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What counts as knowing? The development of conceptual and procedural knowledge of counting from kindergarten through Grade 2.

The development of conceptual and procedural knowledge about counting was explored for children in kindergarten, Grade 1, and Grade 2 (N = 255). Conceptual knowledge was assessed by asking children to make judgments about three types of counts modeled by an animated frog: standard (correct) left-to-right counts, incorrect counts, and unusual counts. On incorrect counts, the frog violated the word-object correspondence principle. On unusual counts, the frog violated a conventional but inessential feature of counting, for example, starting in the middle of the array of objects. Procedural knowledge was assessed using speed and accuracy in counting objects. The patterns of change for procedural knowledge and conceptual knowledge were different. Counting speed and accuracy (procedural knowledge) improved with grade. In contrast, there was a curvilinear relation between conceptual knowledge and grade that was further moderated by children's numeration skills (as measured by a standardized test); the most skilled children gradually increased their acceptance of unusual counts over grade, whereas the least skilled children decreased their acceptance of these counts. These results have implications for studying conceptual and procedural knowledge about mathematics.

Child↗

New drug prescribing by hospital doctors: the nature and meaning of knowledge.

In the UK the high cost of new drugs is partly accountable for the growth in spending on prescription drugs. Most prescribing takes place in general practice and the influence of secondary care prescribing on primary care prescribing is well recognized; yet the factors that influence hospital prescribing have been little researched. Drawing on accounts of actual prescribing events from hospital doctors from a range of specialties, we investigated the processes by which new drugs come into practice, from hospital doctors' awareness of new drugs to the assimilation and interpretation of evidential sources. The determinants of new drug prescribing were interconnected within four forms of knowledge: scientific knowledge, social knowledge, patient knowledge and experiential knowledge. Furthermore, the nature of knowledge could only be understood within its situated context. The revelation of multiple and contingent forms of knowledge highlights the problematic nature of knowledge construction within the approaches of evidence-based medicine.

Diffusion of Innovation↗

Assessment of the impact of an educational course on knowledge of appropriate EUS indications.

BACKGROUND: The knowledge level of EUS among gastroenterologists likely influences the appropriateness of requested indications for EUS. It remains unknown what the impact is of a short EUS course, involving didactic teaching, on knowledge levels of EUS indications for EUS. The aim of this study was to assess the impact of a 3-day educational course on knowledge levels of attending gastroenterologists regarding the appropriateness of indications for EUS. METHODS: A questionnaire was designed that tested knowledge of indications for EUS in 4 anatomic sites: esophagus, gastroduodenum, hepatopancreatobiliary system, and colorectum. This questionnaire was distributed to all attendees of a 3-day EUS educational course. All attendees completed the survey before and immediately after the course. RESULTS: A total of 24 gastroenterologists completed the pre- and post-course survey. Before the course, respondents scored highest in questions on EUS applications in the gastroduodenum (94%) and the hepatopancreatobiliary system (88%) compared with the esophagus (72%) and the colorectum (74%). Statistically significant improvements in knowledge were recorded in all organ categories: gastroduodenum (100%, p = 0.002 vs. pretest score), hepatopancreatobiliary system (99%, p < 0.0001), esophagus (92%, p < 0.0001), and colorectum (93%, p = 0.0004). The biggest improvement was observed in knowledge levels for the esophagus (20%) and the colorectum (18%). CONCLUSIONS: There was a consistent improvement in the gastroenterologists' knowledge levels of EUS indications among all organ categories after an educational course. Our findings suggest that education enhances gastroenterologists' understanding of EUS. Future studies should seek to assess the impact of these improved knowledge levels on the appropriateness of EUS referral patterns.

Clinical Competence↗

Neonatal encephalopathy and cerebral palsy: a knowledge survey of Fellows of The American College of Obstetricians and Gynecologists.

