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This study compared accuracy of clinical reasoning in 2nd year and 4th year medical students and family doctors. Family doctors were superior to the students, and this was thought to be due to superior knowledge encapsulation' theory in that the more experience you get, the better you will be. This is not necessarily based on propositional knowledge, but is a complex intellectual process, which (if we can under- stand) could help to improve the learning environment of students. [ABSTRACT FROM AUTHOR]

Objectives : Drug-related problems are prevalent in older inpatients and can be reduced by providing clinical pharmacy (CP) services. Details concerning implementation in clinical practice are frequently lacking. The aim was to describe the output of one such CP program and to identify factors associated with CP recommendations. Methods : A CP program was installed at three acute geriatric wards in a teaching hospital. A convenience sample was collected, consisting of inpatients who received a CP consultation at discharge. Medical conditions, patient demographics, and drug use were evaluated retrospectively. Number and type of the CP recommendations were determined. A Poisson regression analysis was performed to determine factors associated with the number of CP recommendations. Results : A cohort of 524 patients, aged 85 (interquartile range (IQR): 82-89) years was included. On admission, 10.31 (standard deviation: 4.49) drugs were taken. Three (IQR: 2-4) CP recommendations were provided per patient, of which 70.2% targeted drug discontinuation. A model was derived, containing the following factors: number of drugs on admission (incidence rate ratio (IRR): 1.063; 95% confidence interval (CI): 1.052-1.074), number of previous contacts with the geriatric department (IRR: 0.869; 95%CI: 0.816-0.926), presence of left-ventricular dysfunction (IRR: 1.179, 95% CI: 1.023-1.360), the number of new drugs (IRR: 1.046; 95% CI: 1.021-1.071) and use of colecalciferol (IRR: 1.22; 95% CI: 1.088-1.367). Conclusions : Five factors were associated with the number of CP recommendations at discharge. This could allow for further patient stratification to increase the efficiency of the CP program.

Background: Although active workstations, such as desk bikes, have proven to be beneficial for health, there is limited information regarding their effects on children's acute cognitive performance during self-paced exercise., Methods: This study used a within-subjects, fully counterbalanced design with a sample of 38 preadolescent children (mean age = 12.50 y, SD = 0.62; 43% male), who performed cognitive tests while being seated or while cycling for 45 minutes with a 7-day interval. Effects of using a desk bike were evaluated on cognitive control: verbal and visuospatial working memory capacities were tested, and inhibition was assessed using a modified flanker task. In addition, subjective task experience was explored using self-report measures., Results: Cognitive control performance was not degraded but also not improved with the short-term use of desk bikes. Because of the null effects, there is no direction and magnitude of the outcomes to discuss., Conclusions: These findings suggest that schools can successfully implement desk bikes to increase physical activity and reduce sedentary time among children without compromising cognitive control processes necessary for academic achievement.

Engaging in regular physical activity can have substantial cognitive and academic benefits for children, and is generally promoted for its beneficial effects on children's physical and mental health. Although embodied cognition research has convincingly shown the integral relationship of the human body and mind, in schools physical activity and cognitive activity are typically treated as unrelated processes. Consequently, most physical activities used are neither sufficiently relevant for nor fully integrated into the learning tasks. In reviewing the literature regarding the integration of physical activity into education to promote cognition and learning, two main lines of research emerged: exercise and cognition research vs. embodied cognition research. In this narrative review, we describe these two separately evolved schools of thought, highlighting their differences and commonalities. In categorising the existing studies on a 2 × 2 matrix, concerning the two main categories of relevance for and integration into the learning task, it becomes clear where the different foci lie, and how both lines of research could profit from learning from each other. Finally, a new instructional model that integrates task-relevant physical activities into the cognitive/learning task is proposed to inform both further research and educational practice.

