PJ regularly in May 2020 (=98) and took the second national board examination in human medicine in spring 2020. Results: For students affected by the early PJ, there were measurable negative effects on the choice of training institutions, the quality of the PJ content, preparation for the national board examinations, and career planning. Compared to regular students from other federal states, affected students reported higher psychological stress, with comparable resilience.Conclusion: It can be assumed that the insights gained apply to the entirety of medical students in the affected federal states of Bavaria and Baden-Württemberg. As a conclusion, we make the recommendation to include the position of the students in decisions of great consequence.

Objective: Statistical literacy (SL) of physicians, i.e. the ability to use and interpret statistical numbers in the context of science, is an essential prerequisite for risk estimation and communication. Together with scientific reasoning and argumentation (SRA) skills, SL provides the basis for evidence-based practice. Several studies suggest that in medical students both skills are underdeveloped. The aim of the present study was to investigate these skills in practicing physicians and how these skills were acquired. Methods: Data collection in =71 physicians was conducted online and as paper pencil. SL was assessed with multiple-choice items. SRA skills evidence evaluation and drawing conclusions were measured with a decision scenario. Results: Study results indicated that physicians have medium levels of SL (=17.58, =6.92, max 30 pts.) and SRA (evidence evaluation: =7.75, =1.85, max 10 pts.; drawing conclusions: =37.20, =5.35, max 60 pts.). Skills development via autodidactic learning activities (=4.78, =1.13, range 1-6) was reported significantly more often than development during formal medical education (=2.31, =1.46), (71)=-9.915,

Objective: ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one’s own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students.Method: In a 2x2 experimental test and control group design, =100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS. In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected.Results: Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, (1,96)=1.03, =.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, (1,96)=10.15, =.002, =.10; and a negative effect on student motivation, (1,96)=8.13 , =.005, =.08; but both with comparable diagnostic accuracy.Conclusion: The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.

Advancements in artificial intelligence are rapidly increasing. The new-generation large language models, such as ChatGPT and GPT-4, bear the potential to transform educational approaches, such as peer-feedback. To investigate peer-feedback at the intersection of natural language processing (NLP) and educational research, this paper suggests a cross-disciplinary framework that aims to facilitate the development of NLP-based adaptive measures for supporting peer-feedback processes in digital learning environments. To conceptualize this process, we introduce a peer-feedback process model, which describes learners' activities and textual products. Further, we introduce a terminological and procedural scheme that facilitates systematically deriving measures to foster the peer-feedback process and how NLP may enhance the adaptivity of such learning support. Building on prior research on education and NLP, we apply this scheme to all learner activities of the peer-feedback process model to exemplify a range of NLP-based adaptive support measures. We also discuss the current challenges and suggest directions for future cross-disciplinary research on the effectiveness and other dimensions of NLP-based adaptive support for peer-feedback. Building on our suggested framework, future research and collaborations at the intersection of education and NLP can innovate peer-feedback in digital learning environments.

The way medical students learn anatomy is constantly evolving. Nowadays, technologies such as tablets support established learning methods like drawing. In this study, the effect of drawing on a tablet on medical students' anatomy learning was investigated compared to drawing or summarizing on paper. The quality of drawings or summaries was assessed as a measure of the quality of strategy implementation. Learning outcome was measured with an anatomy test, both immediately afterward and after 4-6 weeks to assess its sustainability. There were no significant group differences in learning outcome at both measurement points. For all groups, there was a significant medium strength correlation between the quality of the drawings or summaries and the learning outcome (p < 0.05). Further analysis revealed that the quality of strategy implementation moderated outcomes in the delayed test: When poorly implemented, drawing on a tablet (M = 48.81) was associated with lower learning outcome than drawing on paper (M = 58.95); The latter (M = 58.89) was related to higher learning outcome than writing summaries (M = 45.59). In case of high-quality strategy implementation, drawing on a tablet (M = 60.98) outperformed drawing on paper (M = 52.67), which in turn was outperformed by writing summaries (M = 62.62). To conclude, drawing on a tablet serves as a viable alternative to paper-based methods for learning anatomy if students can make adequate use of this strategy. Future research needs to identify how to support student drawing, for instance, by offering scaffolds with adaptive feedback to enhance learning.