OBJECTIVE: To assess practicing obstetricians' knowledge of the etiology and pathophysiology of neonatal encephalopathy and its relationship to cerebral palsy. METHODS: A questionnaire designed to test both knowledge and practice patterns was mailed to 413 members of the Collaborative Ambulatory Research Network of The American College of Obstetricians and Gynecologists (ACOG), as well as 600 randomly selected non-Network ACOG Fellows. The questionnaire was composed of 15 knowledge questions and three clinical scenarios containing seven knowledge questions. Six of the questions directly assessed knowledge of cerebral palsy. RESULTS: Of those who returned the questionnaire, 351 practiced obstetrics and were included in the statistical analyses. For the majority of questions, "Don't know" was the most frequent response. The next most frequent response for 8/13 questions was the correct answer. Performance was strongest as regarded actual clinical practice and relatively weak regarding the antecedents of neonatal encephalopathy and cerebral palsy. The physicians' actual knowledge scores showed a significant correlation with their self-assessments of knowledge (r =.41, P <.001). The majority of physicians rated their training on this topic in medical school, residency, and through continuing medical education as marginal or inadequate. CONCLUSION: The results of this survey identified large knowledge gaps in this area, suggesting a need to develop educational projects to address these deficits by both professional organizations and individual teachers.

Adult↗

Effects of the knowledge base on children's memory strategies.

In this article, the importance of examining the linkage between knowledge and strategic factors in children's memory has been suggested. Indeed, it has been argued that a more complete analysis of the development of remembering in children requires a consideration of the operation of memory strategies in the context of the growing knowledge base. The effects of the knowledge base were analyzed in terms of concurrent influences on the use of strategies and long-term consequences for the development of increasingly skilled memory processing. The available evidence suggests that age-related changes in the contents of the knowledge system, as well as increases in the ease with which information can be accessed, contribute to the strategies that are used by children of different ages, and influence the development of efficient modes of processing. Continued research on the concurrent effects of the knowledge base should provide a more complete account of children's memory than that currently available, taking into consideration knowledge of the materials, understanding of the task demands, as well as overall strategic abilities. Similarly, research on the long-term developmental effects of the knowledge base on memory strategies should facilitate an understanding of the mechanisms by which memory processing becomes more efficient and less effortful. Ideally, studies that examine these issues should be longitudinal in scope (Ornstein et al., 1985a), but even cross-sectional research that explores the interrelationships between strategies and knowledge will facilitate an understanding of the development of memory in children.

Adolescent↗

The comprehensive Breast Cancer Knowledge Test: validity and reliability.

Two subscales for a breast cancer knowledge test were developed and tested to be used (a) in determining a woman's general knowledge of breast cancer (i.e. risk factors and epidemiology) and her knowledge of breast cancer curability, and (b) in exploring the relationship between knowledge of breast cancer and utilization of screening practices. These subscales were designed to be used in conjunction with the Breast Cancer Knowledge Test (BCKT), which assesses screening and detection knowledge. The instrument was submitted to four experts in the field of oncology to establish content validity. Reliability testing was conducted on a random sample of 182 women. Internal consistency reliability for the post-tested general knowledge subscale was 0.60, and for the curability subscale was 0.62. The overall alpha coefficient was 0.71. In combination with the BCKT, these subscales can be used to describe a woman's knowledge of breast cancer.

Aged↗

Assessment in general practice: the predictive value of written-knowledge tests and a multiple-station examination for actual medical performance in daily practice.

This study compares the predictive values of written-knowledge tests and a standardized multiple-station examination for the actual medical performance of general practitioners (GPs) in order to select effective assessment methods to be used in quality-improvement activities. A comprehensive assessment was performed in four phases. First, 100 GPs from the southern part of the Netherlands were assessed by a general medical knowledge test and by a knowledge test on technical skills. Second, in order to check for time-order effects, participants were randomly divided into two groups of 50 each, comparable on scores of both knowledge tests and on professional characteristics. Finally, both groups went through a multiple station examination using standardized patients and a practice video assessment of real surgery, but in opposite orders. Consultations were videotaped and assessed by well-trained peer observers. The drop-out rate was 10%. In both groups the predictive value of medical knowledge tests, ranging from 0.43 to 0.56 (Pearson correlation disattenuated), proved to be comparable with the predictive value of the multiple-station examination for actual performance (0.33-0.59). The overall explained variance of scores of the practice video assessment, measured by multiple regression analysis with performance scores as dependent variables and scores on the knowledge tests and the multiple-station examination as independent variables was moderate (19%). A time-order effect showed in only one direction: from practice video assessment to the multiple-station examination. The GP's professional characteristics did not contribute to the explanation of variation in performance. Medical knowledge tests can predict actual clinical performance to the same extent as a multiple-station examination. Compared with a station examination, a knowledge test may be a good alternative method for assessment the procedures of a large number of practising GPs.

