COGNITIVE SKILL ACQUISITION

PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example

Background

Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke.

Methods

The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed.

Results

A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept.

Conclusion

We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Automated discovery of symbolic laws governing skill acquisition from naturally occurring data

Skill acquisition is a key area of research in cognitive psychology as it encompasses multiple psychological processes. The laws discovered under experimental paradigms are controversial and lack generalizability. This paper aims to unearth the laws of skill learning from large-scale training log data. A two-stage algorithm was developed to tackle the issues of unobservable cognitive states and an algorithmic explosion in searching. A deep learning model is initially employed to determine the learner's cognitive state and assess the feature importance. Symbolic regression algorithms are then used to parse the neural network model into algebraic equations. Experimental results show that the algorithm can accurately restore preset laws within a noise range in continuous feedback settings. When applied to Lumosity training data, the method outperforms traditional and recent models in fitness terms. The study reveals two new forms of skill acquisition laws and reaffirms some previous findings.

A theory of the skill-performance relationship

The skill-performance relationship is a cornerstone of a meritocratic society. People are selected for schools, colleges and jobs based on the premise that more skillful individuals perform better. Scientific understanding of the skill-performance relationship demands that the effect of skill on performance is objectively assessed without subjective, social, and political considerations. One of the best areas for this analysis is sports. In many sports settings, the skill-performance relationship can objectively be examined at the technical, behavioral, psychological, and neurological levels. This examination reveals that skill and performance are inextricably intertwined. While skill affects performance, performance in turn defines and affects skill. To disentangle the previously confusing and interchangeable use of these key constructs, the paper presents a theoretical model specifying that ability and effort have their own direct effects on performance, as well as indirect effects on performance through skill possession and skill execution in cognitive and physical domains of human performance. Thus, ability and skill are not the same. Although skill is a key determinant of performance, recent theory and research suggests that successful performers are successful not just because of their skills per se, but because they take advantage of their skills by creating more occurrences of momentum, making them last longer, and using them to bounce back faster from streaks of unsuccessful performance. Thus, momentum is an important mediator of the effects of skill on performance.

The development of simple addition problem solving in children: Reliance on automatized counting or memory retrieval depends on both expertise and problem size

In an experiment, 98 children aged 8 to 9, 10 to 12, and 13 to 15 years solved addition problems with a sum up to 10. In another experiment, the same children solved the same calculations within a sign priming paradigm where half the additions were displayed with the "+" sign 150 ms before the addends. Therefore, size effects and priming effects could be considered conjointly within the same populations. Our analyses revealed that small problems, constructed with addends from 1 to 4, presented a linear increase of solution times as a function of problem sums (i.e., size effect) in all age groups. However, an operator priming effect (i.e., facilitation of the solving process with the anticipated presentation of the "+" sign) was observed only in the group of oldest children. These results support the idea that children use a counting procedure that becomes automatized (as revealed by the priming effect) around 13 years of age. For larger problems and whatever the age group, no size or priming effects were observed, suggesting that the answers to these problems were already retrieved from memory at 8 to 9 years of age. For this specific category of large problems, negative slopes in solution times demonstrate that retrieval starts from the largest problems during development. These results are discussed in light of a horse race model in which procedures can win over retrieval.

Does it make sense to use written instruments to assess communication skills? Systematic review on the concurrent and predictive value of written assessment for performance

OBJECTIVES

To evaluate possible associations between learners' results in written and performance-based assessments of communication skills (CS), either in concurrent or predictive study designs.

METHODS

Search included four databases for peer-reviewed studies containing both written and performance-based CS assessment. Eleven studies met the inclusion criteria.

RESULTS

Included studies predominantly assessed undergraduate medical students. Studies reported mainly low to medium correlations between written and performance-based assessment results (Objective Structured Clinical Examinations or encounters with simulated patients), and gave correlation coefficients ranging from 0.13 to 0.53 (p < 0.05). Higher correlations were reported when specific CS, like motivational interviewing were assessed. Only a few studies gave sufficient reliability indicators of both assessment formats.

CONCLUSIONS

Written assessment scores seem to predict performance-based assessments to a limited extent but cannot replace them entirely. Reporting of assessment instruments' psychometric properties is essential to improve the interpretation of future findings and could possibly affect their predictive validity for performance.

PRACTICE IMPLICATIONS

Within longitudinal CS assessment programs, triangulation of assessment including written assessment is recommended, taking into consideration possible limitations. Written assessments with feedback can help students and trainers to elaborate on procedural knowledge as a strong support for the acquisition and transfer of CS to different contexts.

Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression

Background

To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity.

Method

150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator.

Discussion

Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression.

Trial registration

The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).

Bringing cumulative technological culture beyond copying versus reasoning

The dominant view of cumulative technological culture suggests that high-fidelity transmission rests upon a high-fidelity copying ability, which allows individuals to reproduce the tool-use actions performed by others without needing to understand them (i.e., without causal reasoning). The opposition between copying versus reasoning is well accepted but with little supporting evidence. In this article, we investigate this distinction by examining the cognitive science literature on tool use. Evidence indicates that the ability to reproduce others' tool-use actions requires causal understanding, which questions the copying versus reasoning distinction and the cognitive reality of the so-called copying ability. We conclude that new insights might be gained by considering causal understanding as a key driver of cumulative technological culture.

Second verse, same as the first: learning generalizable relational concepts through functional repetition

The ability to learn and flexibly apply sophisticated concepts is thought by many to be what differentiates humans from all other animals. A basic assumption underlying this belief is that some "lower-order" associative learning mechanisms link perceptual events to specific reactions, whereas the kinds of verbalizable concepts that humans form depend on "higher-order" cognitive processes that rely less on perception and more on rational thought. Evidence in support of this interpretation comes largely from experiments in which animals either fail to learn or generalize concepts that humans readily learn, or learn them with great difficulty. Here, we argue that the formation of generalizable relational concepts may depend more on an individual's capacity to shift attention than on the possession of representational processes that are unique to humans. Studies of relational concept learning in non-human animals show that they can learn generalizable concepts when conditions are favorable. In particular, repetition of similar training experiences appears to facilitate attentional redirection, thereby enabling animals to flexibly reenact past events and to judge the similarity of items within stimulus sets. The conditions that promote concept learning in humans may differ substantially from those experienced by most other animals. This does not imply, however, that either (1) conceptual learning mechanisms differ qualitatively from other learning mechanisms, or (2) that the processes that lead to concept formation in humans differ significantly from those present in other species.

Exploring Automated Classification Approaches to Advance the Assessment of Collaborative Problem Solving Skills

Competency in skills associated with collaborative problem solving (CPS) is critical for many contexts, including school, the workplace, and the military. Innovative approaches for assessing individuals’ CPS competency are necessary, as traditional assessment types such as multiple -choice items are not well suited for such a process-oriented competency. In a move to computer-based environments to support CPS assessment, innovative computational approaches are also needed to understand individuals’ CPS behaviors. In the current study, we describe the use of a simulation-based task on electronics concepts as an environment for higher education students to display evidence of their CPS competency. We further describe computational linguistic methods for automatically characterizing students’ display of various CPS skills in the task. Comparisons between such an automated approach and an approach based on human annotation to characterize student CPS behaviors revealed above average agreement. These results give credence to the potential for automated approaches to help advance the assessment of CPS and to circumvent the time-intensive human annotation approaches that are typically used in these contexts.

Individual Differences in the Evolution of Counting

The alphabet-arithmetic paradigm, in which adults are asked to add a numeral addend to a letter augend (e.g., D + 3 = G), was conceived to mimic the way children learn addition. Studies using this paradigm often conclude that procedural learning leads to the memorization of associations between operands and answers. However, as recently suggested, memorization might only be used by a minority of participants and only for problems with the largest addend. In the present paper, we aim at investigating these individual differences through transfer effects from trained problems to new ones. Participants were trained over 12 learning sessions, followed by 3 transfer sessions. A group of participants, that we called the nonbreakers, showed a linear function associating solution times and addends throughout the experiment. In this group, transfer was observed during the first transfer session, suggesting that a procedural strategy, transferable to new items, was still used at the end of training. In another group of participants, that we called the breakers, we observed a decrease in solution times for problems with the largest addend. In this group, transfer was only observed after two transfer sessions, suggesting that procedural strategies were not used as often in this group than in the other group. This was especially true for problems with the largest addend because transfer effects were stronger when they were excluded. Therefore, during learning and for breakers, the answers to problems with larger addends are retrieved first and, as for non-breakers, the answers to problems with very small operands remain computed.

Exploring ideation strategies as an opportunity to support and evaluate making

Purpose

This paper aims to compare two types of prompts, encouraging participants to think about real-world examples or engineering principles to show how these two approaches can result in vastly different design practices.

