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Investigating Undergraduate Students' Use of Intuitive Reasoning and Evolutionary Knowledge in Explanations of Antibiotic Resistance.

ABSTRACT: Natural selection is a central concept throughout biology; however, it is a process frequently misunderstood. Bacterial resistance to antibiotic medications provides a contextual example of the relevance of evolutionary theory and is also commonly misunderstood. While research has shed light on student misconceptions of natural selection, minimal study has focused on misconceptions of antibiotic resistance. Additionally, research has focused on the degree to which misconceptions may be based in the complexity of biological information or in pedagogical choices, rather than in deep-seated cognitive patterns. Cognitive psychology research has established that humans develop early intuitive assumptions to make sense of the world. In this study, we used a written assessment tool to investigate undergraduate students' misconceptions of antibiotic resistance, use of intuitive reasoning, and application of evolutionary knowledge to antibiotic resistance. We found a majority of students produced and agreed with misconceptions, and intuitive reasoning was present in nearly all students' written explanations. Acceptance of a misconception was significantly associated with production of a hypothesized form of intuitive thinking (all p ? 0.05). Intuitive reasoning may represent a subtle but innately appealing linguistic shorthand, and instructor awareness of intuitive reasoning's relation to student misunderstandings has potential for addressing persistent misconceptions.

SUBMITTER: Richard M

PROVIDER: S-EPMC5589435 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Investigating Undergraduate Students' Use of Intuitive Reasoning and Evolutionary Knowledge in Explanations of Antibiotic Resistance.

Richard Melissa M Coley John D JD Tanner Kimberly D KD

CBE life sciences education 20170101 3

Natural selection is a central concept throughout biology; however, it is a process frequently misunderstood. Bacterial resistance to antibiotic medications provides a contextual example of the relevance of evolutionary theory and is also commonly misunderstood. While research has shed light on student misconceptions of natural selection, minimal study has focused on misconceptions of antibiotic resistance. Additionally, research has focused on the degree to which misconceptions may be based in ...[more]

PMID: 28821540

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Project description:To successfully learn using open Internet resources, students must be able to critically search, evaluate and select online information, and verify sources. Defined as critical online reasoning (COR), this construct is operationalized on two levels in our study: (1) the student level using the newly developed Critical Online Reasoning Assessment (CORA), and (2) the online information processing level using event log data, including gaze durations and fixations. The written responses of 32 students for one CORA task were scored by three independent raters. The resulting score was operationalized as "task performance," whereas the gaze fixations and durations were defined as indicators of "process performance." Following a person-oriented approach, we conducted a process mining (PM) analysis, as well as a latent class analysis (LCA) to test whether-following the dual-process theory-the undergraduates could be distinguished into two groups based on both their process and task performance. Using PM, the process performance of all 32 students was visualized and compared, indicating two distinct response process patterns. One group of students (11), defined as "strategic information processers," processed online information more comprehensively, as well as more efficiently, which was also reflected in their higher task scores. In contrast, the distributions of the process performance variables for the other group (21), defined as "avoidance information processers," indicated a poorer process performance, which was also reflected in their lower task scores. In the LCA, where two student groups were empirically distinguished by combining the process performance indicators and the task score as a joint discriminant criterion, we confirmed these two COR profiles, which were reflected in high vs. low process and task performances. The estimated parameters indicated that high-performing students were significantly more efficient at conducting strategic information processing, as reflected in their higher process performance. These findings are so far based on quantitative analyses using event log data. To enable a more differentiated analysis of students' visual attention dynamics, more in-depth qualitative research of the identified student profiles in terms of COR will be required.