Clinical Competence↗

Sex knowledge and sexual attitudes among medical and nursing students.

OBJECTIVES: The aim of this study was to assess the relationship between background and sociodemographic variables, attitudes toward controversial aspects of human sexuality and sex knowledge among medical and nursing students. METHOD: The study design was a questionnaire-based survey of medical and nursing students in Western Australia. Participants were first- through fifth-year medical students at the University of Western Australia and first- through third-year undergraduate nursing students at Edith Cowan University. Outcome measures were students' attitudes toward controversial aspects of human sexuality expressed on a five-point Likert scale and a modified version of the Kinsey Institute/Roper Organization National Sex Knowledge Test. RESULTS: A significant relationship was found between certain background and sociodemographic variables, sexual attitudes and sex knowledge. The background variable most strongly related to both attitudes and knowledge was frequency of attendance at religious services of any religious denomination during the past month, with those attending three or more times more likely to express negative attitudes and have lower sex knowledge scores. Lower sex knowledge was related to negative attitudes toward gay/lesbian/bisexual behaviour, masturbation, premarital sex and contraception. Other important background and sociodemographic variables related to negative attitudes were: never having experienced sexual intercourse; right-wing political orientation; lower family income; gender and ethnicity. CONCLUSIONS: Negative attitudes toward controversial aspects of human sexuality and lower sex knowledge scores among medical and nursing students can be predicted on the basis of background and sociodemographic variables. Education aimed at increasing sex knowledge and modifying negative attitudes may increase students' ability to function more effectively as sexual history takers and sex counsellors.

Attitude↗

Risks of smoking to reproductive health: assessment of women's knowledge.

OBJECTIVE: Our aim was to assess the knowledge of women regarding the gender-specific health risks associated with smoking. STUDY DESIGN: A cross-sectional survey was given to 388 female hospital employees. Knowledge of smoking-related illnesses that are specific to women was assessed. Regression analysis was used to discern potential predictors of this knowledge. RESULTS: Most women are aware that smoking causes respiratory disease (99%), lung cancer (99%), heart disease (96%), and pregnancy complications (91%). Few women are aware of the health risks of smoking that are specific to women, such as infertility (22%), osteoporosis (30%), early menopause (17%), spontaneous abortion (39%), ectopic pregnancy (27%), and cervical cancer (24%). Knowledge of these health risks was not predicted by age, education, or smoking status. Health care professionals were no more likely than other women to have knowledge of these risks. CONCLUSION: Most women are unaware of the health risks specific to women from smoking. Even female health care professionals do not generally have greater knowledge of these conditions. Further public health measures are necessary to increase knowledge of smoking risks that may be particularly relevant to women. This increase in knowledge has the potential to reduce significantly the smoking-related illnesses in women.

Adolescent↗

Assessments in evidence-based medicine workshops: loose connection between perception of knowledge and its objective assessment.

The outcome of continuing education programs is often based on self-assessment. We evaluated the relationship of self-assessment of knowledge based on rating scales with scores obtained on objective validated tests in evidence-based medicine workshops. In the West Midlands region (1998), 55 participants attended three workshops in critical appraisal of the medical literature.They completed two self-assessment questionnaires: one used a rating scale to subjectively examine the level of knowledge of six different literature appraisal issues; the other objectively assessed participants' literature appraisal knowledge in those issues using validated multiple true-false questions. Comparison of subjective scores reflecting understanding of specific literature appraisal issues with corresponding objective test scores revealed a poor correlation (r(s) ranged from -0.29 to 0.60 for the different knowledge issues assessed). Perception of ones level of knowledge did not always correlate with correctly possessed knowledge. In some instances, those who thought they were knowledgeable actually possessed incorrect knowledge. Therefore, continuing medical education programs should focus on objective, not subjective tests to assess outcome.

Journal Article↗

The role of teacher knowledge in elementary physical education instruction: an exploratory study.

