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To understand expertise and expertise development, interactions between knowledge, cognitive processing and task characteristics must be examined in people at different levels of training, experience, and performance. Interviewing is widely used in the initial exploration of domain expertise. Work and cognitive task analysis chart the knowledge, skills, and strategies experts employ to perform effectively in representative tasks. Interviewing may also shed light on the learning processes involved in acquiring and maintaining expertise and the way experts deal with critical incidents. Interviews may focus on specific tasks, events, scenarios, and examples, but they do not directly tap the representations involved in task performance. Methods that collect verbal protocols during and immediately after task performance better probe the ongoing processes in representing problems and accomplishing tasks. This article provides practical guidelines and examples to help researchers to prepare, conduct, analyse, and report expertise studies using interviews and verbal protocols that are derived from thinking aloud, dialogues or group discussions, free recall, explanation, and retrospective reports. In a multi-method approach, these methods and other techniques need to be combined to fully grasp the nature of expertise. This article shows how the cognitive processes in data collection constrain data quality and highlights how research questions guide the development of coding schemes that enable meaningful interpretation of the rich data obtained. It focuses on professional expertise and provides examples from medicine including visual tasks. This comprehensive review of qualitative research methods aims to contribute to the advancement of expertise.

The aim of the present empirical study was to explore students' self-regulated learning behaviours in vocational education and training and to describe the micro processes associated with planning, monitoring and evaluating during practical learning tasks. The 18 participants were well-performing students from upper secondary vocational education. We collected data from observations, interviews and self-reports to gain detailed insights into students' behaviours and thoughts during practical task performance. The results reveal that most of the students planned their time and resources, but did not develop elaborate plans to regulate their learning behaviours. They monitored their work carefully and adjusted when necessary. When evaluating, students focussed more on work outcomes than learning processes. The results also showed that the students' actual behaviours corresponded with self-reports on internal regulation, with three students overestimating their internal regulation. This study sheds light on an underexplored context and population regarding self-regulated learning. Though the well-performing vocational students engaged in self-regulation, their self-regulating behaviours were led by a combination of hands-on activities and evolving work outcomes. Thus, it was the emerging performance and experiences that triggered their learning. Although self-regulated learning behaviours in vocational education and training were present, we conclude that instructional support needs to be developed and empirically tested to actively facilitate and foster vocational students' learning by doing and reflection.

In vocational education, workplace simulations (WPS) have been implemented to ensure a better connection between the educational setting and the labour market. Moreover, WPS are supposed to motivate students and promote self-directed learning. So far, however, not much is known about the way students experience these WPS. The aim of the present exploratory case study was to investigate students' perceptions and preparedness for WPS and explore what factors they perceive to be relevant for their learning in these simulations. Forty students from three different pre-vocational secondary schools participated. Semi-structured group interviews were conducted and thematic analysis was used to examine the qualitative data. The results revealed that authentic WPS can increase student motivation and engagement. Learner characteristics regarded as relevant in WPS were motivation, responsibility, independence and discipline. For students, the presence and guidance of the teacher played an essential role in their working and learning effectively. They felt limited in making choices to direct their own learning. Assessment criteria were not transparent enough for students. Concluding, we found that students perceived factors closely related to self-regulated and self-directed learning to be relevant for their learning; however, these learning activities and processes have not yet been sufficiently promoted and supported in the investigated vocational schools. The study highlights design dilemmas for vocational practice and offers indications in how to match both learning environmental characteristics and teacher support tailored to learners' needs.

Higher education (HE) is engaged in a variety of educational innovations, as well as professional development initiatives (PDIs) to support teachers in attaining the required expertise. To improve teacher professional learning and development (PLD) and innovation processes, it is important to understand whether, how and why different PLD practices work for different innovations, contexts and populations. However, research is characterized by descriptive, single case studies and lacks a common framework to relate research findings. To address this shortcoming, this study collected and compared a wide variety of cases to develop a typology of practices. The results showed that educational innovations and teacher PLD were typically configured in three ways: (1) the focus is on implementing a new form of education and teacher learning is used as a means to this end, (2) the focus is on teachers' professional learning and the educational innovations are spin-offs, and (3) the focus is on stimulating innovations and teacher learning is a side-effect. These types of configurations differed regarding the educational innovation, required teacher expertise, professional development initiatives, teacher learning, and outcome measures. The typology serves as a framework that may help to reflect on practices, bridge disciplines, and formulate hypotheses for future research. [ABSTRACT FROM AUTHOR]