Design/methodology/approach

Two studies (N = 20, N = 40) examine the impact of two different prompts. Non-expert students, from high school and university, completed a hands-on, engineering design task in pairs. Half were prompted to ideate using real-world examples, while the other half were prompted to ideate using engineering principles. The findings are based on human coding and artifact analyses.

Findings

In both studies, and across multiple measures, students in the principle-based condition performed better than students in the example-based condition.

Research limitations/implications

A seemingly small difference in how students are prompted or encouraged to approach a problem can have a significant impact on their experience. The findings also suggest that leveraging engineering principles, even when those principles are only loosely formed, can be effective even for non-experts. Finally, the findings motivate identifying student reasoning strategies over time as a potential means for assessment in Makerspaces.

Practical implications

Encouraging makers to think about different ways for approaching problems can be an important way to help them succeed. It may also be a useful way to chronicle their learning pathway.

Originality/value

To the author's knowledge, explicitly looking at ideation strategies has not been widely discussed within the Maker community as a way to support learners, or as a way to evaluate learning.

What is communicative competence and how can it be acquired?

The commentary deals with the question of what constitutes communicative competence (or communication skills) and to what extent findings regarding motor and social skills are transferable to the domain of communication. After a proposal for a definition, the commentary considers how learners acquire communicative competence and what needs to be considered from the trainers' perspective in order to support learners in their competence development. The commentary does not claim to present all definitions of the concept of competence or communicative competence in a comprehensive way. Nor does it aim to present the current state of research. Our aim is to provide teachers and interested individuals in medical education with a pragmatic guide to how communicative competence can be taught and learned based on a skills model.

Domain-Specificity of Educational and Learning Capital: A Study With Musical Talents

The Education and Learning Capital Approach (ELCA) has been widely used to investigate talent development. A research gap is the implicit consideration of the domain specificity of educational and learning capital. In an empirical study with 365 school students we investigated the domain specificity of the approach for the domains of school learning and learning to play a musical instrument. At the beginning of the school year, students filled out a version of the Questionnaire for Educational and Learning Capital (QELC) for both domains and also responded to other domain-related measures (self-efficacy, grades). Six weeks later, students filled out a learning diary for 1 week in which they reported their activities on an hourly basis and responded to questions concerning these activities. Based on the Sociotope Approach this procedure helped to identify times in which students actually practiced their musical instrument, times that students could potentially practice their musical instrument (objective action space), and times that students would be expected to practice their musical instrument (normative action space). Three hypotheses were tested and could be supported. First, the availability of educational and learning capital for school learning and learning an instrument differed. Second, a confirmatory factor analysis supported the factorial validity of the domain-specific capital measurements. Third, domain-congruent correlations were mostly higher than domain-incongruent correlations, i.e., the availability of educational and learning capital for school learning correlated more closely with variables related to school learning than with variables related to learning a musical instrument. Similarly, the availability of the capitals for learning a musical instrument correlated more closely with variables related to learning a musical instrument.

FAST: A Novel, Executive Function-Based Approach to Cognitive Enhancement

The present study introduces a novel cognitive intervention aimed at improving fluid intelligence (Gf), based on a framework we refer to as FAST: Flexible, Adaptive, Synergistic Training. FAST leverages a combination of novel game-based executive function (EF) training—designed specifically to enhance the likelihood of transfer—and transcranial electrical stimulation (tES), with aims to synergistically activate and strengthen mechanisms of cognitive control critical to Gf. To test our intervention, we collected three Gf measures from 113 participants [the advanced short Bochumer Matrizen-Test (BOMAT), Raven’s Advanced Progressive Matrices (APM), and matrices similar to Raven’s generated by Sandia labs], prior to and following one of three interventions: (1) the FAST + tRNS intervention, a combination of 30 min of daily training with our novel training game, Robot Factory, and 20 min of concurrent transcranial random noise stimulation applied to bilateral dorsolateral prefrontal cortex (DLPFC); (2) an adaptively difficult Active Control intervention comprised of visuospatial tasks that specifically do not target Gf; or (3) a no-contact control condition. Analyses of changes in a Gf factor from pre- to post-test found numerical increases for the FAST + tRNS group compared to the two control conditions, with a 0.3 SD increase relative to Active Control (p = 0.07), and a 0.19 SD increase relative to a No-contact control condition (p = 0.26). This increase was found to be largely driven by significant differences in pre- and post-test Gf as measured on the BOMAT test. Progression through the FAST training game (Robot Factory) was significantly correlated with changes in Gf. This is in contrast with progress in the Active Control condition, as well as with changes in individual EFs during FAST training, which did not significantly correlate with changes in Gf. Taken together, this research represents a useful step forward in providing new insights into, and new methods for studying, the nature of Gf and its malleability. Though our results await replication and extension, they provide preliminary evidence that the crucial characteristic of Gf may, in fact, be the ability to combine EFs rapidly and adaptively according to changing demand, and that Gf may be susceptible to targeted training.

