Multiple choice questions (MCQs) offer high reliability and easy machine-marking, but allow for cueing and stimulate recognition-based learning. Very short answer questions (VSAQs), which are open... Show moreMultiple choice questions (MCQs) offer high reliability and easy machine-marking, but allow for cueing and stimulate recognition-based learning. Very short answer questions (VSAQs), which are open-ended questions requiring a very short answer, may circumvent these limitations. Although VSAQ use in medical assessment increases, almost all research on reliability and validity of VSAQs in medical education has been performed by a single research group with extensive experience in the development of VSAQs. Therefore, we aimed to validate previous findings about VSAQ reliability, discrimination, and acceptability in undergraduate medical students and teachers with limited experience in VSAQs development. To validate the results presented in previous studies, we partially replicated a previous study and extended results on student experiences. Dutch undergraduate medical students (n = 375) were randomized to VSAQs first and MCQs second or vice versa in a formative exam in two courses, to determine reliability, discrimination, and cueing. Acceptability for teachers (i.e., VSAQ review time) was determined in the summative exam. Reliability (Cronbach's & alpha;) was 0.74 for VSAQs and 0.57 for MCQs in one course. In the other course, Cronbach's & alpha; was 0.87 for VSAQs and 0.83 for MCQs. Discrimination (average R-ir) was 0.27 vs. 0.17 and 0.43 vs. 0.39 for VSAQs vs. MCQs, respectively. Reviewing time of one VSAQ for the entire student cohort was & PLUSMN;2 minutes on average. Positive cueing occurred more in MCQs than in VSAQs (20% vs. 4% and 20.8% vs. 8.3% of questions per person in both courses). This study validates the positive results regarding VSAQs reliability, discrimination, and acceptability in undergraduate medical students. Furthermore, we demonstrate that VSAQ use is reliable among teachers with limited experience in writing and marking VSAQs. The short learning curve for teachers, favourable marking time and applicability regardless of the topic suggest that VSAQs might also be valuable beyond medical assessment. Show less
Scholarly doctors require research knowledge and skills (Ausbildung), as well as an academic mindset, which includes curiosity, creativity, and critical thinking (Bildung). However, in contrast to... Show moreScholarly doctors require research knowledge and skills (Ausbildung), as well as an academic mindset, which includes curiosity, creativity, and critical thinking (Bildung). However, in contrast to knowledge and skills, summative assessment of the development of an academic mindset is not so easy in an objective and so-called 'fair' way. As a result, in practice, assessing knowledge and skills tends to dominate in scholarly development. In this perspective, we explore the issues that arise when we give priority to objective assessment of knowledge and skills in scholarly development to safeguard fairness and, consequently, standardize educational procedures and learning pathways. We argue that eventually this approach may even result in hampered development of a true academic mindset and can be considered unfair rather than fair. To solve this, perhaps we should go back to the core business of the university and in the tradition of founder of the modern university Von Humboldt focus on shaping an academic mindset (Bildung). To rebalance Ausbildung and Bildung in academic education, we should go beyond the assumption that objectivity is a prerequisite for achieving fairness in assessment. Shifting the focus from pure objectivity to both objectivity and subjectivity in assessment as well as learning pathways can assist in protecting fairness and, as a result, bring back Bildung to medical education to ensure future doctors to be true scholars. Show less
Objectives The medical field is facing a clinician-scientist shortage. Medical schools could foster the clinician-scientist workforce by offering students research opportunities. Most medical... Show moreObjectives The medical field is facing a clinician-scientist shortage. Medical schools could foster the clinician-scientist workforce by offering students research opportunities. Most medical schools offer elective research programmes. Subsequently, a subset of doctors graduates without any research experience. Mandatory research projects may be more sufficient to develop clinician-scientist, but take more supervision and curricular time. There is limited insight in the scientific outcomes of mandatory research experiences. This study aims to examine publication rates of a mandatory research experience, identify factors associated with publication, and includes postgraduate research engagement. Design and setting Prospective follow-up study involving 10 cohorts of medical students' mandatory research projects from Leiden University Medical Center. Participants All medical students who conducted their research project between 2008 and 2018 (n=2329) were included. Main outcome measure Publication rates were defined as peer-reviewed scientific publications, including