This research explores the beliefs medical educators hold on being a teacher as well as on the process of teaching and learning, within the context of learning-centred education. It also explores... Show moreThis research explores the beliefs medical educators hold on being a teacher as well as on the process of teaching and learning, within the context of learning-centred education. It also explores the relationship between these two areas of inquiry, and how medical educators mature through developing their beliefs about being a teacher over time.We conclude that maturation of medical educators’ beliefs about being a teacher can take place but is not self-evident, and seems to proceed through developmental stages of awareness of, successively, educational competencies, identity and mission. Awareness of a personal educational mission can reinforce and nurture an educator’s identity. Moreover, it gives meaning to an educator’s professional life and can fuel motivation for further development. This is an important explanation as to why educators who are aware of their educational mission have the most elaborate, learning-centred, beliefs about teaching and learning. Thus, supporting educators in becoming aware of and developing their educational mission is essential to foster learning-centred beliefs. This dissertation offers a deeper understanding of medical educators’ maturation, the factors influencing maturation, and its relationship with beliefs about teaching and learning, thereby contributing to the quality of learning of the next generation healthcare professionals. Show less
Clinician-scientists are the driving force behind advancements in the medical field by connecting clinical care with medical research. The pathway of clinician-scientist careers is often referred... Show moreClinician-scientists are the driving force behind advancements in the medical field by connecting clinical care with medical research. The pathway of clinician-scientist careers is often referred to as 'the leaky pipeline', as many (potential future) clinician-scientists during their career are leaking out of this pipeline, resulting in acurrent clinician-scientist shortage worldwide. This shortage of clinician-scientists has been attributed to a lack of supply and/or (too many) obstacles to stay actively engaged in research, considered as leaks. Research training interventions in medical education are often opted as part of the solution. In this thesis we investigated undergraduate and postgraduate research programmes including its challenges, outcomes and the role of motivation for research during these programmes; therebyaiming to contribute to a sustainable clinician-scientist workforce. Show less
For medical students, the transition from the preclinical to the clinical phase of their curriculum (clerkships) can result in increased levels of stress and anxiety. This is partly caused by low... Show moreFor medical students, the transition from the preclinical to the clinical phase of their curriculum (clerkships) can result in increased levels of stress and anxiety. This is partly caused by low self-perception of preparedness. By using 360 & DEG; video-based virtual reality it is possible to provide learners virtual access to clinical situations ahead of time. This technique can provide active and contextual user experiences and offers opportunities to demonstrate both behavioral skills and subject knowledge. We developed two 360 & DEG; video-based virtual reality applications for medical students transitioning to the clerkships. In this study, we describe the development and evaluated the user experiences. Two virtual reality applications were developed for use in a small group learning session. One of the applications is an interactive virtual tour of a hospital ward, in which learners explore the Internal Medicine ward and learn about the roles of different health care professionals and their mutual interactions. In each room, the learners listen to a voice-over and look at hotspots to gather additional information. The other application has been developed to train students in observing (un)professional behavior of healthcare providers in their daily activities. An evaluation was performed by an anonymous explorative questionnaire with open and closed questions (Likert scales) regarding the user experience and cybersickness symptoms. In our study, 171 students used the applications and completed the questionnaire. For 63% of the respondents, this was their first experience with a virtual reality headset. Qualitative analysis showed that students evaluated the learning method as realistic, informative and enjoyable. Most students evaluated virtual reality as a good (59%) or excellent (26%) tool for learning. Forty-five percent of the students experienced physical discomfort, such as nausea, dizziness, headache and disorientation. In most cases, these complaints were mild, although a small number experienced severe nausea (n = 6) or severe headache (n = 2). Students suggested several areas of improvement including increase of display resolution and decrease of ambient noise causing distraction. 360 & DEG; video-based virtual reality can successfully be implemented in the medical curriculum to create a realistic learning experience to prepare students for the clerkships. Show less