Optimizing Performative Skills in Social Interaction: Insights From Embodied Cognition, Music Education, and Sport Psychology

Embodied approaches to cognition conceive of mental life as emerging from the ongoing relationship between neural and extra-neural resources. The latter include, first and foremost, our entire body, but also the activity patterns enacted within a contingent milieu, cultural norms, social factors, and the features of the environment that can be used to enhance our cognitive capacities (e.g., tools, devices, etc.). Recent work in music education and sport psychology has applied general principles of embodiment to a number of social contexts relevant to their respective fields. In particular, both disciplines have contributed fascinating perspectives to our understanding of how skills are acquired and developed in groups; how musicians, athletes, teachers, and coaches experience their interactions; and how empathy and social action participate in shaping effective performance. In this paper, we aim to provide additional grounding for this research by comparing and further developing original themes emerging from this cross-disciplinary literature and empirical works on how performative skills are acquired and optimized. In doing so, our discussion will focus on: (1) the feeling of being together, as meaningfully enacted in collective musical and sport events; (2) the capacity to skillfully adapt to the contextual demands arising from the social environment; and (3) the development of distributed forms of bodily memory. These categories will be discussed from the perspective of embodied cognitive science and with regard to their relevance for music education and sport psychology. It is argued that because they play a key role in the acquisition and development of relevant skills, they can offer important tools to help teachers and coaches develop novel strategies to enhance learning and foster new conceptual and practical research in the domains of music and sport.

Clinical Reasoning in Physical Therapy: A Concept Analysis

BACKGROUND

Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research.

OBJECTIVE

The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research.

DESIGN/METHODS

The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified.

RESULTS

Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management.

LIMITATIONS

Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded.

CONCLUSIONS

A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

Age, familiarity, and intuitive use: An empirical investigation

Research has shown that older adults interact with products less intuitively than younger adults, and that familiarity is an essential element of intuitive interaction. This paper reports on the findings of two empirical studies that examined familiarity in younger and older adults. Each study comprised 32 participants over four age groups. The first study required participants to use their own contemporary products in their homes in order to investigate older adults' familiarity with them, and how this familiarity differed from that of younger adults. Older people were less familiar with their own contemporary products that younger people. The second study aimed to investigate differences in familiarity between younger and older adults while using products that they did not own and were likely to be less familiar with. When using products not already familiar to them, both middle aged and older adults showed significantly lower familiarity than younger people. The significance of this research is in its empirical findings about familiarity differences between age groups. It has been recognised that the identification and understanding of differences in familiarity will enable designers to design more intuitive interfaces and systems for both younger and older cohorts. The implications of the findings from the two studies reported here are discussed in light of this recognition.

Systematizing Professional Knowledge of Medical Doctors and Teachers: Development of an Interdisciplinary Framework in the Context of Diagnostic Competences

Professional knowledge is highlighted as an important prerequisite of both medical doctors and teachers. Based on recent conceptions of professional knowledge in these fields, knowledge can be differentiated within several aspects. However, these knowledge aspects are currently conceptualized differently across different domains and projects. Thus, this paper describes recent frameworks for professional knowledge in medical and educational sciences, which are then integrated into an interdisciplinary two-dimensional model of professional knowledge that can help to align terminology in both domains and compare research results. The models’ two dimensions differentiate between cognitive types of knowledge and content-related knowledge facets and introduces a terminology for all emerging knowledge aspects. The models’ applicability for medical and educational sciences is demonstrated in the context of diagnosis by describing prototypical diagnostic settings for medical doctors as well as for teachers, which illustrate how the framework can be applied and operationalized in these areas. Subsequently, the role of the different knowledge aspects for acting and the possibility of transfer between different content areas are discussed. In conclusion, a possible extension of the model along a “third dimension” that focuses on the effects of growing expertise on professional knowledge over time is proposed and issues for further research are outlined.