The purpose of this study was to describe how providing teachers with research based knowledge about developmental throwing can influence teachers' observational interpretations and their students' practice patterns. Eight kindergarten classroom teachers with high generic teaching skill competence taught a 6-week overhand throwing unit to the children in their intact classes. Prior to the unit, four of the teachers were randomly assigned to a 4-hour knowledge training program. The other four teachers served as a comparison group (underwent no knowledge training). During the unit, data from stimulated recall interviews were used to describe and compare the thoughts and knowledge concepts expressed by the two groups of teachers. The throwing practice experienced by the children in the knowledge-trained and comparison teachers' classes was videotaped and analyzed for frequency of opposite foot stepping. The knowledge acquired during training was associated with different patterns of skill observation. The knowledge concepts the teachers acquired during training formed the basis of many of their thoughts and were reflected in the instructional procedures implemented. The knowledge-trained teachers' classes demonstrated more than twice as many opposite foot throws during the unit than the comparison teachers' classes.

Achievement↗

Teaching new words to children with poor existing vocabulary knowledge: a controlled evaluation of the definition and context methods.

BACKGROUND: Children who have poor vocabulary knowledge are at risk of wider language weaknesses and reading comprehension difficulties, which will impact upon their educational achievement. The central question addressed in this paper is how best to teach new vocabulary items to these children. AIMS: To investigate the effects of two different methods of teaching vocabulary on both vocabulary knowledge and reading comprehension. METHODS & PROCEDURES: Twenty-four children (aged 7-8 years) with poor existing vocabulary knowledge took part in an intervention study. Half the children were taught new vocabulary items using definitions; the other half were taught a strategy for deriving meanings from written context. Tests of vocabulary knowledge were given before teaching, immediately after teaching and 3 months later. OUTCOMES & RESULTS: Immediately after teaching, both groups had improved equivalently in vocabulary knowledge for the taught words. However, 3 months later, the context group showed significantly better expressive vocabulary knowledge. The context group went on to show significantly better comprehension of text containing a number of the taught words and demonstrated that they could use the newly acquired strategy independently to derive meanings from written context. CONCLUSIONS: The context method developed is effective in increasing vocabulary knowledge and improving reading comprehension in children with poor existing vocabulary knowledge, and this is therefore recommended for use with children who require extra help developing vocabulary and comprehension skills.

Case-Control Studies↗

The influence of sociodemographic factors on awareness, knowledge and attitude toward andropause among health professionals in Ile-Ife, Nigeria.

A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.

Adult↗

Developing the KAMA instrument (knowledge and management of abuse).

OBJECTIVE: to develop and validate an instrument which measures applied knowledge and practice regarding identification and management of potentially abusive situations in staff who work with older vulnerable inpatients. One of the anticipated uses will be to measure any change produced by attending an educational intervention designed to improve management of abuse. A vignette-based instrument was chosen to measure applied knowledge and practice over other methods of assessments which were felt not to be practical or provide too much cueing for the volunteering staff. METHOD: a parallel form vignette-based instrument was developed so that not only baseline knowledge but also change in knowledge could be measured. Abusive scenarios were adapted from researchers' clinical practice and from the literature. Advice from senior nurses about the suitability of the vignettes for ward and community based staff was obtained and the instrument was piloted. Staff working with older people and employed by health or social services working in inner London completed the questionnaire. RESULTS: 79 (92%) of the eligible staff took part in this study. All completed the instrument. Version A of the Knowledge and Management instrument was answered by 39 staff, whilst 40 answered version B. The proportion of qualified and unqualified staff as well as the proportion employed by health or social services was similar for each parallel version of the instrument. The measure of internal consistency Cronbach's alpha was 0.89 for version A and 0.79 for version B. Parallel form reliability coefficient was calculated as 0.82, indicating that the two versions of the Knowledge and Management instrument perform similarly. Measures for concurrent validity according to years of experience and professional education also proved significant. Inter-rater reliability was calculated at 0.98 (P=0.01). Test-retest reliability at 0.69 (P=0.01) indicated that the instrument is stable yet sensitive to change. CONCLUSION: this instrument is a valid assessment tool that can be used to identify gaps in applied knowledge and management in potentially abusive situations in older people and allow knowledge in this field to be built on.

Attitude↗

Arden Syntax: the emerging standard language for representing medical knowledge in computer systems.