Project description:BACKGROUND:Over-testing of patients is a significant problem in clinical medicine that can be tackled by education. Clinical reasoning learning (CRL) is a potentially relevant method for teaching test ordering and interpretation. The feasibility might be improved by using an interactive whiteboard (IWB) during the CRL sessions to enhance student perceptions and behaviours around diagnostic tests. Overall, IWB/CRL could improve their skills. METHODS:Third-year undergraduate medical students enrolled in a vertically integrated curriculum were randomized into two groups before clinical placement in either a respiratory disease or respiratory physiology unit: IWB-based CRL plus clinical mentoring (IWB/CRL + CM: n = 40) or clinical mentoring only (CM-only: n = 40). Feasibility and learning outcomes were assessed. In addition, feedback via questionnaire of the IWB students and their classmates (n = 233) was compared. RESULTS:Analyses of the IWB/CRL sessions (n = 40, 27 paperboards) revealed that they met validated learning objectives. Students perceived IWB as useful and easy to use. After the IWB/CRL + CM sessions, students mentioned more hypothesis-based indications in a test ordering file (p < 0.001) and looked for more nonclinical signs directly on raw data tests (p < 0.01) compared with students in the CM-only group. Last, among students who attended pre- and post-assessments (n = 23), the number of diagnostic tests ordered did not change in the IWB/CRL + CM group (+ 7%; p = N.S), whereas it increased among CM-only students (+ 30%; p < 0.001). Test interpretability increased significantly in the IWB/CRL + CM group (from 4.7 to 37.2%; p < 0.01) but not significantly in the CM-only group (from 2.4 to 9.8%; p = 0.36). CONCLUSIONS:Integrating IWB into CRL sessions is feasible to teach test ordering and interpretation to undergraduate students. Moreover, student feedback and prospective assessment suggested a positive impact of IWB/CRL sessions on students' learning.

Project description:BACKGROUND AND OBJECTIVE:Intuition is an important part of human decision-making and can be explained by the dual-process theory where analytical and non-analytical reasoning processes continually interact. These processes can also be identified in physicians' diagnostic reasoning. The valuable role of intuition, including gut feelings, has been shown among general practitioners and nurses, but less is known about its role among hospital specialists. This study focused on the diagnostic reasoning of hospital specialists, how they value, experience and use intuition. DESIGN AND PARTICIPANTS:Twenty-eight hospital specialists in the Netherlands and Belgium participated in six focus groups. The discussions were recorded, transcribed verbatim and thematically coded. A circular and iterative analysis was applied until data saturation was achieved. RESULTS:Despite initial reservations regarding the term intuition, all participants agreed that intuition plays an important role in their diagnostic reasoning process. Many agreed that intuition could guide them, but were cautious not to be misguided. They were especially cautious since intuition does not have probative force, for example, in medicolegal situations. 'On-the-job experience' was regarded as a precondition to relying on intuition. Some participants viewed intuition as non-rational and invalid. All participants said that intuitive hunches must be followed by analytical reasoning. Cultural differences were not found. Both the doctor as a person and his/her specialty were seen as important determinants for using intuition. CONCLUSIONS:Hospital specialists use intuitive elements in their diagnostic reasoning, in line with general human decision-making models. Nevertheless, they appear to disagree more on its role and value than previous research has shown among general practitioners. A better understanding of how to take advantage of intuition, while avoiding pitfalls, and how to develop 'skilled' intuition may improve the quality of hospital specialists' diagnostic reasoning.

Project description:Background: Clinical reasoning refers to a thinking process including medical problem solving and medical decision making skills. Several studies have shown that the clinical reasoning process can be influenced by a number of factors, e.g. context or personality traits, and the results of this thinking process are expressed in case presentation. The aim of this study was to identify factors, which predict the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students in an assessment simulating the first day of residency. Methods: To investigate factors predicting aspects of clinical reasoning 67 advanced undergraduate medical students participated in the role of a beginning resident in our competence-based assessment, which included a consultation hour, a patient management phase, and a handover. Participants filled out a Post Encounter Form (PEF) to document their case summary statements and other aspects of clinical reasoning. After each phase, they filled out the Strain Perception Questionnaire (STRAIPER) to measure their situation dependent mental strain. To assess medical knowledge the participants completed a 100 questions multiple choice test. To measure stress resistance, adherence to procedures, and teamwork students took part in the Group Assessment of Performance (GAP) test for flight school applicants. These factors were included in a multiple linear regression analysis. Results: Medical knowledge and teamwork predicted the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students and explained approximately 20.3% of the variance. Neither age, gender, undergraduate curriculum, academic advancement nor high school grade point average of the medical students of our sample had an effect on their clinical reasoning skills. Conclusion: The quality of case summary statements as an indicator of clinical reasoning can be predicted in undergraduate medical students by their medical knowledge and teamwork. Students should be supported in developing abilities to work in a team and to acquire long term knowledge for good case summary statements as an important aspect of clinical reasoning.