Are multiple-trial experiments appropriate for eyewitness identification studies? Accuracy, choosing, and confidence across trials

Eyewitness identification experiments typically involve a single trial: A participant views an event and subsequently makes a lineup decision. As compared to this single-trial paradigm, multiple-trial designs are more efficient, but significantly reduce ecological validity and may affect the strategies that participants use to make lineup decisions. We examined the effects of a number of forensically relevant variables (i.e., memory strength, type of disguise, degree of disguise, and lineup type) on eyewitness accuracy, choosing, and confidence across 12 target-present and 12 target-absent lineup trials (N = 349; 8,376 lineup decisions). The rates of correct rejections and choosing (across both target-present and target-absent lineups) did not vary across the 24 trials, as reflected by main effects or interactions with trial number. Trial number had a significant but trivial quadratic effect on correct identifications (OR = 0.99) and interacted significantly, but again trivially, with disguise type (OR = 1.00). Trial number did not significantly influence participants' confidence in correct identifications, confidence in correct rejections, or confidence in target-absent selections. Thus, multiple-trial designs appear to have minimal effects on eyewitness accuracy, choosing, and confidence. Researchers should thus consider using multiple-trial designs for conducting eyewitness identification experiments.

Intentional Forgetting in Organizations: The Importance of Eliminating Retrieval Cues for Implementing New Routines

To cope with the already large, and ever increasing, amount of information stored in organizational memory, "forgetting," as an important human memory process, might be transferred to the organizational context. Especially in intentionally planned change processes (e.g., change management), forgetting is an important precondition to impede the recall of obsolete routines and adapt to new strategic objectives accompanied by new organizational routines. We first comprehensively review the literature on the need for organizational forgetting and particularly on accidental vs. intentional forgetting. We discuss the current state of the art of theory and empirical evidence on forgetting from cognitive psychology in order to infer mechanisms applicable to the organizational context. In this respect, we emphasize retrieval theories and the relevance of retrieval cues important for forgetting. Subsequently, we transfer the empirical evidence that the elimination of retrieval cues leads to faster forgetting to the forgetting of organizational routines, as routines are part of organizational memory. We then propose a classification of cues (context, sensory, business process-related cues) that are relevant in the forgetting of routines, and discuss a meta-cue called the "situational strength" cue, which is relevant if cues of an old and a new routine are present simultaneously. Based on the classification as business process-related cues (information, team, task, object cues), we propose mechanisms to accelerate forgetting by eliminating specific cues based on the empirical and theoretical state of the art. We conclude that in intentional organizational change processes, the elimination of cues to accelerate forgetting should be used in change management practices.

Representation scaffolds improve diagnostic efficiency in medical students

CONTEXT

Diagnostic efficiency is important in daily clinical practice as doctors have to face problems within a limited time frame. To foster the clinical reasoning of students is a major challenge in medical education research. Little is known about students' diagnostic efficiency. On the basis of current theories, scaffolds for case representation (statement of the case as far as it is summarised in the mind) could be a promising approach to make the diagnostic reasoning of intermediate medical students more efficient.

METHODS

Clinical case processing of 88 medical students in their fourth and fifth years was analysed in a randomised, controlled laboratory study. Cases dealing with dyspnoea were provided in an electronic learning environment (CASUS). Students could freely choose the time, amount and sequence of clinical information. During the learning phase the intervention group was asked to write down case representation summaries while working on the cases. In the assessment phase diagnostic efficiency was operationalised as the number of correct diagnoses divided by the time spent on diagnosing.

RESULTS

Diagnostic efficiency was significantly improved by the representation scaffolding (M = 0.12 [SD = 0.07], M = 0.09 [SD = 0.06] correct cases/time, p = 0.045), whereas accuracy remained unchanged (M = 2.28 [SD = 1.10], M = 2.09 [SD = 1.08], p = 0.52). Both groups screened the same amount of clinical information, but the scaffolding group did this faster (M = 20.8 minutes [SD = 7.15], M = 24.6 minutes [SD = 7.42], p = 0.01; Cohen's d = 0.5).

CONCLUSION

Diagnostic efficiency is an important outcome variable in clinical reasoning research as it corresponds to workplace challenges. Scaffolding for case representations significantly improved the diagnostic efficiency of fourth and fifth-year medical students, most likely because of a more targeted screening of the available information.

