The Effect of Proximity, Explicitness, and Representation of Basic Science Information on Student Clinical Problem-Solving

Problem: Medical and veterinary students memorize facts but then have difficulty applying those facts in clinical problem solving. Cognitive engineering research suggests that the inability of medical and veterinary students to infer concepts from facts may be due in part to specific features of how information is represented and organized in educational materials. First, physical separation of pieces of information may increase the cognitive load on the student. Second, information that is necessary but not explicitly stated may also contribute to the student’s cognitive load. Finally, the types of representations – textual or graphical – may also support or hinder the student’s learning process. This may explain why students have difficulty applying biomedical facts in clinical problem solving. Purpose: To test the hypothesis that three specific aspects of expository text – the patial distance between the facts needed to infer a rule, the explicitness of information, and the format of representation – affected the ability of students to solve clinical problems. Setting: The study was conducted in the parasitology laboratory of a college of veterinary medicine in Texas. Sample: The study subjects were a convenience sample consisting of 132 second-year veterinary students who matriculated in 2007. The age of this class upon admission ranged from 20-52, and the gender makeup of this class consisted of approximately 75% females and 25% males. Results: No statistically significant difference in student ability to solve clinical problems was found when relevant facts were placed in proximity, nor when an explicit rule was stated. Further, no statistically significant difference in student ability to solve clinical problems was found when students were given different representations of material, including tables and concept maps. Findings: The findings from this study indicate that the three properties investigated – proximity, explicitness, and representation – had no statistically significant effect on student learning as it relates to clinical problem-solving ability. However, ad hoc observations as well as findings from other researchers suggest that the subjects were probably using rote learning techniques such as memorization, and therefore were not attempting to infer relationships from the factual material in the interventions, unless they were specifically prompted to look for patterns. A serendipitous finding unrelated to the study hypothesis was that those subjects who correctly answered questions regarding functional (non-morphologic) properties, such as mode of transmission and intermediate host, at the family taxonomic level were significantly more likely to correctly answer clinical case scenarios than were subjects who did not correctly answer questions regarding functional properties. These findings suggest a strong relationship (p < .001) between well-organized knowledge of taxonomic functional properties and clinical problem solving ability. Recommendations: Further study should be undertaken investigating the relationship between knowledge of functional taxonomic properties and clinical problem solving ability. In addition, the effect of prompting students to look for patterns in instructional material, followed by the effect of factors that affect cognitive load such as proximity, explicitness, and representation, should be explored.

"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

Objective: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility?

Methods: Six focus groups were conducted with (pre-)/clerkship students.

Results: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models.

Conclusion: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor.

Practice Implications: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.

Worry and problem-solving skills and beliefs in primary school children

Objective. To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. Method. Children (8–11 years) were screened using the Penn State Worry Questionnaire for Children. High (N ¼ 27) and low (N ¼ 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs(confidence and perceived control). Results. High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. Conclusions. Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit froma focus on increasing positive problem-solving beliefs.

Preventing adolescent depression: An evaluation of the problem solving for life program

This study evaluated the effectiveness of the Problem Solving For Life program as it universal approach to the prevention of adolescent depression. Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group. Low-risk participants who received the intervention reported a small but significant decrease in depression scores over the intervention period, whereas the low-risk controls reported an increase in depression scores. The low-risk group reported a significantly greater increase in problem-solving scores over the intervention period compared with low-risk controls. These results were not maintained, however, at 12-month follow-up.

The influence of eating psychopathology on autobiographical memory specificity and social problem-solving

The primary aim was to examine to influence of subclinical disordered eating on autobiographical memory specificity (AMS) and social problem solving (SPS). A further aim was to establish if AMS mediated the relationship between eating psychopathology and SPS. A non-clinical sample of 52 females completed the autobiographical memory test (AMT), where they were asked to retrieve specific memories of events from their past in response to cue words, and the means-end problem-solving task (MEPS), where they were asked to generate means of solving a series of social problems. Participants also completed the Eating Disorders Inventory (EDI) and Hospital Anxiety and Depression Scale. After controlling for mood, high scores on the EDI subscales, particularly Drive-for-Thinness, were associated with the retrieval of fewer specific and a greater proportion of categorical memories on the AMT and with the generation of fewer and less effective means on the MEPS. Memory specificity fully mediated the relationship between eating psychopathology and SPS. These findings have implications for individuals exhibiting high levels of disordered eating, as poor AMS and SPS are likely to impact negatively on their psychological wellbeing and everyday social functioning and could represent a risk factor for the development of clinically significant eating disorders.