This thesis aimed to find opportunities to improve proactivity and patient-centredness in palliative care, focussing on education and care outcomes. The 2009 national blueprint on medical education... Show moreThis thesis aimed to find opportunities to improve proactivity and patient-centredness in palliative care, focussing on education and care outcomes. The 2009 national blueprint on medical education and the Dutch medical curricula did not comprise all essential elements about end-of-life care. Factors associated with approaching death in patients with advanced cancer visiting the LUMC’s Emergency Department (ED) in the last three months of life were lung cancer, neurologic deterioration, dyspnoea, hypercalcemia and jaundice. Patients with haematological malignancies received more potentially inappropriate care than advanced cancer patients. They rarely had limitations on life-sustaining treatments, although they often died of disease progression or treatment toxicity. The surprise question (SQ) is a simple tool to identify patients with palliative care needs . Adding poor performance status to the SQ improved the predictive value for one-year mortality in advanced cancer patients visiting the LUMC’s ED. The Leiden Guide on Palliative Care (LGP) was developed by the Centre of Expertise in Palliative Care to assess symptom burden and information needs. Patients and family wanted information about current problems and about their worries. Patients, family and clinicians found the LGP helpful. Using their input, the LGP was improved for use by generalist palliative care clinicians. Show less
Background Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later... Show moreBackground Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. Methods We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. Results Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. Conclusions The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation. Show less
As physician-scientists are able to connect research and practice, they are important to make advancements within medicine. Currently, the medical field is facing a physician-scientist shortage.... Show moreAs physician-scientists are able to connect research and practice, they are important to make advancements within medicine. Currently, the medical field is facing a physician-scientist shortage. Promoting student research engagement could be the solution. Following the need to identify how medical training could contribute to developing future physician-scientists, the general aim of this thesis was to provide insights into the impact early phases of medical training may have on cultivating physician-scientists, by elaborating on the role of motivation for research and extracurricular research programmes. By conducting quantitative and qualitative research, we showed that medical students are motivated for research at the start of medical school and that intrinsic motivation for research is related to actual research involvement. Furthermore, factors contributing to intrinsic motivation for research were identified: research self-efficacy beliefs, positive perceptions of research, curiosity, need for challenge, authentic research experiences, feelings of autonomy and relatedness, feelings of relevance or personal meaning, inspiring role models, and extracurricular research programme participation. Previous studies suggested that student research involvement is related to research involvement in professional practice. This thesis therefore emphasizes that first steps to cultivate physician-scientists could be made early on in medical school – ‘future physician-scientists: let’s catch them young!’ Show less
The overall aim of this thesis was to improve health professions education by investigating spaced learning, concept learning and metacognitive learning using an educational neuroscience-inspired... Show moreThe overall aim of this thesis was to improve health professions education by investigating spaced learning, concept learning and metacognitive learning using an educational neuroscience-inspired approach. Our studies illustrate that cognitive psychology and neuroscience may guide the development of educational interventions. Examples from cognitive psychology are: the post-decision wagering method, overt learning theory, and metacognitive theory. Additionally, neuroscience informed us on the use of spacing formats. Vice versa, we used educational theories as input for neuroscientific hypotheses to uncover the mechanisms of concept learning. Our fMRI study is an example of how educational neuroscience may also be used to answer fundamental research questions about the science of learning. Overall, I argue that the value of educational neuroscience-inspired research lies in the interdisciplinary nature of the field and the open-minded view on collaborating with other disciplines. Furthermore, educational neuroscience has an urge to explain underlying mechanisms of behaviour and the field embraces the importance of flexibility in methods. I believe it is this combination of qualities that makes educational neuroscience a valuable addition to currently existing approaches in the health professions education research community. Show less
Research forms an important part of the academic competencies attained during academic study.For medical students, this includes learning how to critically appraise and interpret medical and... Show moreResearch forms an important part of the academic competencies attained during academic study.For medical students, this includes learning how to critically appraise and interpret medical and widerhealth care research, particularly – but not only – when relevant for one»s own current or future practice.It also includes understanding the core principles of different methods and research ethics and learningto participate in research. The teaching – research nexus: strategies to implement research education in the medical curriculum. In this paper, we offer reflections on how to do this on the basis of professional anecdotal experiences by a general educationalist with a particular interest in medical education; an undergraduate medical student with a research-focussed, stand-alone additional degree, and a medical academic.Our paper initially explores the need for research education; tying in Healey»s theoretical frameworkin student research, and the nature of providing evidence-based patient care. The paper then presents areport on a student research programme at the University of Birmingham, England. Show less