research papers, reviews, and published meeting abstracts. Postgraduate research engagement was defined as research participation and dissemination of research at scientific conferences or in journals. Results In total, 644 (27.7%) of all mandatory research experiences resulted in publication, with students mainly as first (n=984, 42.5%) or second author (n=587, 25.3%) and above world average citation impact (mean normalised journal score 1.29, mean normalised citation score 1.23). Students who conducted their research in an academic centre (adjusted OR 2.82; 95% CI 2.10 to 3.77), extended their research (adjusted OR 1.73; 95% CI 1.35 to 2.20), were involved in an excellency track (adjusted OR 2.08; 95% CI 1.44 to 3.01), or conducted clinical (adjusted OR 2.08; 95% CI 1.15 to 3.74) or laboratory (adjusted OR 2.16; 95% CI 1.16 to 4.01) research published their research more often. Later as junior doctors, this group significantly more often disseminate their research results at scientific conferences (adjusted OR 1.89; 95% CI 1.11 to 3.23) or in journals (adjusted OR 1.98; 95% CI 1.14 to 3.43). Conclusions Our findings suggest that a significant subset of hands-on mandatory research projects with flexible learning pathways result in tangible research output with proper impact and that such successful experiences can be considered as diving board towards a research-oriented career. Show less
Versteeg, M.; Bressers, G.; Wijnen-Meijer, M.; Ommering, B.W.C.; Beaufort, A.J. de; Steendijk, P. 2021
PhenomenonAs a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one's thinking.... Show morePhenomenonAs a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one's thinking. Having a metacognitive habit of mind is essential for healthcare professionals. This study identified the metacognitive competencies of medical students as they completed a conceptual learning task, and provided insight into students' perceptions of self-regulated learning in their curriculum. Approach: Eleven third-year medical students from a Dutch University were purposively sampled to participate in this qualitative study. The study design included a think-aloud assignment followed by a semi-structured interview. During the assignment, participants were instructed to think aloud while solving questions about medical physiological concepts such as blood flow, pressure, and resistance. Think-aloud data were collected through audiotaping and used to identify participants' metacognitive competencies. The assignment also served as a prompt for an interview in which participants were questioned about metacognitive knowledge, monitoring, experiences, and perceptions of self-regulated learning in their curriculum. All data were transcribed verbatim and analyzed iteratively using a template analysis. Findings: Students differed in their use of metacognitive skills, with an overall focus on monitoring and, to a lesser extent, on planning and evaluation. Additionally, differences were found in students' metacognitive knowledge and metacognitive experiences. There was apparent use of inefficient, superficial predictive cues. Regarding perceptions of self-regulated learning skills, some students felt no need to develop such skills as they perceived medical education as an exercise in memorizing facts. Others emphasized the need for more insight into their actual level of knowledge and competence. Insights: Pre-clinical medical students require explicit teaching of metacognitive skills to facilitate self-regulated learning. Educators should aim to integrate metacognition in the everyday discourse of the classroom to foster an environment in which students discuss their own learning.Supplemental data for this article is available online at . Show less
Versteeg, M.; Hafkemeijer, A.; Beaufort, A.J. de; Steendijk, P. 2020
Obtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in... Show moreObtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in the brain. Therefore, misconceptions must be cognitively inhibited in order to select the scientific knowledge. There is, however, lack of substantial neuroscientific evidence supporting this hypothesis. In this study, we sought for this evidence by investigating medical students who solved a cardiovascular conceptual problem in a magnetic resonance imaging scanner. Brain activation was compared between understanders who had the scientific knowledge, and misunderstanders who held a misconception. No significant activation was found in brain areas related to cognitive inhibition in understanders compared with misunderstanders. Therefore, we could not confirm the idea that cognitive inhibition is involved in overcoming a misconception. Instead, we found that the putamen was significantly activated in misunderstanders compared with understanders, suggesting a role for episodic memory in learners holding a misconception. Show less
Versteeg, M.; Hafkemeijer, A.; Beaufort, A.J. de; Steendijk, P. 2020
Obtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in... Show moreObtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in the brain. Therefore, misconceptions must be cognitively inhibited in order to select the scientific knowledge. There is, however, lack of substantial neuroscientific evidence supporting this hypothesis. In this study, we sought for this evidence by investigating medical students who solved a cardiovascular conceptual problem in a magnetic resonance imaging scanner. Brain activation was compared between understanders who had the scientific knowledge, and misunderstanders who held a misconception. No significant activation was found in brain areas related to cognitive inhibition in understanders compared with misunderstanders. Therefore, we could not confirm the idea that cognitive inhibition is involved in overcoming a misconception. Instead, we found that the putamen was significantly activated in misunderstanders compared with understanders, suggesting a role for episodic memory in learners holding a misconception. Show less
Dijkhuizen, K.; Bustraan, J.; Bogaard, M.E.D. van den; Velthuis, S.I.; Lith, J.M.M. van; Driessen, E.W.; Beaufort, A.J. de 2020
Objectives Postgraduate trainee selection is a high-stakes process. While many studies focused on selection methods and psychometrics, little is known about the influence of selectors' personal... Show moreObjectives Postgraduate trainee selection is a high-stakes process. While many studies focused on selection methods and psychometrics, little is known about the influence of selectors' personal values and beliefs in the judgment and decision-making process. A better understanding of these factors is vital since selectors determine the future workforce. Methods We interviewed programme directors (PDs) from 11 specialties in one University Hospital. Thematic analysis was conducted with a combined approach of generic and in-vivo coding. Results PDs value excellence, 'fit' and personal characteristics. The content of these values are subject to personal interpretation and differ between PDs. PDs use various 'proxies' as alternative indicators of performance. They consider intuition, teamwork and autonomy important in judgement and decision-making. PDs find selection challenging and feel great accountability towards candidates and society. Conclusions Selectors criteria of judgement- and decision-making often remain implicit and focus on prior achievements and 'fit' with the current trainee-pool, possibly compromising the workforce's diversity. Implicit 'proxies' and intuitive decision-making may be an unwitting source of judgemental bias. 'Making the implicit explicit', by increasing awareness of personal values and beliefs and structuring the selection interview, may improve the quality of trainee selection. Show less
Bustraan, J.; Dijkhuizen, K.; Velthuis, S.; Post, R. van der; Driessen, E.; Lith, J.M.M. van; Beaufort, A.J. de 2019
Objective To gain insight into factors involved in attrition) from) hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training... Show moreObjective To gain insight into factors involved in attrition) from) hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme.Design Nationwide online survey study.Setting Postgraduate education of all hospital-based specialties in the Netherlands.Participants 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017.Main outcome measures Factors involved in trainees' decisions to leave specialty training and their subsequent career plans.Results The response rate was 38 /0. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital -based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet.Conclusions This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty. Show less
Background: Current postgraduate medical training programmes fall short regarding residents' development of generic competencies (communication, collaboration, leadership, professionalism) and... Show moreBackground: Current postgraduate medical training programmes fall short regarding residents' development of generic competencies (communication, collaboration, leadership, professionalism) and reflective and deliberate practice. Paying attention to these non-technical skills in a structural manner during postgraduate training could result in a workforce better prepared for practice. A development oriented performance assessment (PA), which assists residents with assessment of performance and deliberately planned learning activities, could potentially contribute to filling this gap. This study aims to explore residents experiences with the PA.Methods: We conducted a qualitative interview study with 16 residents from four different medical specialties who participated in the PA, scheduled halfway postgraduate training. The PA was conducted by an external facilitator, a psychologist, and focused specifically on professional development and career planning. Residents were interviewed 6 months after the PA. Data were analysed using the framework method for qualitative analysis.Results: Residents found the PA to be of additional value for their training. The overarching merit was the opportunity to evaluate competencies not usually addressed in workplace-based assessments and progress conversations. In addition, the PA proved a valuable tool for assisting residents with reflecting upon their work and formulating their learning objectives and activities. Residents reported increased awareness of capacity, self-confidence and enhanced feelings of career ownership. An important factor contributing to these outcomes was the relationship of trust with the facilitator and programme director.Conclusion: The PA is a promising tool in fostering the development of generic competencies and reflective and deliberate practice. The participating residents, facilitator and programme directors were able to contribute to a safe learning environment away from the busy workplace. The facilitator plays an important role by providing credible and informative feedback. Commitment of the programme director is important for the implementation of developmental plans and learning activities. Show less
