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Biomedical subjects

G Regehr

Publications and source records attributed to G Regehr.

49 records · Page 3Linked to original sources
PubMed1996

Who should rate candidates in an objective structured clinical examination?

PURPOSE: To determine who is the better rater of history taking in an objective structured clinical examination (OSCE): a physician or a standardized patient (SP). METHOD: During the 1991 pilot administration of an OSCE for the Medical Council of Canada's qualifying examination, five history-taking stations were videotaped. Candidates at these stations were scored by three raters: a physician (MD), an SP observer (SPO), and an SP rating from recall (SPR). To determine the validity of each rater's scores, these scores were compared with a "gold standard", which was the average of videotape ratings by three physicians, each scoring independently. Analysis included both correlations with the standard and a repeated-measures analysis of variance (ANOVA) comparing raters' mean scores on each station with mean scores of the gold standard. RESULTS: Ninety-one videotapes were scored by the "gold-standard" physicians. Correlations with the standard showed no clear preference for MD, SPO, or SPR raters. ANOVAs revealed significant differences from the standard on three stations for the SPR, two stations for the SPO, and one stations for the MD. CONCLUSIONS: An MD rater is less likely to differ from a standard established by a consensus of MD ratings than are SP raters rating from recall. If an MD cannot be used, an SP observer is preferable to an SP rating from recall.

Analysis of Variance↗
PubMed1996

Issues in cognitive psychology: implications for professional education.

Education and cognitive psychology have tended to pursue parallel rather than overlapping paths. Yet there is, or should be, considerable common ground, since both have major interests in learning and memory. This paper presents a number of topics in cognitive psychology, summarizes the findings in the field, and explores the implications for teaching and learning. THE ORGANIZATION OF LONG-TERM MEMORY: The acquisition of expertise in an area can be characterized by the development of idiosyncratic memory structures called semantic networks, which are meaningful sets of connections among abstract concepts and/or specific experiences. Information (such as the assumptions and hypotheses that are necessary to diagnose and manage cases) is retrieved through the activation of these networks. Thus, when teaching, new information must be embedded meaningfully in relevant, previously existing knowledge to ensure that it will be retrievable when necessary. INFLUENCES ON STORAGE AND RETRIEVAL FROM MEMORY: A wide variety of variables affect the capacity to store and retrieve information from memory, including meaning, the context and manner in which information is learned, and relevant practice in retrieval. Educational strategies must, therefore, be directed at three goals--to enhance meaning, to reduce dependence on context, and to provide repeated relevant practice in retrieving information. PROBLEM SOLVING AND TRANSFER: Much of the development of expertise involves the transition from using general problem-solving routines to using specialized knowledge that reduces the need for classic "problem solving." Two manifestations of this specialized knowledge are the use of analogy and the specialization of general routines in specific domains. To develop these specialized forms of knowledge, the learner must have extensive practice in using relevant problem-solving routines and in identifying the situations in which a particular routine is likely to be useful. CONCEPT FORMATION: Experts possess both abstract proto-typical information about categories and an extensive set of separate, specific examples of categories, which have been obtained through individual experience. Both these sources of information are used in categorization and diagnostic classifications. Thus, it is important for educators to be aware that experience with sample cases is not just an opportunity to apply and practice the rules "at the end of the chapter." Instead, experience with cases provides an alternative method of reasoning that is independent of, but equally useful to, analytical rules. DECISION MAKING: Experts clearly do not use classic formal decision theory, but rather make use of heuristics, or shortcuts, when making decisions. Nonetheless, experts generally make appropriate decisions. This suggests that the shortcuts are useful more often than not. Rather than teaching learners to avoid heuristics, then, it might be more reasonable to help them recognize those relatively infrequent situations where their heuristics are likely to fail.

Cognition↗
PubMed1996

Validation of an objective structured assessment of technical skill for surgical residents.

PURPOSE: This study examined the concurrent validity of the Objective Structured Assessment of Technical Skill (OSATS), a new test of technical skill for general surgery residents. METHOD: Twelve residents (six in their senior, or fifth, year and six in their junior, or third, year) at the University of Toronto in 1994-95 were ranked within level of training according to their OSATS marks and by surgical faculty. Correspondence between OSATS and faculty rankings was assessed using Spearman rank-order correlation coefficients. RESULTS: The correlations between test scores and faculty rankings were generally high for the senior residents but low for the junior residents. CONCLUSION: Scores on the OSATS accurately reflect the independent opinions of faculty regarding the technical skills of senior residents, suggesting that it is a valid measure of technical skill for these individuals. The scores did not, however, reproduce faculty rankings of the junior residents. Whether this was a failing of the OSATS or the faculty rankings requires further study.

Clinical Competence↗
PubMed1996

The efficacy of a computer-assisted preoperative tutorial for clinical clerks.

OBJECTIVE: To assess the effectiveness of computer-assisted preoperative tutorials on human anatomy in improving the operating-room learning experience for clinical clerks. DESIGN: Crossover trials with immediate assessment and approximately 1-week delay between trials. SETTING: General surgery operating room of a university teaching hospital. SUBJECTS: Eight 4th-year clinical clerks on a single 8-week surgical rotation. MAIN OUTCOME MEASURES: The senior surgeon's assessment of the clerk's knowledge and understanding of the operation, according to a six-item questionnaire, and the clerk's own assessment of the experience in the operating room, according to an eight-item questionnaire. RESULTS: Surgeons rated the clerks' performances in the operating room as better when they had received the preoperative tutorial (mean [and standard deviation], 3.7 [0.4]) than when they had not received the preoperative tutorial (3.0 [0.3]). The difference (0.7 [0.6]) was statistically significant (t7 = 3.3, p < 0.01). Similarly, clerks rated their own experience more positively when they had received the tutorial (4.0 [0.2]) than when they had not (3.1 [0.3]), with the difference (0.9 [0.5]) being statistically significant (t7 = 4.9, p < 0.001). CONCLUSIONS: Short, preoperative, computer-assisted tutorials on human anatomy can have a positive impact on the clerk's level of knowledge and confidence in the operating room. Further research is warranted into the extent to which students spontaneously make use of these tutorials.

Anatomy↗
PubMed1993

Perceptual manifestations of an analytic structure: the priority of holistic individuation.

Properties that make items perceptually distinctive may not be represented in the dimensional structure used by subjects for analysis. In a classification task, a single dimensional structure, actually used by subjects when analyzing, occurred in several perceptual forms. Two types of perceptual variation were compared: (a) feature individuation, whether a feature occurs in a unique form in different items and (b) holistic individuation, the extent to which an item's features cohere into an individuated whole. These types of individuation had separate effects on exemplar-based classification. However, holistic individuation had priority in that the presence of individuated features did not produce exemplar-based transfer if the item's holistic properties were altered. This priority of holistic individuation occurred whether the subjects had been given the classification rule or had attempted to discover it.

Adult↗