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Biomedical subjects

Geoffrey Norman

Publications and source records attributed to Geoffrey Norman.

8 recordsLinked to original sources
PubMed2005

PBL in undergraduate medical education: a qualitative study of the views of Canadian residents.

BACKGROUND AND OBJECTIVES: At McMaster University, the birthplace of problem-based learning (PBL), administrators and curriculum planners have begun the process of renewing the undergraduate MD curriculum. One step has been to conduct an environmental scan that includes input from medical residents. METHODS: Individual interviews with 17 medical residents and fellows currently enrolled at McMaster University and are graduates of six Canadian medical schools. RESULTS: PBL appears to be well known even by graduates of non-PBL Canadian medical schools. Tutors are key to a successful PBL program, should be knowledgeable about the content area under study and able to effectively facilitate groups. Tutorial problems should be realistic, up-to-date, and challenge students to investigate more than the medical aspects of the case in question. Students need to be prepared, willing to participate in peer teaching, and supportive of the group learning process. PBL programs can be improved if they incorporate elements of traditional medical programs (e.g., mini-lectures, clear learning objectives, and unbiased evaluation of student progress) while retaining the essence of student-generated learning. CONCLUSIONS: Medical residents are an underutilized source of information about undergraduate medical programs. According to our participants, more emphasis on faculty development and upgrading health care problems will improve PBL-based undergraduate medical education.

Canada↗
PubMed2005

From theory to application and back again: implications of research on medical expertise for psychological theory.

Research directed at an understanding of medical expertise is about 30 years old, and many developments in this literature parallel progress in cognitive psychology. Over the past 15 years or so, this research became much more closely identified with particular psychological theories. Initial forays into medicine were essentially direct applications of methods developed in the psychology lab to the more natural domain of medicine, with varying degrees of success. These attempts were followed by a second wave that took the psychological theories themselves more seriously in a more thoughtful application of psychological methods to the medical domain. I will argue in the present paper that the methods and theories used in the study of medical expertise have advanced to the point that there is some reverse flow and they are providing a unique and valuable perspective on the nature of thinking.

Clinical Competence↗
PubMed2005

Research in clinical reasoning: past history and current trends.

BACKGROUND: Research in clinical reasoning has been conducted for over 30 years. Throughout this time there have been a number of identifiable trends in methodology and theory. PURPOSE: This paper identifies three broad research traditions, ordered chronologically, are: (a) attempts to understand reasoning as a general skill--the "clinical reasoning" process; (b) research based on probes of memory--reasoning related to the amount of knowledge and memory; and (c) research related to different kinds of mental representations--semantic qualifiers, scripts, schemas and exemplars. RESULTS AND CONCLUSIONS: Several broad themes emerge from this review. First, there is little evidence that reasoning can be characterised in terms of general process variables. Secondly, it is evident that expertise is associated, not with a single basic representation but with multiple coordinated representations in memory, from causal mechanisms to prior examples. Different representations may be utilised in different circumstances, but little is known about the characteristics of a particular situation that led to a change in strategy. IMPLICATIONS: It becomes evident that expertise lies in the availability of multiple representations of knowledge. Perhaps the most critical aspect of learning is not the acquisition of a particular strategy or skill, nor is it the availability of a particular kind of knowledge. Rather, the critical element may be deliberate practice with multiple examples which, on the hand, facilitates the availability of concepts and conceptual knowledge (i.e. transfer) and, on the other hand, adds to a storehouse of already solved problems.

Clinical Competence↗
PubMed2003

Hi! How are you? Response shift, implicit theories and differing epistemologies.

Measures of Health Related Quality of Life (HRQL) occupy a continuum, from highly standardized econometric methods such as the time tradeoff and standard gamble to individualized global measures. Each has its vocal adherents, each involves different assumptions about the nature and interpretation of HRQL, and each has potential advantages and disadvantages. In this paper, I begin by exploring two theories which attempt to explain how people make assessments of health over time: 'response shift' and the 'implicit theory of change' model. I show that the theories, which are based on different views of the underlying cognitive processes, make opposite predictions about the validity of prospective and retrospective judgments. I examine the broader issue of individualized vs. standardized questions, and discuss a fundamental epistemological difference which places the current discussion in a broader philosophical context. I propose that a partial resolution may arise from a more careful consideration of the goals of HRQL assessment in a particular situation.

Attitude to Health↗
PubMed2000

Medline for Medical Students? Searching for the Right Answer.

Objective: Does MEDLINE use, when added to more traditional sources of information, improve the accuracy of medical students' clinical decisions when compared to those obtained using traditional sources only? Design: Randomized control trial. Setting: McMaster University Faculty of Medicine, Undergraduate Program. Participants: The entire class of 101 medical students, class of 1998. Overall response rate on 9 items was 56% (510/909), with 35% (35/101) completing all 9 items. Intervention: All participants were randomized on each of the nine clincal scenarios for which the student could choose to apply, or refrain from applying, a proferred intervention. When randomized to the control arm, the student used traditional sources of information for decision-making. When randomized to the experimental arm, the student used MEDLINE searching in addition to more traditional sources of information, for decision-making. Main Outcome Measures: Prior to, and subsequent to the information search, the students indicated their comfort in using the proffered intervention on a seven point Likert scale. Results: Analyzed with one-way ANOVA, the mean rating post-search of the control non- MEDLINE arm was 2.94 (SD = 1.80) (where 1 = correct, 7 = incorrect) and of the experimental MEDLINE arm was 2.71 (SD = 1.81), (F(1,522) = 2.03, p = 0.15 n.s). The mean change of the control arm was 0.97 (SD = 2.04) and of the experimental arm was 1.008 (SD = 1.92), (F(1,511) = 0.04, p = 0.84n.s.). Conclusions: The addition of MEDLINE to more traditional answer-seeking behaviors by medical students does not translate into a beneficial impact on clinical decision-making.

Journal Article↗
PubMed1988

Tender points in fibromyalgia.

To establish inter-rater and test-retest reliability of use of a pressure algometer, 5 males and 5 females suffering from chronic fibromyalgia ('fibrositis'), and a normal group of 5 males and 5 females, were examined 2 times by each of 2 independent examiners, using 1 kg/sec rate of application, over 10 paired and typical 'tender points,' localized by skin marker. Tenderness thresholds of tender points were coded and analyzed using repeated measures ANOVA, for factors sex, normal/fibromyalgia, and side, rater, and time 1/time 2. There was significantly lower tenderness thresholds of tender points in fibromyalgia compared to normal subjects. Generalizability coefficients were calculated and showed high inter-rater (0.85), and test-retest (0.85) reliability. Highly significant differences were found between specific tender points. A further 10 normals and 10 fibromyalgia subjects were then examined for 5 paired tender points and 5 paired non-tender points. A 2-way ANOVA was conducted for summed and averaged scores for all tender and non-tender points, with factors normal/fibromyalgia and tender/non-tender; again, there was a large difference between normal and fibromyalgia subjects, and between tender and non-tender points. The interaction was small but significant, but there was a larger difference between fibromyalgia and normal subjects observed on non-tender points. The low tenderness threshold observed at the tender points of fibromyalgia patients may reflect a more generalized lowering of tenderness thresholds, seen at non-tender points as well.

Female↗