Time Does Not Help Orangutans Pongo abelii Solve Physical Problems

Many questions in animal intelligence and cognition research are challenging. One challenge is to identify mechanisms underlying reasoning in experiments. Here, we provide a way to design such tests in non-human animals. We know from research in skill acquisition in humans that reasoning and thinking can take time because some problems are processed in multiple steps before a solution is reached (e.g., during mental arithmetics). If animals are able to learn through similar processes their decision making can be time consuming, and most importantly improve if more time to process information is allowed. We tested if performance of two Sumatran orangutans (Pongo abelii) increased in a two-choice experiment when they were allowed extra time before making their decisions, compared to when they were forced to decide immediately. We found that the performance of the orangutans did not depend on the time they were allowed to process the information before making their decisions. This methodology provides a potential avenue for empirical tests of mechanisms underlying reasoning in non-human animals.

Eye tracking in Educational Science: Theoretical frameworks and research agendas

Eye tracking is increasingly being used in Educational Science and so has the interest of the eye tracking community grown in this topic. In this paper we briefly introduce the discipline of Educational Science and why it might be interesting to couple it with eye tracking research. We then introduce three major research areas in Educational Science that have already successfully used eye tracking: First, eye tracking has been used to improve the instructional design of computer-based learning and testing environments, often using hyper- or multimedia. Second, eye tracking has shed light on expertise and its development in visual domains, such as chess or medicine. Third, eye tracking has recently been also used to promote visual expertise by means of eye movement modeling examples. We outline the main educational theories for these research areas and indicate where further eye tracking research is needed to expand them.

Using stroke thrombolysis to describe the role of repetition in learning a cognitive skill

OBJECTIVE

To empirically describe how independent physicians develop a new cognitive clinical skill through repetition using the initiation of a stroke thrombolysis programme as a model.

METHODS

This was a retrospective cohort study from April 2009 to March 2013. The setting was a single-centre, Canadian tertiary-care community hospital. The participants were 52 physicians with no prior formal training in stroke thrombolysis assuming a new role of being front-line hyperacute stroke physicians. The main outcome measures were: time needed to accrue experience, door-to-needle time (DTN), with achievement of expertise defined as an average of ≤ 60 minutes, computed tomography (CT)-to-needle time (CTN), with achievement of expertise defined as an average of ≤ 35 minutes, usage of an outside expert stroke telemedicine service, and complication rates with intracranial haemorrhage (ICH).

RESULTS

Seven hundred and fifteen cases of hyperacute stroke were seen over the 4-year study period. On average, a physician saw 0.025 cases per hour of code stroke coverage provided; only seven (13.5%) accrued more than 20 code stroke cases and only six (11.6%) ordered thrombolysis more than 10 times. By regression analysis, the average first DTN was 81.0 minutes (95% confidence interval [CI], 77.1-84.9 minutes) and incrementally improved linearly by 0.259 minutes per case seen (95% CI, 0.182-0.337 minutes per case). An estimated 71 cases needed to be seen for the average physician to achieve expertise. Results using CTN were highly similar. Overall, physicians used the external stroke telemedicine providers 23.2% of the time for their first five cases, a rate that decreased to about 5% by the 45th case. Over time, ICH rates were kept at expected benchmarks.

CONCLUSIONS

Accruing sufficient experience of a new cognitive clinical skill can be challenging for independent physicians, with expertise gradually emerging in a largely linear fashion only after much repetition.

Cognitive foundations of organizational learning: re-introducing the distinction between declarative and non-declarative knowledge

Contemporary research into socio-cognitive foundations of organizational learning tends to disregard the distinction between declarative and non-declarative knowledge. By reviewing the literature from organizational learning research and cognitive psychology we explain that this distinction is crucial. We describe the foundations of organizational learning by referring to models that consider the interplay between individual and collective knowledge-related processes in organizations. We highlight the existence of a research gap resulting from the finding that these approaches have widely neglected the existence of different types of knowledge. We then elaborate on characteristics of declarative and non-declarative knowledge in general, consider organizations as structures of distributed cognition, and discuss the relationship between organizational knowledge and practice. Subsequently, we examine the role of declarative and non-declarative knowledge in the context of organizational learning. Here, we analyze (1) the cognitive and social mechanisms underlying the development of declarative and non-declarative knowledge within structures of distributed cognition; and (2) the relationship between alterations in declarative and non-declarative types of knowledge on the one hand and changes in organizational practice on the other. Concluding, we discuss implications of our analysis for organizational learning research. We explain how our integrative perspective may offer starting points for a refined understanding of the sub-processes involved in organizational learning and unlearning and may support a better understanding of practical problems related to organizational learning and change.

