Academic medicine : journal of the Association of American Medical Colleges
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Review Meta Analysis
Mastery learning for health professionals using technology-enhanced simulation: a systematic review and meta-analysis.
Competency-based education requires individualization of instruction. Mastery learning, an instructional approach requiring learners to achieve a defined proficiency before proceeding to the next instructional objective, offers one approach to individualization. The authors sought to summarize the quantitative outcomes of mastery learning simulation-based medical education (SBME) in comparison with no intervention and nonmastery instruction, and to determine what features of mastery SBME make it effective. ⋯ Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time.
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A dominant theory of clinical reasoning is the so-called "dual processing theory," in which the diagnostic process may proceed through a rapid, unconscious, intuitive process (System 1) or a slow, conceptual, analytical process (System 2). Diagnostic errors are thought to arise primarily from cognitive biases originating in System 1. In this issue, Custers points out that this model is unnecessarily restrictive and that it is more likely that diagnostic tasks may proceed through a variety of mental strategies ranging from "analytical" to "intuitive."The authors of this commentary agree that the notion that System 1 and System 2 processes are somehow in competition and will necessarily lead to different conclusions is unnecessarily restrictive. On the other hand, they argue that there is substantial evidence in support of a dual processing model, and that most objections to dual processing theory can be easily accommodated by simply presuming that both processes operate in concertand that solving any task may rely to varying degrees on both processes.
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Clinical faculty often complete in-training evaluation reports (ITERs) poorly. Faculty development (FD) strategies should address this problem. An FD workshop was shown to improve ITER quality, but few physicians attend traditional FD workshops. To reach more faculty, the authors developed an "at-home" FD program offering participants various types of feedback on their ITER quality based on the workshop content. Program impact is evaluated here. ⋯ The results suggest that faculty are able to improve ITER quality following a minimal "at-home" FD intervention. This also adds to the growing literature that has found success with improving the quality of trainee assessments following rater training.
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Current focus in medical education on competencies and curricular objectives draws attention to boundaries rather than the openness inherent in the learning process. This qualitative study explored the tension between boundedness (mandated curricular objectives) and openness (variability in learning experience as students traverse the explicit, implicit, and extracurriculum) in the curriculum. ⋯ The findings can inform discussions about how to balance the boundedness of curricular mandates with the inherent openness of students' learning experiences.
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Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: "System 1," the unconscious, intuitive, or nonanalytic system, and "System 2," the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems. This article outlines the difficulties of this "two-system view" and presents an alternative, developed by K. ⋯ First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called "quasirationality." Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning.