Implementing Kolb´s Experiential Learning Cycle by Linking Real Experience, Case-Based Discussion and Simulation.

BACKGROUND: Background: To prepare medical students for their future, they must become acquainted with clinical practice, for example by means of simulations, clerkships and discussing patient cases. By connecting these different approaches, according to Kolb´s experiential learning cycle, the learning effect can be strengthened. Methodology: In the development of a didactical program for students who are being prepared for their role as general practitioners, we have adopted a new didactic approach, in which educational formats are interlinked, according to Kolb´s experiential learning cycle. The content of these courses is determined by the Entrustable Professional Activities (EPAs) for the clerkship in family medicine, combined with the most common chief complaints of patients in the GP's practice. In 2019, the first course was implemented at the Technical University of Munich, Germany, with 6 medical students. A first seminar discusses patients who the students have seen for themselves during their clerkship in family medicine. In addition, matching theory is discussed and skills are practiced. In the next seminar, students apply the acquired knowledge and skills in scenarios with standardized patients. Students evaluated the courses as positive. The evaluations show they find discussing personally experienced patient cases and the opportunity to practice very valuable. Conclusions: A course design according to Kolb's Experiential learning cycle, which integrates experience, theory and simulation, is a valuable addition to existing forms of teaching in medical education. Students appreciated both discussing personally experienced patient cases and the opportunity to re-practice similar cases in a simulated environment. To gain more insight into the learning effects, it is recommended to further explore this approach in a different context.

Refuting misconceptions in medical physiology.

BACKGROUND: In medical physiology, educators and students face a serious challenge termed misconceptions. Misconceptions are incorrect ideas that do not match current scientific views. Accordingly, they have shown to hamper teaching and learning of physiological concepts. Conceptual Change Theory forms the basis of new teaching and learning practices that may alleviate misconceptions and facilitate critical thinking skills that are essential in becoming knowledgeable, self-regulated health professionals. In this study, we examined if such an intervention named refutation texts, could enhance medical students' cognition and metacognition. METHODS: First-year medical students (N = 161) performed a pre-test and post-test on cardiovascular physiology concepts, including a self-perceived confidence rating. In between, students read either a standard text with an explanation of the correct answer, or a refutation text which additionally refuted related misconceptions. RESULTS: In both groups, average performance scores (refutation: + 22.5%, standard: + 22.8%) and overall confidence ratings (refutation: Δ0.42 out of 5, standard: Δ0.35 out of 5) increased significantly (all p < .001), but a significant effect of the specific refutation element was not found. Initially incorrect answers were corrected less frequently in cases of high confidence (35.8%) than low confidence (61.4%). CONCLUSIONS: Our results showed that refutation texts significantly increased students' knowledge, however, the refutation element did not have a significant additional effect. Furthermore, high confidence in incorrect answers negatively affected the likelihood of correction. These findings provide implications for teaching practices on concept learning, by showing that educators should take into account the key role of metacognition, and the nature of misconceptions.

[Overview on research in the field of medical education]. / Übersicht über die Forschung im Bereich der medizinischen Ausbildung.

Medical education is a relatively young field of research that has been characterized by many innovations over the last 20 years. The main topics were the preparation of students for their medical work and imparting of profound knowledge about scientific contexts in medicine. For a long time, the main focus was on learning the necessary knowledge and skills; however, this is no longer considered sufficient. In order to carry out the work as a physician well, other qualities are also necessary, such as communication, collaboration, professionalism, science and reflectivity. Worldwide these aspects are being increasingly integrated into the learning objectives of medical schools and residency programs. The structure of medical studies at many universities has also changed. So-called vertical integration strengthens the integration of theoretical preclinical training and the clinical phase. This means that in the preclinical phase training is more practice-oriented and in the clinical phase a more structured form of training takes place. In the first years of study, students are prepared for the clinical phase by discussing patient cases and practicing skills in simulation centers. In addition, the clinical working environment is increasingly used as a learning environment. Developments have also been made regarding examinations: in addition to knowledge and skills, students and residents are now also assessed regarding performance in practice. Using more realistic assessments, e.g., Objective Structured Clinical Examinations and Workplace-based Assessments, students are evaluated more on their actual performance in practice. By means of the Entrustable Professional Activities method, students are gradually given more responsibility in order to prepare them for their future tasks.

An argument-based approach to the validation of UHTRUST: can we measure how recent graduates can be trusted with unfamiliar tasks?

There is a need for valid methods to assess the readiness for clinical practice of medical graduates. This study evaluates the validity of Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test (UHTRUST), an authentic simulation procedure to assess whether medical trainees are ready to be entrusted with unfamiliar clinical tasks near the highest level of Miller's pyramid. This assessment, in which candidates were judged by clinicians, nurses and standardized patients, addresses the question: can this trainee be trusted with unfamiliar clinical tasks? The aim of this paper is to provide a validity argument for this assessment procedure. We collected data from various sources during preparation and administration of a UHTRUST-assessment. In total, 60 candidates (30 from the Netherlands and 30 from Germany) participated. To provide a validity argument for the UHTRUST-assessment, we followed Kane's argument-based approach for validation. All available data were used to design a coherent and plausible argument. Considerable data was collected during the development of the assessment procedure. In addition, a generalizability study was conducted to evaluate the reliability of the scores given by assessors and to determine the proportion of variance accounted by candidates and assessors. It was found that most of Kane's validity assumptions were defendable with accurate and often parallel lines of backing. UHTRUST can be used to compare the readiness for clinical practice of medical graduates. Further exploration of the procedures for entrustment decisions is recommended.