Diagnostic Activities and Diagnostic Practices in Medical Education and Teacher Education: An Interdisciplinary Comparison

Intervention skills - a neglected field of research in medical education and beyond

Intervention reasoning as a critical component of clinical reasoning has been understudied in medical education in contrast to the well-established field of diagnostic reasoning. This resonates in a lack of comprehensive understanding of the cognitive processes involved and a deficit in research to promote intervention skills in future clinicians. In this commentary, we present a conceptual framework for intervention reasoning that includes four phases: generating, selecting, implementing, and evaluating interventions. The conceptualization highlights cognitive processes such as developing interventions based on a patient's diagnosis and signs and symptoms; selecting the most appropriate option by contrasting, prioritizing, and evaluating interventions in terms of feasibility, effectiveness, and the patient's context-specific needs; and predicting patient outcomes within so-called "developmental corridors" to adjust treatments accordingly. In addition to these cognitive processes, interventions require collaborative activities, such as sharing information with other care providers, distributing roles among care teams, or acting together. Future research should validate the proposed framework, examine the impact of intervention reasoning on clinical outcomes, and identify effective training methods (e.g., simulation and AI-based approaches). In addition, it would be valuable to explore the transferability and generalizability of the model to other areas of health education and contexts outside of health education.

Where experience makes a difference: teachers' judgment accuracy and diagnostic reasoning regarding student learning characteristics

The concept of teacher professional vision suggests that experienced teachers, compared to novice teachers, might be better at making accurate judgments of students' learning characteristics, which can be explained by their advanced reasoning in diagnostic situations. This study examines experienced and novice teachers' diagnoses of different student characteristic profiles: three inconsistent profiles (overestimating, uninterested, and underestimating) and two consistent profiles (strong and struggling). We examined both experienced (n = 19 in-service mathematics teachers) and novice teachers (n = 24 pre-service mathematics teachers) to determine the extent of differences in their judgment accuracy and their diagnostic reasoning about observable cues when diagnosing student profiles while watching a lesson video. ANOVA results indicate that experienced teachers generally achieved a higher judgment accuracy in diagnosing student profiles compared to novice teachers. Moreover, epistemic network analysis of observable cues in experienced and novice teachers' diagnostic reasoning showed that, compared to novice teachers, experienced teachers make more relations between a broader spectrum of both surface cues (e.g., a student's hand-raising behavior) and deep cues (e.g., a student being interested in the subject). Experienced teachers thereby construct more comprehensive and robust reasoning compared to novice teachers. The findings highlight how professional experience shapes teachers' professional skills, such as diagnosing, and suggest strategies for enhancing teacher training.

Can Pre-Service Biology Teachers’ Professional Knowledge and Diagnostic Activities Be Fostered by Self-Directed Knowledge Acquisition via Texts?

In a diagnostic context of reasoning about instructional quality, scientific reasoning skills can be described as diagnostic activities, which require professional knowledge. Different approaches to enhance pre-service teachers’ professional knowledge (PCK, CK, PK), as well as diagnostic activities exist. However, results about their effectiveness are still inconsistent. We systematically investigated the effectiveness of self-directed knowledge acquisition via texts on PCK, CK, PK, and diagnostic activities of 81 pre-service biology teachers following an experimental design. Paper-pencil tests, measuring PCK, CK, and PK, and the video-based assessment tool DiKoBi Assess, measuring diagnostic activities in the context of diagnosing instructional quality, were used pre and post an intervention. Intervention included four treatments on self-directed knowledge acquisition via texts on (1) PCK, (2) CK, (3) PK, (4) combination PCK/CK/PK. Treatment (5) served as control. Mixed ANOVAs showed large time effects for PCK and CK, but no interaction effect concerning knowledge facets between time and treatment for any of the treatments. Time effects might be due to pre-service teachers’ scientific reasoning on biology instruction that activated knowledge. An ANCOVA showed no significant effect of treatment on diagnostic activities either. We conclude that scientific reasoning about instructional quality is more effective for knowledge acquisition than text-work.