Context: Conventional continuing medical education (CME) has been shown to have modest effects on doctor performance. New educational approaches based on the review of routine practices have brought better results. Little is known about factors that affect the outcomes of these approaches, especially in middle-income countries. This study aimed to investigate factors that influence the learning and quality of clinical performance in CME based on reflection upon experiences., Methods: A questionnaire and a clinical performance test were administered to 165 general practitioners engaged in a CME programme in Brazil. The questionnaire assessed behaviours related to four input variables (individual reflection on practices, peer review of experiences, self-regulated learning and learning skills) and two mediating variables (identification of learning needs and engagement in learning activities, the latter consisting of self-study of scientific literature, consultations about patient problems, and attendance at courses). Structural equation modelling was used to test a hypothesised model of relationships between these variables and the outcome variable of clinical performance, measured by the clinical performance test., Results: After minor adjustments, the hypothesised model fit the empirical data well. Individual reflection fostered identification of learning needs, but also directly positively influenced the quality of clinical performance. Peer review did not affect identification of learning needs, but directly positively affected clinical performance. Learning skills and self-regulation did not help in identifying learning needs, but self-regulation enhanced study of the scientific literature, the learning activity that most positively influenced clinical performance. Consultation with colleagues, the activity most frequently triggered by the identification of learning needs, did not affect performance, and attendance of courses had only limited effect., Conclusions: This study shed light on the factors that influence learning and performance improvement in continuing education based on the review of routine practices in middle-income settings. The findings support the importance of reflection on practices as an instrument for enhancing clinical performance., (© 2013 John Wiley & Sons Ltd.)

Many aspects of the problem-based learning cycle aim at stimulating students to elaborate on their knowledge. This elaborative process is considered to be one of the most effective study aids for learning and applying information. One of the opportunities to stimulate this elaboration process is by offering students more, and more diverse, learning resources. Under laboratory conditions, increasing the richness and diversity of the learning materials has often been shown to support students in learning, remembering and applying information. In this study, a curricular perspective was adopted on the question whether students would benefit from more learning resources. Mean study times and achievement scores for 28 problem-based courses were calculated and included in the analyses. Independent variables in both analyses were the number of primary learning resources (i.e., resources students were recommended to study) and the number of supplementary resources (i.e., related, but non-essential resources). Results showed a significant increase in achievement scores for courses with more primary learning resources, but the effect of supplementary resources was limited.

Purpose: To investigate the role of biomedical and diagnostic inferences in clinical reasoning of advanced medical students and experienced family physicians using a lexical decision task., Method: In 2002, 15 family physicians and 20 fourth-year medical students at Maastricht University medical school in The Netherlands were instructed to carefully study 60 short clinical texts consisting of signs and symptoms associated with a particular disease. Participants read the texts on a computer screen and responded using a computer keyboard. Each text was followed by a target item (i.e., biomedical item, diagnostic item, or a nonword). Participants had to decide as quickly and accurately as possible whether the presented target item was a word or a nonword. For both groups, mean response time and mean error rate for all levels of item type were analyzed., Results: Findings indicate that both physicians and medical students judged diagnostic target items faster and more accurately than biomedical target items. However, physicians were considerably faster than were students on judging biomedical and diagnostic target items., Conclusions: These findings are largely in line with knowledge encapsulation in that biomedical knowledge still plays a prominent role in the physician's clinical reasoning.

Medical specialists, diagnosing cases within their domain of expertise, do not rely on intentional causal reasoning, in which they use explicit principles or rules of their domain. Rather, their reasoning has become an automatic process using schema-based knowledge. However, the difference between diagnoses made by medical specialists and diagnoses made by nonspecialists (i.e., subexperts) is unclear. In the present study, cardiologists (the experts), pulmonologists (the subexperts), and advanced medical students evaluated two clinical cases within the domain of cardiology. The cases were divided into four components (i.e., patient's history, physical examination, laboratory data, and additional findings) that were sequentially presented. The task was to study, diagnose, and recall the segmented clinical case description. It was expected that the subexperts and students, as a result of their lack of specific expertise, would focus on different case components than the experts would. However, results indicated that the main difference between experts and subexperts (and to a lesser extent, students) was not a difference in emphasis on case components, but the speed and accuracy of processing these case components.