The Arden Syntax for Medical Logic Modules standard language for knowledge-based computer systems is described. Knowledge systems can use computerized patient data in decision-making. Although they have the potential to reduce adverse drug events and infection rates, improve drug dosing, and decrease the cost of care, knowledge systems have not yet reached the average patient. Arden Syntax for Medical Logic Modules is the standard language for defining clinical decision rules that drive alerts, reminders, clinical guidelines, and data interpretations. Each medical logic module (MLM) in an Arden Syntax knowledge base is designed to make one type of decision. MLMs usually represent either rules that can be encoded, such as generating a warning that the potassium concentration is decreasing in a patient taking digoxin, or complex decision trees for individual patient care plans and clinical protocols. An MLM contains maintenance slots (title, file name, version, originating institution, author, date, specialist, validation information), library slots (stating the MLM's purpose and providing keywords for searching), and knowledge slots (containing the "essence" of the MLM). Arden Syntax is receiving growing support from the medical and information systems communities as the standard language for medical knowledge systems, but legal, ethical, regulatory, and ownership issues remain. If pharmacy is to grow and prosper as a knowledge profession, it should adopt an accepted standard language for representing active, applied knowledge in computer systems.

Decision Support Techniques↗

Change in knowledge of general practitioners during their professional careers.

In this study the level of knowledge of general practitioners (GPs) in different stages of their career, from the undergraduate level onwards to more than 20 years after certification, has been investigated. The total body of knowledge as well as the knowledge about different aspects of care was established. Participants were 108 medical students, 445 postgraduate trainees in six different stages of their training and 351 GPs with 5 to more than 20 years of experience. They all took the same written test, designed to assess knowledge closely related to patient care. An increase in test score was found from the start of postgraduate training onwards followed by a decrease starting 5-10 years after certification. The curves for the different aspects of care varied. It is concluded that the body of knowledge of GP-trainees increases during postgraduate training and reaches the level of knowledge of GPs who are less than 10 years certified. From 10 years after certification onwards the knowledge decreases as well as changes over time. The latter had also been found in two American studies relating to the knowledge of certified GPs and internists. The results seem important for the organization and content of postgraduate training and continuous medical education.

Clinical Competence↗

Condition-related knowledge among children with spina bifida: longitudinal changes and predictors.

OBJECTIVE: To examine changes in three domains of condition-related knowledge among youth with spina bifida and to examine the utility of youth cognitive ability level and condition severity as predictors of knowledge change. METHODS: Seventy preadolescents with spina bifida completed a 12-item questionnaire assessing knowledge of spina bifida at three time points during middle childhood and early adolescence. Specific domains of knowledge assessed included (a) etiology of spina bifida, (b) functional status, and (c) shunt functioning (completed by participants with shunted hydrocephalus only). RESULTS: Findings revealed gains in accuracy of knowledge on 6 of 12 items; however, neither children's cognitive ability level nor condition severity predicted changes in knowledge over time. Most condition domains were characterized by low-to-moderate levels of knowledge across time. CONCLUSIONS: Although significant gains were evident in children's condition-related knowledge, at Time 3, many participants still failed to understand basic information about the etiology of their condition or major functional issues associated with spina bifida. Additional education about catheterization and shunt malfunction are two domains that may be of particular clinical significance.

Adolescent↗

Knowledge gain in a problem-based surgery clerkship.

PURPOSE: To determine the magnitude of students' knowledge gain in a problem-based surgery clerkship and to identify the relationship of this gain to measures of clinical performance. METHOD: Third-year students in a problem-based surgery clerkship at the University of Kentucky College of Medicine in 1990-91 were evaluated by a comprehensive set of objective measures: surgery subject examinations of the National Board of Medical Examiners (NBME) given as pretest and posttest to assess knowledge gain, two multiple-choice quizzes, a modified-essay examination, a standardized-patient examination, and an objective structured clinical examination (OSCE). The students were also evaluated by faculty tutors and preceptors and by their peers. NBME data were available for 66 students, and data were available on the other measures for 42 students. Statistical analysis involved two-way analysis of variance, single group t-test, Pearson correlations, and partial correlations. RESULTS: The students' knowledge gain was statistically significant. The posttest mean score did not differ significantly from the national candidate mean of 500. All but two of the other knowledge and performance measures (the preceptor and tutor evaluations) correlated significantly with the knowledge gain score. The highest correlations were for peer evaluations, the standardized-patient examination, and the modified-essay examination. The overall reliability of the eight measures of student knowledge and performance was .81; deleting any measure, except the preceptor evaluation, lowered the reliability below the benchmark of .80. CONCLUSION: The results suggest that a highly significant knowledge gain occurred during the problem-based clerkship and that this gain in knowledge was closely related to improved clinical performance.

Clinical Clerkship↗