Semantic priming increases word frequency judgments: Evidence for the role of memory strength in frequency estimation

Previous research has demonstrated a systematic, nonlinear relationship between word frequency judgments and values from word frequency norms. This relationship could reflect a perceptual process similar to that found in the psychophysics literature for a variety of sensory phenomena. Alternatively, it could reflect memory strength differences that are expected for words of varying levels of prior exposure. Two experiments tested the memory strength explanation by semantically priming words prior to frequency judgments. Exposure to related word meanings produced a small but measurable increase in target word frequency ratings. Repetition but not semantic priming had a greater impact on low compared to high frequency words. These findings are consistent with a memory strength view of frequency judgments that assumes a distributed network with lexical and semantic levels of representation.

From Generating in the Lab to Tutoring Systems in Classrooms

Work in cognitive and educational psychology examines a variety of phenomena related to the learning and retrieval of information. Indeed, Alice Healy, our honoree, and her colleagues have conducted a large body of groundbreaking research on this topic. In this article we discuss how 3 learning principles (the generation effect, deliberate practice and feedback, and antidotes to disengagement) discussed in Healy, Schneider, and Bourne (2012) have influenced the design of 2 intelligent tutoring systems that attempt to incorporate principles of skill and knowledge acquisition. Specifically, this article describes iSTART-2 and the Writing Pal, which provide students with instruction and practice using comprehension and writing strategies. iSTART-2 provides students with training to use effective comprehension strategies while self-explaining complex text. The Writing Pal provides students with instruction and practice to use basic writing strategies when writing persuasive essays. Underlying these systems are the assumptions that students should be provided with initial instruction that breaks down the tasks into component skills and that deliberate practice should include active generation with meaningful feedback, all while remaining engaging. The implementation of these assumptions is complicated by the ill-defined natures of comprehension and writing and supported by the use of various natural language processing techniques. We argue that there is value in attempting to integrate empirically supported learning principles into educational activities, even when there is imperfect alignment between them. Examples from the design of iSTART-2 and Writing Pal guide this argument.

Brain computer interface learning for systems based on electrocorticography and intracortical microelectrode arrays

A brain-computer interface (BCI) system transforms neural activity into control signals for external devices in real time. A BCI user needs to learn to generate specific cortical activity patterns to control external devices effectively. We call this process BCI learning, and it often requires significant effort and time. Therefore, it is important to study this process and develop novel and efficient approaches to accelerate BCI learning. This article reviews major approaches that have been used for BCI learning, including computer-assisted learning, co-adaptive learning, operant conditioning, and sensory feedback. We focus on BCIs based on electrocorticography and intracortical microelectrode arrays for restoring motor function. This article also explores the possibility of brain modulation techniques in promoting BCI learning, such as electrical cortical stimulation, transcranial magnetic stimulation, and optogenetics. Furthermore, as proposed by recent BCI studies, we suggest that BCI learning is in many ways analogous to motor and cognitive skill learning, and therefore skill learning should be a useful metaphor to model BCI learning.

Cognitive demands of lower paleolithic toolmaking

Stone tools provide some of the most abundant, continuous, and high resolution evidence of behavioral change over human evolution, but their implications for cognitive evolution have remained unclear. We investigated the neurophysiological demands of stone toolmaking by training modern subjects in known Paleolithic methods (“Oldowan”, “Acheulean”) and collecting structural and functional brain imaging data as they made technical judgments (outcome prediction, strategic appropriateness) about planned actions on partially completed tools. Results show that this task affected neural activity and functional connectivity in dorsal prefrontal cortex, that effect magnitude correlated with the frequency of correct strategic judgments, and that the frequency of correct strategic judgments was predictive of success in Acheulean, but not Oldowan, toolmaking. This corroborates hypothesized cognitive control demands of Acheulean toolmaking, specifically including information monitoring and manipulation functions attributed to the "central executive" of working memory. More broadly, it develops empirical methods for assessing the differential cognitive demands of Paleolithic technologies, and expands the scope of evolutionary hypotheses that can be tested using the available archaeological record.

How Older Persons Structure Information in the Decision to Seek Medical Care

Typical models of the decision to seek care consider information as a single conceptual object. This paper presents an alternative that allows multiple objects. For older persons seeking care, results support this alternative. Older decision-makers that segregate information into multiple conceptual objects assessed separately are characterized by socio-demographic (younger age, racial category, non-Hispanic, higher education, higher income, and not married), health status (better general health for men and worse general health for women, fewer known illnesses), and neuropsychological (less memory loss for men, trouble concentrating and trouble making decisions for men) factors. Results of this study support the conclusion that older persons are more likely to integrate information, and individuals with identifiable characteristics are more likely to do so than others. The theory tested in this study implies a potential explanation for misutilization of care (either over or under-utilization).