Timmer, M.C.J.; Steendijk, P.; Arend, S.M.; Versteeg, M. 2020
IntroductionPoor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures.... Show moreIntroductionPoor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures. Guided by neuroscientific literature, we designed a spaced learning lecture in which the educator repeats the to-be-learned information using short temporal intervals. We investigated if this modified instructional design could enhance students' retention.Materials and MethodsSecond-year medical students (n = 148) were randomly allocated to either the spaced lecture or the traditional lecture. The spaced lecture consisted of three 15-min instructional periods, separated by 5-min intervals. A short summary of the preceding information was provided after each interval. The traditional lecture encompassed the same information including the summary in the massed format, thus without the intervals. All students performed a baseline knowledge test 2 weeks prior to the lectures and students' knowledge retention was assessed 8 days after the lectures.ResultsThe average score on the retention test (alpha = 0.74) was not significantly different between the spaced lecture group (33.8% 13.6%) and the traditional lecture group (31.8% +/- 12.9%) after controlling for students' baseline-test performance (F(1,104) = 0.566, p = 0.458). Students' narrative comments showed that the spaced lecture format was well-received and subjectively benefitted their attention-span and cognitive engagement.Discussion and Conclusion We were unable to show increased knowledge retention after the spaced lecture compared with the traditional lecture. Based on these findings, we provide recommendations for further research. Ultimately, we aim for optimized spaced learning designs to facilitate learning in the medical curriculum and to help educate health professionals with a solid knowledge base. 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
Bruin, J. de; Verhoef, M.J.; Slaets, J.P.J.; Bodegom, D. van 2018
The medical field is currently facing a physician-scientist shortage. One possible solution is to direct medical students towards a research oriented career. To do so, knowledge is needed on how to... Show moreThe medical field is currently facing a physician-scientist shortage. One possible solution is to direct medical students towards a research oriented career. To do so, knowledge is needed on how to motivate medical students to do research. Therefore, this study examines motivation for research and identifies factors influencing intrinsic and extrinsic motivation for research among first-year medical students.First-year medical students were surveyed at the beginning of their bachelor's program in 2016. On a 7-point Likert scale, students reported their motivation for research, self-efficacy, perceptions of research, curiosity, and need for challenge. Regression analyses were used to examine the influence of these factors on students' motivation for research.Out of 316 approached students, 315 participated (99.7%). On average, students scored 5.49 on intrinsic, and 5.66 on extrinsic motivation for research. All factors measured influenced intrinsic and extrinsic motivation for research significantly and positively, also after adjusting for gender and age. Cumulative regression showed that these factors explained 39.6% of the variance in intrinsic, and 14% in extrinsic motivation for research.All factors play an important role in intrinsic and, to a lesser extent, extrinsic motivation for research. First-year medical students' motivation for research could be enhanced by stimulating positive self-efficacy beliefs, positive perceptions of research, and curiosity. Also, it is important to fulfil students' needs for challenge by stimulating them to actively conduct research. Thus, to catch students young and cultivate physician-scientists, students should be stimulated to engage in research from the beginning of medical training. Show less
In this research project characteristics of effective instructional development were identified that are appealing to medical teachers and relevant for medical education. Furthermore, we wanted to... Show moreIn this research project characteristics of effective instructional development were identified that are appealing to medical teachers and relevant for medical education. Furthermore, we wanted to know if medical teachers__ learning improved if an instructional development program was adapted in such a way that it included more of these characteristics. In this project we conducted two studies. In the first study, described in Chapters 2 and 3, we focused on selecting characteristics of effective instructional development programs for the medical context. In this study teachers and teacher educators were asked to indicate which of 35 characteristics that had been derived from the literature on effective instructional development (Guskey, 2003; Steinert et al., 2006) were important to them. In the second study, on which we report in Chapters 4 and 5, we used the characteristics collected in the first study as a framework to analyze a successful instructional course called Train the Trainers. This provided insight into its effectiveness and impact. We constructed a new instructional development course, using the information from the framework, and studied the learning processes of the medical teachers who participated in this Plus Course Show less