In the context of the complexity of today's organizations, help seeking behavior is considered as an important step to problem solving and learning in organizations. Yet, help seeking has received less attention in organizational literature. To increase the potential impact of help seeking on learning, it is essential to understand which mechanisms affect help seeking. The present study questioned whether the characteristics of the relationships that employees have in the workplace are related to help seeking behavior. This study draws on a social network perspective to investigate the employees' relationships within their professional network. In particular, the role of accessibility, awareness of expertise, trust, and hierarchy in help seeking was explored. Results indicated that the perceptions of the help provider's expertise, accessibility and trust were positively associated with the likelihood to seek help, frequency by which help is sought, and perceived quality of the help. Moreover, employees seem more likely to seek help upward from higher status individuals and less likely downward from lower status individuals. Employees perceived the help of higher status individuals as more useful and constructive. These results highlight the importance of investing in the strength of relationships, ensuring the accessibility of expertise and fostering a work environment, in which employees trust and respect each other. Furthermore, the results suggest valuable and promising avenues for future research and practice.

This study examined physicians' motivation to engage in work-related learning and its contribution to expertise development beyond work experience. Based on deliberate practice theory, semi-structured interviews were conducted with 17 residents and 28 experienced physicians in internal medicine, focusing on the activities they engaged in during work that might contribute to professional development and the goals underlying this behavior. Learning motivation was also measured using a goal orientation questionnaire. Expertise was measured by a case test derived from the Medical Knowledge Self Assessment Program (MKSAP). The interviews showed that participants' learning was largely embedded in everyday work; most of their learning activities were inherent to the job rather than motivated by competence improvement goals. The problems encountered in patient care played a key role in prompting learning. Role, work experience and work situation affected the type of activities engaged in, as well as the intensity of practice. Deliberate engagement in work-related learning activities was related neither to goal orientations nor to case test performance, except activities by the experienced physicians to keep up-to-date. Work experience, in contrast, showed a clear positive relationship with the performance of residents. Two main conclusions can be drawn from this study: (1) patient care induced relevant learning activities aimed at performance improvement for the patient's sake; (2) deliberate investments in learning can be enhanced to promote expertise development. Self-regulated learning by physicians needs to be strengthened and the organization for which they work should facilitate and encourage learning in daily practice.

Purpose: This study aims to investigate quality of feedback as offered by supervisor-assessors with varying levels of assessor expertise following assessment of performance in residency training in a health care setting. It furthermore investigates if and how different levels of assessor expertise influence feedback characteristics. Design/methodology/approach: Experienced (n = 18) and non-experienced (n = 16) supervisor-assessors with different levels of assessor expertise in general practice (GP) watched two videotapes, each presenting a trainee in a "real-life" patient encounter. After watching each videotape, participants documented performance ratings, wrote down narrative feedback comments and verbalized their feedback. Deductive content analysis of feedback protocols was used to explore quality of feedback. Between-group differences were assessed using qualitative-based quantitative analysis of feedback data. Findings: Overall, specificity and usefulness of both written and verbal feedback was limited. Differences in assessor expertise did not seem to affect feedback quality. Research limitations/implications: Results of the study are limited to a specific setting (GP) and assessment context. Further study in other settings and larger sample sizes may contribute to better understanding of the relation between assessor characteristics and feedback quality. Practical implications: Findings suggest that even with supervisor-assessors with varying levels of assessor expertise who are trained in performance assessment and the provision of performance feedback, high-quality feedback is not self-evident; coaching "on the job" of feedback providers and continuous evaluation of feedback processes in performance management systems is crucial. Instruments should facilitate provision of meaningful feedback in writing. Originality/value: The paper investigates quality of feedback immediately following assessment of performance, and links feedback quality to assessor expertise. Findings can contribute to improvement of performance management systems and assessments for developmental purposes. (Contains 2 tables and 2 figures.)

This study brings together findings from different research angles on informal feedback in the workplace. We explore the individual and joint influences of three contextual antecedents of seeking feedback: support for learning, psychological safety, and work pressure. Based on our survey of 138 employees from various organizations, hierarchical regression analyses revealed that support in the work environment positively influenced the quality of the self-initiated feedback from colleagues and (in particular) from the supervisor. Psychological safety positively related to the quality of the self-initiated feedback from colleagues. No relation was found between support, psychological safety and the frequency of feedback seeking, however, an indication for the existence of a curvilinear effect of work pressure on the frequency of feedback seeking was found. The study highlights the importance of fostering supportive and psychological safe work environments, so that employees and supervisors will look for and give constructive feedback. Learning in organizations can be stimulated by creating enough time and opportunities for informal feedback, and the results suggest several valuable and promising avenues for future research.

Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians engage in during their work that might further their professional development. As deliberate practice requires a focused effort to improve performance, the study also examined the goals underlying this behaviour. Semi-structured interviews were conducted with 50 internal medicine physicians: 19 residents, 18 internists working at a university hospital, and 13 working at a non-university hospital. The results showed that learning in medical practice was very much embedded in clinical work. Most relevant learning activities were directly related to patient care rather than motivated by competence improvement goals. Advice and feedback were sought when necessary to provide this care. Performance standards were tied to patients' conditions. The patients encountered and the discussions with colleagues about patients were valued most for professional development, while teaching and updating activities were also valued in this respect. In conclusion, physicians' learning is largely guided by practical experience rather than deliberately sought. When professionals interact in diagnosing and treating patients to achieve high-quality care, their experiences contribute to expertise development. However, much could be gained from managing learning opportunities more explicitly. We offer suggestions for increasing the focus on learning in medical practice and further research. (Contains 2 tables.)

Background: Worked examples are very effective for novice learners. They typically present a written-out ideal (didactical) solution for learners to study. Aims: This study used worked examples of patient history taking in physiotherapy that presented a "non"-didactical solution (i.e., based on actual performance). The effects of model expertise (i.e., worked example based on advanced, third-year student model or expert physiotherapist model) in relation to students' expertise (i.e., first- or second-year) were investigated. Sample: One hundred and thirty-four physiotherapy students (61 first-year and 73 second-year). Methods: Design was 2x2 factorial with factors "Student Expertise" (first-year vs. second-year) and "Model Expertise" (expert vs. advanced student). Within expertise levels, students were randomly assigned to the Expert Example or the Advanced Student Example condition. All students studied two examples (content depending on their assigned condition) and then completed a retention and test task. They rated their invested mental effort after each example and test task. Results: Second-year students invested less mental effort in studying the examples, and in performing the retention and transfer tasks than first-year students. They also performed better on the retention test, but not on the transfer test. In contrast to our hypothesis, there was no interaction between student expertise and model expertise: all students who had studied the Expert examples performed better on the transfer test than students who had studied Advanced Student Examples. Conclusions: This study suggests that when worked examples are based on actual performance, rather than an ideal procedure, expert models are to be preferred over advanced student models.

Background: Family physicians perceive that gut feelings, i.e. a 'sense of reassurance' or a 'sense of alarm', play a substantial role in diagnostic reasoning. A measuring instrument is desirable for further research. Our objective is to validate a questionnaire measuring the presence of gut feelings in diagnostic reasoning. Methods: We constructed 16 case vignettes from real practice situations and used the accompanying 'sense of reassurance' or the 'sense of alarm' as reference labels. Based on the results of an initial study (26 family physicians), we divided the case vignettes into a group involving a clear role for the sense of reassurance or the sense of alarm and a group involving an ambiguous role. 49 experienced family physicians evaluated each 10 vignettes using the questionnaire. Construct validity was assessed by testing hypotheses and an internal consistency procedure was performed. Results: As hypothesized we found that the correlations between the reference labels and corresponding items were high for the clear-case vignettes (0.59 - 0.72) and low for the ambiguous-case vignettes (0.08 - 0.23). The agreement between the classification in clear sense of reassurance, clear sense of alarm and ambiguous case vignettes as derived from the initial study and the study population's judgments was substantial (Kappa = 0.62). Factor analysis showed one factor with opposites for sense of reassurance and sense of alarm items. The questionnaire's internal consistency was high (0.91). We provided a linguistic validated English-language text of the questionnaire. Conclusions: The questionnaire appears to be valid. It enables quantitative research into the role of gut feelings and their diagnostic value in family physicians' diagnostic reasoning. [ABSTRACT FROM AUTHOR]

Dutch medical disciplinary boards consider physicians' gut feelings an element of the professional standards. Some indications can be found in the international literature suggesting intuitive feelings of unease of patients or their relatives can also contribute to adequate diagnostics. What is the view of disciplinary boards on this? A search in the disciplinary boards' database (2010-2017) found 55 rulings where the search term 'ongerust' (worried) was related to a patient, family member or partner and 51 rulings where the term 'bezorgd' (concerned) was related to a patient, family member or partner. The disciplinary boards expect that doctors are prepared to discuss worry and concern with their patients. Additionally, they consider patients' worry and concern to be a useful part of the doctors' diagnostics, which may possibly result in reviewing the diagnosis. This is consistent with the international literature.

What role does uncertainty play in the doctor's diagnostic reasoning process? Would it not be better to avoid uncertainty as much as possible? In this article we answer this question from an epistemological perspective. Doctors build up relevant, situational knowledge during the diagnostic process through listening, observation and interpretation during their contact with the patient. Uncertainty can play a crucial role in this. We use a practical case to illustrate how allowing in some uncertainty - in the form of gut feelings - can improve the quality of the diagnostic thought process.