Research should be explicated in undergraduate teaching in a way that stimulates student learning. Previous studies in higher education have shown that student perceptions of research integrated... Show moreResearch should be explicated in undergraduate teaching in a way that stimulates student learning. Previous studies in higher education have shown that student perceptions of research integrated into teaching could promote student learning, but have also indicated that it can be difficult to confront first-year undergraduates with research during courses. In this study, we describe relationships between first-year medical student perceptions of research, learning outcomes and beliefs about the value of research. The Student Perception of Research Integration Questionnaire was filled out by 261 students. Answers were related to student achievement. The findings suggest that student motivation for research is strongly related to merging current research into teaching. Students rather recognised an emphasis on research methodologies than research engagement. Particularly student beliefs about research are related to achievement. It is suggested that to foster positive beliefs about research, teachers should familiarise students with current research and create enthusiasm for research. Show less
Research should be explicated in undergraduate teaching in a way that stimulates student learning. Previous studies in higher education have shown that student perceptions of research integrated... Show moreResearch should be explicated in undergraduate teaching in a way that stimulates student learning. Previous studies in higher education have shown that student perceptions of research integrated into teaching could promote student learning, but have also indicated that it can be difficult to confront first-year undergraduates with research during courses. In this study, we describe relationships between first-year medical student perceptions of research, learning outcomes and beliefs about the value of research. The Student Perception of Research Integration Questionnaire was filled out by 261 students. Answers were related to student achievement. The findings suggest that student motivation for research is strongly related to merging current research into teaching. Students rather recognised an emphasis on research methodologies than research engagement. Particularly student beliefs about research are related to achievement. It is suggested that to foster positive beliefs about research, teachers should familiarise students with current research and create enthusiasm for research. Show less
Background: The massive pulmonary neutrophil influx in respiratory distress syndrome (RDS) in preterm infants has been ascribed to the effect of leukotriene B-4 (LTB4). Objectives: To investigate... Show moreBackground: The massive pulmonary neutrophil influx in respiratory distress syndrome (RDS) in preterm infants has been ascribed to the effect of leukotriene B-4 (LTB4). Objectives: To investigate whether secretory phospholipase A(2) (sPLA(2)), the rate-limiting enzyme in LTB4 production, is present in lungs of RDS infants and stimulates neutrophil migration. Methods: sPLA(2) was measured in tracheal aspirates from 15 preterm infants with RDS. The effect of aspirates on cord blood neutrophil migration was first measured, and the contribution of sPLA(2) was assessed by addition of its endogenous inhibitor Clara cell protein (CC16) or absorption of sPLA(2) from the aspirates. The role of intracellular signal transduction activation and LTB4 formation in sPLA(2)-induced neutrophil migration was determined using purified sPLA(2), several inhibitors of signal transduction, a LTB4 synthesis inhibitor and a LTB4 receptor antagonist. Results: All aspirates contained sPLA(2), which significantly stimulated neutrophil migration. Addition of CC16 or absorption of sPLA(2) abolished the stimulatory effect. All inhibitors significantly reduced sPLA(2)-induced neutrophil migration. Conclusions: sPLA(2) is present in tracheal aspirates of preterm infants with RDS. Human recombinant sPLA(2) and pancreatic type sPLA(2) stimulate in vitro cord blood neutrophil migration via activation of intracellular signal transduction pathways, LTB4 production and receptor binding. We speculate that sPLA(2) contributes to pulmonary neutrophil influx in RDS. Further studies are needed to determine the potential of sPLA(2) inhibition as a treatment for RDS. Copyright (C) 2009 S. Karger AG, Basel Show less
