The Impact of Emotion on Learners' Application of Basic Science Principles to Novel Problems

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

BACKGROUND

Using malpractice claims cases as vignettes is a promising approach for improving clinical reasoning education (CRE), as malpractice claims can provide a variety of content- and context-rich examples. However, the effect on learning of adding information about a malpractice claim, which may evoke a deeper emotional response, is not yet clear. This study examined whether knowing that a diagnostic error resulted in a malpractice claim affects diagnostic accuracy and self-reported confidence in the diagnosis of future cases. Moreover, suitability of using erroneous cases with and without a malpractice claim for CRE, as judged by participants, was evaluated.

METHODS

In the first session of this two-phased, within-subjects experiment, 81 first-year residents of general practice (GP) were exposed to both erroneous cases with (M) and erroneous cases without (NM) malpractice claim information, derived from a malpractice claims database. Participants rated suitability of the cases for CRE on a five-point Likert scale. In the second session, one week later, participants solved four different cases with the same diagnoses. Diagnostic accuracy was measured with three questions, scored on a 0-1 scale: (1) What is your next step? (2) What is your differential diagnosis? (3) What is your most probable diagnosis and what is your level of certainty on this? Both subjective suitability and diagnostic accuracy scores were compared between the versions (M and NM) using repeated measures ANOVA.

RESULTS

There were no differences in diagnostic accuracy parameters (M vs. NM next step: 0.79 vs. 0.77, p = 0.505; differential diagnosis 0.68 vs. 0.75, p = 0.072; most probable diagnosis 0.52 vs. 0.57, p = 0.216) and self-reported confidence (53.7% vs. 55.8% p = 0.390) of diagnoses previously seen with or without malpractice claim information. Subjective suitability- and complexity scores for the two versions were similar (suitability: 3.68 vs. 3.84, p = 0.568; complexity 3.71 vs. 3.88, p = 0.218) and significantly increased for higher education levels for both versions.

CONCLUSION

The similar diagnostic accuracy rates between cases studied with or without malpractice claim information suggests both versions are equally effective for CRE in GP training. Residents judged both case versions to be similarly suitable for CRE; both were considered more suitable for advanced than for novice learners.

"Studying cognitive reappraisal as an antidote to the effect of negative emotions on medical residents' learning: a randomized experiment"

BACKGROUND

Medical trainees often encounter situations that trigger emotional reactions which may hinder learning. Evidence of this effect on medical trainees is scarce and whether it could be counteracted is unclear. This study investigated the effect of negative emotions on medical residents' learning and whether cognitive reappraisal counteracts it.

METHODS

Ninety-nine medical residents participated in a three-phase experiment consisting of: (1) watching a video, either a neutral or an emotion-induction version, the latter either followed by cognitive reappraisal or not (2) learning: all participants studied the same medical text; study-time and cognitive engagement were measured; (3) test: a recall-test measured learning. Data was analysed using Chi-square test and one-way ANOVA.

RESULTS

Study time significantly varied between conditions (p = 0.002). The two emotional conditions spent similar time, both significantly less than the neutral condition. The difference in test scores failed to reach significance level (p = 0.053). While the emotional conditions performed similarly, their scores tended to be lower than those of the neutral condition.

CONCLUSION

Negative emotions can adversely affect medical residents' learning. The effect of emotions was not counteracted by cognitive reappraisal, which has been successfully employed to regulate emotions in other domains. Further research to examine emotion regulation strategies appropriate for medical education is much needed.

Beyond the tensions within transfer theories: implications for adaptive expertise in the health professions

Ensuring trainees develop the flexibility with their knowledge to address novel problems, and to efficiently build upon prior knowledge to learn new knowledge is a common goal in health profession education. How trainees come to develop this capacity to transfer and transform knowledge across contexts can be described by adaptive expertise, which focuses on the ability of some experts to innovate upon their existing knowledge to develop novel solutions to novel problems. While adaptive expertise is often presented as an alternative framework to more traditional cognitivist and constructivist expertise models, it is unclear whether the non-routine and routine forms of transfer it describes are distinct from those described by other accounts of transfer. Furthermore, whether what (e.g., knowledge) is transferred and how (e.g., cognitive processes) differs between these views is still debated. In this review, we describe various theories of transfer and present a synthesis clarifying the relationship between transfer and adaptive expertise. Informed by our analysis, we argue that the mechanisms of transfer in adaptive expertise share important commonalities with traditional accounts of transfer, which when understood, can complement efforts by educators and researchers to foster and study adaptive expertise. We present three instructional principles that may better support transfer and adaptive expertise in trainees: i) identifying and incorporating meaningful variability in practice, ii) integrating conceptual knowledge during practice iii) using assessments of trainees' transfer. Taken together, we offer an integrative perspective to how educational systems and experiences can be designed to develop and encourage adaptive expertise and transfer.

Emotions in simulation-based education: friends or foes of learning?

In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another. Emotions are also powerful: they guide ongoing cognitive processes in order to direct attention, memory and judgment towards addressing the stimulus that triggers the emotion. This occurs in a predictable way. The purpose of this paper is to present a narrative overview of the research on emotions, cognitive processes and learning, in order to inform the simulation community of the potential role of emotions during simulation-based education.

Influence of negative emotions on residents' learning of scientific information: an experimental study

INTRODUCTION

Medical training is consistently described as emotionally challenging. Students commonly encounter situations that are likely to trigger emotional reactions, but the influence of emotional reactions to these situations on learning is unclear. This experiment examined the effects of negative emotions on medical residents' learning of scientific information.

METHODS

Sixty first-year internal medicine residents (i.e. physicians in training to become specialists) at the São Paulo University Medical School were randomly assigned to watching a video clip either presenting an emotional (experimental group) or a neutral (control group) version of the same situation. Subsequently, all residents studied the same scientific text. Main outcome measurements were learning processes (inferred through study time and cognitive engagement) and outcomes (recall accuracy). Data were analyzed using chi-square and independent t‑tests.

RESULTS

The experimental group spent significantly less time (p < 0.001) studying the text and performed significantly worse on the free recall test (p < 0.001) than the control group.

DISCUSSION

Negative emotions decreased time invested in a learning task and the amount of knowledge gained from it, possibly because they automatically activated avoidance attitudes or captured part of the residents' cognitive resources, hindering processing of the learning material. Future studies should further explore the underlying mechanisms of this effect and how it can be diminished.

Scholarly Conversations in Medical Education

This supplement includes the eight research papers accepted by the 2016 Research in Medical Education Program Planning Committee. In this Commentary, the authors use "conversations in medical education" as a guiding metaphor to explore what these papers contribute to the current scholarly discourse in medical education. They organize their discussion around two domains: the topic of study and the methodological approach. The authors map the eight research papers to six "hot topics" in medical education: (1) curriculum reform, (2) duty hours restriction, (3) learner well-being, (4) innovations in teaching and assessment, (5) self-regulated learning, and (6) learning environment, and to three purposes commonly served by medical education research: (1) description, (2) justification, and (3) clarification. They discuss the range of methods employed in the papers. The authors end by encouraging educators to engage in these ongoing scholarly conversations.