Project description:IntroductionProper measures to combat antimicrobial resistance development and spread in Sub Saharan Africa are very crucial bearing in mind the projected burden of antimicrobial resistance which is expected to be increase by 2050. Training of medical doctor and pharmacy students in antimicrobial stewardship is vital to combat antimicrobial resistance. This study was designed to evaluate the knowledge, attitude, and perception of final year medical and pharmacy students on antimicrobial use and antimicrobial resistance at three universities in Uganda, Kenya, and Tanzania.MethodologyA cross-sectional survey was carried out among final year undergraduate medical and pharmacy students at three universities in East Africa. A Self-administered questionnaire was developed which included dichotomous questions and questions using a 4-point Likert scale. The questions were based on knowledge and attitude about antibiotics, and preparedness to use antibiotics in clinical scenarios. Data were analyzed using STATA version 16 following the objective of the study.ResultsThree hundred and twenty-eight final year students participated in the survey from MUK 75, MKU 75 and CUHAS 178. Slightly majority of participants were male 192(58.5%) and their median age was 25 [23 - 27] years. In general, 36.6% (120/328) of students had good overall total knowledge. More students at MUK had good knowledge compared to MKU, and CUHAS (72% vs, 40% vs. 20.2%; p<0.001). The mean scores for overall good total knowledge, general knowledge about antibiotics, knowledge about antibiotic resistance, and knowledge about antibiotic use in clinical scenarios were 58% (CI: 57%- 60%), 95% (CI: 94%- 97%), 54% (CI: 52% - 56%), and 46% (CI:44% - 48%) respectively. More pharmacy students compared to medical students had a good attitude and perception on antibiotic use (79.6% vs. 68.4%; p = 0.026). The students at CUHAS perceived being more prepared to use antibiotic in district hospitals compared to MKU and MUK (75.3% vs. 62.7% vs. 65.3%; p = 0.079). While two hundred and seventy (82.3%) students perceived knowing when to start antimicrobial therapy, 112 (34.2%) did not know how to select the appropriate antibiotic (p<0.0001), 97 (29.6%) did not know the antibiotic dose to give (p<0.0001), and 111 (33.8%) did not know when to switch form an intravenous antibiotic to oral regimen (p<0.0001).ConclusionFinal year students have low scores in knowledge about antimicrobial resistance and antibiotic use in clinical scenarios. This has exposed gaps in practical training of students, while they may feel confident, are not fully prepared to prescribe antibiotics in a hospital setting. A multidisciplinary and practical approach involving medical schools across the East African region should be undertaken to train final year undergraduate students in antimicrobial resistance and antimicrobial stewardship programs. Antimicrobial resistance and antimicrobial stewardship courses should be introduced into the curriculum of final year medicine and pharmacy programs.

Project description:BACKGROUND:The clinical reasoning process, which requires biomedical knowledge, knowledge about problem-solving strategies, and knowledge about reasons for diagnostic procedures, is a key element of physicians' daily practice but difficult to assess. The aim of this study was to empirically develop a Clinical Reasoning Indicators-History Taking-Scale (CRI-HT-S) and to assess the clinical reasoning ability of advanced medical students during a simulation involving history taking. METHODS:The Clinical Reasoning Indictors-History Taking-Scale (CRI-HT-S) including a 5-point Likert scale for assessment was designed from clinical reasoning indicators identified in a qualitative study in 2017. To assess indicators of clinical reasoning ability, 65 advanced medical students (semester 10, n =?25 versus final year, n =?40) from three medical schools participated in a 360-degree competence assessment in the role of beginning residents during a simulated first workday in hospital. This assessment included a consultation hour with five simulated patients which was videotaped. Videos of 325 patient consultations were assessed using the CRI-HT-S. A factor analysis was conducted and the students' results were compared according to their advancement in undergraduate medical training. RESULTS:The clinical reasoning indicators of the CRI-HT-S loaded on three factors relevant for clinical reasoning: 1) focusing questions, 2) creating context, and 3) securing information. Students reached significantly different scores (p <?.001) for the three factors (factor 1: 4.07?±?.47, factor 2: 3.72?±?.43, factor 3: 2.79?±?.83). Students in semester 10 reached significantly lower scores for factor 3 than students in their final year (p <?.05). CONCLUSIONS:The newly developed CRI-HT-S worked well for quantitative assessment of clinical reasoning indicators during history taking. Its three-factored structure helped to explore different aspects of clinical reasoning. Whether the CRI-HT-S has the potential to be used as a scale in objective structured clinical examinations (OCSEs) or in workplace-based assessments of clinical reasoning has to be investigated in further studies with larger student cohorts.

Dataset Information

Investigating Undergraduate Students' Use of Intuitive Reasoning and Evolutionary Knowledge in Explanations of Antibiotic Resistance.

Publications

Investigating Undergraduate Students' Use of Intuitive Reasoning and Evolutionary Knowledge in Explanations of Antibiotic Resistance.

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