Disclosure and Privacy Settings on Social Networking Sites

The present study evaluated a video-based intervention designed to permit users of social networking to make informed decisions about the information they disclosed online. The videos provided information regarding potential risks of disclosure and well as step-by-step instructions on privacy setting use. Novice (n=40) and experienced (n=40). FacebookTM users were randomly assigned to either the video intervention condition, or given the choice to watch the video intervention then were asked to construct a new FacebookTM account or work on their existing account. Viewing the video encouraged greater use of privacy settings as well as use of more restrictive privacy settings. Gender differences revealed greater use of privacy settings among women. Experienced users continued to disclose more than novice users, however, they increased their use of privacy settings which restricted the availability of the disclosed information. This study shows promising use of direct and explicit instruction in the teaching of privacy online.

Developing intuition: neural correlates of cognitive-skill learning in caudate nucleus

The superior capability of cognitive experts largely depends on automatic, quick information processing, which is often referred to as intuition. Intuition develops following extensive long-term training. There are many cognitive models on intuition development, but its neural basis is not known. Here we trained novices for 15 weeks to learn a simple board game and measured their brain activities in early and end phases of the training while they quickly generated the best next-move to a given board pattern. We found that the activation in the head of caudate nucleus developed over the course of training, in parallel to the development of the capability to quickly generate the best next-move, and the magnitude of the caudate activity was correlated with the subject's performance. In contrast, cortical activations, which already appeared in the early phase of training, did not further change. Thus, neural activation in the caudate head, but not those in cortical areas, tracked the development of capability to quickly generate the best next-move, indicating that circuitries including the caudate head may automate cognitive computations.

Corticostriatal plasticity is necessary for learning intentional neuroprosthetic skills

The ability to learn new skills and perfect them with practice applies not only to physical skills but also to abstract skills, like motor planning or neuroprosthetic actions. Although plasticity in corticostriatal circuits has been implicated in learning physical skills, it remains unclear if similar circuits or processes are required for abstract skill learning. Here we use a novel behavioural task in rodents to investigate the role of corticostriatal plasticity in abstract skill learning. Rodents learned to control the pitch of an auditory cursor to reach one of two targets by modulating activity in primary motor cortex irrespective of physical movement. Degradation of the relation between action and outcome, as well as sensory-specific devaluation and omission tests, demonstrate that these learned neuroprosthetic actions are intentional and goal-directed, rather than habitual. Striatal neurons change their activity with learning, with more neurons modulating their activity in relation to target-reaching as learning progresses. Concomitantly, strong relations between the activity of neurons in motor cortex and the striatum emerge. Specific deletion of striatal NMDA receptors impairs the development of this corticostriatal plasticity, and disrupts the ability to learn neuroprosthetic skills. These results suggest that corticostriatal plasticity is necessary for abstract skill learning, and that neuroprosthetic movements capitalize on the neural circuitry involved in natural motor learning.

Automatic and intentional number processing both rely on intact right parietal cortex: a combined FMRI and neuronavigated TMS study

Practice and training usually lead to performance increase in a given task. In addition, a shift from intentional toward more automatic processing mechanisms is often observed. It is currently debated whether automatic and intentional processing is subserved by the same or by different mechanism(s), and whether the same or different regions in the brain are recruited. Previous correlational evidence provided by behavioral, neuroimaging, modeling, and neuropsychological studies addressing this question yielded conflicting results. Here we used transcranial magnetic stimulation (TMS) to compare the causal influence of disrupting either left or right parietal cortex during automatic and intentional numerical processing, as reflected by the size congruity effect and the numerical distance effect, respectively. We found a functional hemispheric asymmetry within parietal cortex with only the TMS-induced right parietal disruption impairing both automatic and intentional numerical processing. In contrast, disrupting the left parietal lobe with TMS, or applying sham stimulation, did not affect performance during automatic or intentional numerical processing. The current results provide causal evidence for the functional relevance of right, but not left, parietal cortex for intentional, and automatic numerical processing, implying that at least within the parietal cortices, automatic, and intentional numerical processing rely on the same underlying hemispheric lateralization.