Experts perceive and evaluate domain‐specific visual information with high accuracy. In doing so, they exhibit eye movements referred to as "expert gaze" to rapidly focus on task‐relevant areas. Using eye tracking, it is possible to record these implicit gaze patterns and present them to histology novice learners during training. This article presents a comprehensive evaluation of such expert gaze cueing on pattern recognition of medical students in histology. For this purpose, 53 students were randomized into two groups over eight histology sessions. The control group was presented with an instructional histology video featuring voice commentary. The gaze cueing group was presented the same video, but with an additional overlay of a live recording of the expert's eye movements. Afterward, students' pattern recognition was assessed through 20 image‐based tasks (5 retention, 15 transfer) and their cognitive load with the Paas scale. Results showed that gaze cueing significantly outperformed the control group (p = 0.007; d = 0.40). This effect was evident for both, retention (p = 0.003) and transfer tasks (p = 0.046), and generalized across different histological contexts. The cognitive load was similar in both groups. In conclusion, gaze cueing helps histology novice learners to develop their pattern recognition skills, offering a promising method for histology education. Histology educators could benefit from this instructional strategy to provide new forms of attentional guidance to learners in visually complex learning environments. [ABSTRACT FROM AUTHOR]

Peer-feedback efficiency might be influenced by the oftentimes voiced concern of students that they perceive their peers' competence to provide feedback as inadequate. Feedback literature also identifies mindful processing of (peer)feedback and (peer)feedback content as important for its efficiency, but lacks systematic investigation. In a 2 × 2 factorial design, peer-feedback content (concise general feedback [CGF] vs. elaborated specific feedback [ESF]) and competence of the sender (high vs. low) were varied. Students received a scenario containing an essay by a fictional student and fictional peer feedback, a perception questionnaire, and a text revision, distraction, and peer-feedback recall task. Eye tracking was applied to measure how written peer feedback was (re-)read, e.g., glance duration on exact words and sentences. Mindful cognitive processing was inferred from the relation between glance duration and (a) text-revision performance and (b) peer-feedback recall performance. Feedback by a high competent peer was perceived as more adequate. Compared to CGF, participants who received ESF scored higher on positive affect towards the peer feedback. No effects were found for peer-feedback content and/or sender's competence level on performance. Glance durations were negatively correlated to text-revision performance regardless of condition, although peer-feedback recall showed that a basic amount of mindful cognitive processing occurred in all conditions. Descriptive findings also hint that this processing might be dependent on an interaction between peer-feedback content and sender's competence, signifying a clear direction for future research.

The interpretation of graphs plays a pivotal role in education because it is relevant for understanding and representing data and comprehending concepts in various domains. Accordingly, many studies examine students' gaze behavior by comparing different levels of expertise when interpreting graphs. This literature review presents an overview of 32 articles comparing the gaze behavior of experts and non-experts during problem-solving and learning with graphs up to January 2022. Most studies analyzed students' dwell time, fixation duration, and fixation count on macro- and meso-, as well as on micro-level areas of interest. Experts seemed to pay more attention to relevant parts of the graph and less to irrelevant parts of a graph, in line with the information-reduction hypothesis. Experts also made more integrative eye movements within a graph in terms of dynamic metrics. However, the determination of expertise is inconsistent. Therefore, we recommend four factors that will help to better determine expertise. This review gives an overview of evaluation strategies for different types of graphs and across various domains, which could facilitate instructing students in evaluating graphs. [ABSTRACT FROM AUTHOR]

