Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual... Show moreMisconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding: however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students' awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students (N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation. i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation (R-2 = 0.13, P = 0.001) between students' confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students' conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education. Show less
Students learn more effectively when they know what they do not know. Gaining insight into students' metacognitive awareness is needed as misalignment between actual and self-perceived knowledge... Show moreStudents learn more effectively when they know what they do not know. Gaining insight into students' metacognitive awareness is needed as misalignment between actual and self-perceived knowledge impedes their learning process. The optimal method of measuring self-perceived knowledge is still under debate. In this study, we evaluate the use of psychology-derived post-decision wagering for mapping students self-perceived knowledge.Students (n = 71) performed a pre-test on medical physiology, followed by a teacher-moderated discussion and a post-test with isomorph questions. Half of the students rated their self-perceived knowledge on each question using post-decision wagering, i.aEuroe. betting 1-5 points on the correctness of their answer, whereas the other half used a 5-point Likert scale to rate their confidence.Self-perceived knowledge scores were higher for post-decision wagering (pre: 3.75 +/- 0.14, post: 4.60 +/- 0.07) compared with Likert scales (pre: 3.13 +/- 0.08, post: 3.92 +/- 0.08) despite similar actual knowledge scores. Furthermore, Likert ratings showed a near-normal distribution, whereas wagers were placed preferentially using the outer ends of the scale. Correlations between mean actual and self-perceived knowledge scores were low in both groups. On average, 8.5% of responses were classified as misconceptions, defined as highly confident incorrect answers.Despite the presumed reliability of post-decision wagering, our findings suggest that we should adhere to the use of Likert scales as a balanced measure for self-perceived knowledge in medical education. Moreover, the prevalence of misconceptions did not alter after instruction, indicating a need for instructional designs that enhance students' conceptual understanding in basic sciences. Show less
Introduction. Students learn more effectively when they know what they do not know. Gaining insight into students’ metacognitive awareness is needed as misalignment between actual and self... Show moreIntroduction. Students learn more effectively when they know what they do not know. Gaining insight into students’ metacognitive awareness is needed as misalignment between actual and self-perceived knowledge impedes their learning process. The optimal method of measuring self-perceived knowledge is still under debate. In this study, we evaluate the use of psychology-derived post-decision wagering for mapping students self-perceived knowledge. Methods Students (n= 71) performed a pre-test on medical physiology, followed by a teacher-moderated discussion and a post-test with isomorph questions. Half of the students rated their self-perceived knowledge on each question using post-decision wagering, i. e. betting 1–5 points on the correctness of their answer, whereas the other half used a 5-point Likert scale to rate their confidence. Results. Self-perceived knowledge scores were higher for post-decision wagering (pre: 3.75± 0.14, post: 4.60± 0.07) compared with Likert scales (pre: 3.13± 0.08, post: 3.92± 0.08) despite similar actual knowledge scores. Furthermore, Likert ratings showed a near-normal distribution, whereas wagers were placed preferentially using the outer ends of the scale. Correlations between mean actual and self-perceived knowledge scores were low in both groups. On average, 8.5% of responses were classified as misconceptions, defined as highly confident incorrect answers. Discussion. Despite the presumed reliability of post-decision wagering, our findings suggest that we should adhere to the use of Likert scales as a balanced measure for self-perceived knowledge in medical education. Moreover, the prevalence of misconceptions did not alter after instruction, indicating a need for instructional designs that enhance students’ conceptual understanding in basic sciences. Show less
AIMS: Restrictive mitral annuloplasty (RMA) can provide a durable solution for functional mitral regurgitation (MR), but might result in obstruction to antegrade mitral flow. Aim of this study was... Show moreAIMS: Restrictive mitral annuloplasty (RMA) can provide a durable solution for functional mitral regurgitation (MR), but might result in obstruction to antegrade mitral flow. Aim of this study was to assess the magnitude of change in mitral valve area (MVA) during exercise after RMA, to relate the change in MVA to left ventricular (LV) geometry and function, and to assess its haemodynamic and clinical impact.METHODS AND RESULTS: Bicycle exercise echocardiography was performed in 32 patients after RMA. Echocardiographic data at rest and during exercise were compared with preoperative echocardiographic data. Clinical endpoints were collected following the study visit. MVA increased during exercise in 25 patients (1.6 ± 0.4 cm2 to 2.0 ± 0.6 cm2, P < 0.001), whereas MVA decreased in 7 patients (1.8 ± 0.5 cm2 to 1.5 ± 0.4 cm2, P = 0.020). Patients with an increased MVA showed a significant reduction in LV volumes at rest compared to preoperatively, and an increase in stroke volume and cardiac output (CO) during exercise. In patients with decreased MVA, LV reverse remodelling was absent and myocardial flow reserve limited. Patients with decreased exercise MVA had a higher increase in mean pulmonary artery pressure (PAP) with respect to CO and worse survival 36 months after the study visit (69±19% vs. 92±5%, P = 0.005).CONCLUSIONS: Both increased and decreased MVA were observed during exercise echocardiography after RMA for functional MR. Change in MVA was related to the extent of LV geometrical and functional changes. A decreased MVA during exercise was associated with a higher increase in mean PAP with respect to CO, and worse survival. Show less
Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual... Show moreMisconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding; however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students’ awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students (N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation, i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation (R2 = 0.13, P = 0.001) between students’ confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students’ conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education. Show less
Versteeg, M.; Blankenstein, F.M. van; Putter, H.; Steendijk, P. 2018
Comprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer... Show moreComprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer instruction (PI) is known to stimulate students' comprehension, but its relative efficacy and working mechanisms remain to be elucidated. In this study, we investigated if and how PI could optimize comprehension of physiological concepts and transfer relative to Self-explanation (SE) which is considered a lower-order type of overt learning. First-year medical students (n = 317) were randomly assigned to either PI or SE in a pre-post test design, followed by a set of near and far transfer questions. In both PI and SE groups post-test scores were significantly improved (p < 0.0001) with PI outperforming SE (+ 35% vs. + 23%, p = 0.006). Interestingly, a substantial number of students with initial incorrect answers even had enhanced scores after discussion with an incorrect peer. Both methods showed higher transfer scores than control (p = 0.006), with a tendency for higher near transfer scores for PI. These findings support PI as a valuable method to enhance comprehension of physiological concepts. Moreover, by comparing the effects of interactive PI with constructive SE we have established new insights that complement educational theories on overt learning activities. Show less
Oratie uitgesproken door Prof.dr. P. Steendijk bij de aanvaarding van het ambt van hoogleraar in de Cardiovasculaire Fysiologie, in het bijzonder Onderzoek van Methoden en Vernieuwingen van het ... Show moreOratie uitgesproken door Prof.dr. P. Steendijk bij de aanvaarding van het ambt van hoogleraar in de Cardiovasculaire Fysiologie, in het bijzonder Onderzoek van Methoden en Vernieuwingen van het (bio)Medisch Onderwijs aan de Universiteit Leiden op vrijdag 20 oktober 2017 Show less
Reil, J.C.; Tauchnitz, M.; Tian, Q.H.; Hohl, M.; Linz, D.; Oberhofer, M.; ... ; Lipp, P. 2016