A Case Based Methodology for Problem Solving aiming at Knee Osteoarthritis Detection

Knee osteoarthritis is the most common type of arthritis and a major cause of impaired mobility and disability for the ageing populations. Therefore, due to the increasing prevalence of the malady, it is expected that clinical and scientific practices had to be set in order to detect the problem in its early stages. Thus, this work will be focused on the improvement of methodologies for problem solving aiming at the development of Artificial Intelligence based decision support system to detect knee osteoarthritis. The framework is built on top of a Logic Programming approach to Knowledge Representation and Reasoning, complemented with a Case Based approach to computing that caters for the handling of incomplete, unknown, or even self-contradictory information.

Losing their marbles : syntax-free programming for assessing problem-solving skills

Novice programmers have difficulty developing an algorithmic solution while simultaneously obeying the syntactic constraints of the target programming language. To see how students fare in algorithmic problem solving when not burdened by syntax, we conducted an experiment in which a large class of beginning programmers were required to write a solution to a computational problem in structured English, as if instructing a child, without reference to program code at all. The students produced an unexpectedly wide range of correct, and attempted, solutions, some of which had not occurred to their teachers. We also found that many common programming errors were evident in the natural language algorithms, including failure to ensure loop termination, hardwiring of solutions, failure to properly initialise the computation, and use of unnecessary temporary variables, suggesting that these mistakes are caused by inexperience at thinking algorithmically, rather than difficulties in expressing solutions as program code.

Group metacognition during mathematical problem solving

Although various studies have shown that groups are more productive than individuals in complex mathematical problem solving, not all groups work together cooperatively. This review highlights that addressing organisational and cognitive factors to help scaffold group mathematical problem solving is necessary but not sufficient. Successful group problem solving also needs to incorporate metacognitive factors in order for groups to reflect on the organisational and cognitive factors influencing their group mathematical problem solving.

Future directions and perspectives for problem solving research and curriculum development

Since the 1960s, numerous studies on problem solving have revealed the complexity of the domain and the difficulty in translating research findings into practice. The literature suggests that the impact of problem solving research on the mathematics curriculum has been limited. Furthermore, our accumulation of knowledge on the teaching of problem solving is lagging. In this first discussion paper we initially present a sketch of 50 years of research on mathematical problem solving. We then consider some factors that have held back problem solving research over the past decades and offer some directions for how we might advance the field. We stress the urgent need to take into account the nature of problem solving in various arenas of today’s world and to accordingly modernize our perspectives on the teaching and learning of problem solving and of mathematical content through problem solving. Substantive theory development is also long overdue—we show how new perspectives on the development of problem solving expertise can contribute to theory development in guiding the design of worthwhile learning activities. In particular, we explore a models and modeling perspective as an alternative to existing views on problem solving.

Methodologies for investigating relationships between concept development and the development of problem solving abilities

This paper is the second in a pair that Lesh, English, and Fennewald will be presenting at ICME TSG 19 on Problem Solving in Mathematics Education. The first paper describes three shortcomings of past research on mathematical problem solving. The first shortcoming can be seen in the fact that knowledge has not accumulated – in fact it has atrophied significantly during the past decade. Unsuccessful theories continue to be recycled and embellished. One reason for this is that researchers generally have failed to develop research tools needed to reliably observe, document, and assess the development of concepts and abilities that they claim to be important. The second shortcoming is that existing theories and research have failed to make it clear how concept development (or the development of basic skills) is related to the development of problem solving abilities – especially when attention is shifted beyond word problems found in school to the kind of problems found outside of school, where the requisite skills and even the questions to be asked might not be known in advance. The third shortcoming has to do with inherent weaknesses in observational studies and teaching experiments – and the assumption that a single grand theory should be able to describe all of the conceptual systems, instructional systems, and assessment systems that strongly molded and shaped by the same theoretical perspectives that are being used to develop them. Therefore, this paper will describe theoretical perspectives and methodological tools that are proving to be effective to combat the preceding kinds or shortcomings. We refer to our theoretical framework as models & modeling perspectives (MMP) on problem solving (Lesh & Doerr, 2003), learning, and teaching. One of the main methodologies of MMP is called multi-tier design studies (MTD).