Background Childhood stroke is rare and can predispose to post-stroke epilepsy. The purpose of this study was to evaluate long-term quality of life (QoL) in patients with childhood stroke, focusing on epileptic aspects. Method This involves a retrospective study of 98 patients with childhood stroke (pre- and neonatal strokes excluded), who had been inpatients between 1986 and 2003 for early rehabilitation. Data were obtained via interviews using a standardized questionnaire: QoL evaluation with KINDL, functional outcome with Barthel Index, and motor handicaps-assessment with modified Rankin Score. Results Forty-nine of 98 patients (31 males, mean follow-up 16 years, range 8–25 years) were included. Six patients passed away (three of sudden unexpected death in epilepsy). At least one epileptic seizure occurred in 27/49 patients (occurrence: 2 days–13 years.; mean 3.3 years.). Epilepsy manifested in 19/49 patients. No correlation was found between the development of epilepsy and the location or etiology of the stroke. The presence of functional independence was significantly higher in seizure-free patients and in patients without epilepsy. For the external assessment (filled in for the patient by the parent/caregiver), there was no significant difference in QoL in patients with and without epilepsy; however, in the in-person KINDL questionnaire a significantly lower QoL was noted in epilepsy patients compared with patients without epilepsy. Conclusion One important finding in our study is that in the long-term course 39% of patients developed epilepsy after a childhood stroke. It occurred as late as 13 years after the acute episode and affected the QoL especially in cognitively less handicapped patients. [ABSTRACT FROM AUTHOR]

Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi‐and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation. It concludes with an integrative vision of the use of eHRs, and the special role of the patient, for teaching and learning in medicine. Electronic health records (eHRs) play an increasingly important role for documentation and exchange of information in multi‐ and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning sciences perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation. [ABSTRACT FROM AUTHOR]

The need to understand potential climate impacts and feedbacks in Arctic regions has prompted recent interest in modeling of permafrost dynamics in a warming climate. A new fine-scale integrated surface/subsurface thermal hydrology modeling capability is described and demonstrated in proof-of-concept simulations. The new modeling capability combines a surface energy balance model with recently developed three-dimensional subsurface thermal hydrology models and new models for nonisothermal surface water flows and snow distribution in the microtopography. Surface water flows are modeled using the diffusion wave equation extended to include energy transport and phase change of ponded water. Variation of snow depth in the microtopography, physically the result of wind scour, is modeled phenomenologically with a diffusion wave equation. The multiple surface and subsurface processes are implemented by leveraging highly parallel community software. Fully integrated thermal hydrology simulations on the tilted open book catchment, an important test case for integrated surface/subsurface flow modeling, are presented. Fine-scale 100 year projections of the integrated permafrost thermal hydrological system on an ice wedge polygon at Barrow Alaska in a warming climate are also presented. These simulations demonstrate the feasibility of microtopography-resolving, process-rich simulations as a tool to help understand possible future evolution of the carbon-rich Arctic tundra in a warming climate. [ABSTRACT FROM AUTHOR]

All in all, EU Cohesion policy has been a success. It has facilitated growth and jobs in less developed areas, contributing to their prosperity. However, convergence has slowed down significantly during the crisis. This puts even more pressure on safeguarding that cohesion policy generates optimal results to ensure lasting economic and social cohesion. Room for improvement has been identified. The delivery mechanisms can be improved; its territorial dimension strengthened; and its focus more firmly directed at supporting a resource-efficient economy, research, development and innovation. Even more important, the economic crisis in the EU has underscored the need for creating pan-European institutions, like the banking union, to complete the integration of financial markets. The recent substantial reforms of the EU's economic architecture are aimed at creating an unprecedented level of integration that will allow private capital to flow more easily and more responsibly to the most productive and growth-enhancing investments in convergence regions. The unleashing of these market forces, combined with a reformed cohesion policy to efficiently address market failures where they exist, carries the potential to initiate a new success story in the convergence of living conditions in the EU. The EIB is committed to play an important role in this effort. It has already integrated the new smart and sustainable orientations of the Structural Funds and will strive to facilitate better alignment between its sector and regional objectives. Expanding and deepening the nature and scope of financial and non-financial instruments developed jointly with the European Commission will further improve the leverage effect of EU funding and help attract private investors. [ABSTRACT FROM AUTHOR]