Validity of entrustment scales within anesthesiology residency training.

INTRODUCTION: Competency-based medical education requires robust assessment in authentic clinical environments. Using work-based assessments, entrustment scales have emerged as a means of describing a trainee's ability to perform competently. Nevertheless, psychometric properties of entrustment-based assessment are relatively unknown, particularly in anesthesiology. This study assessed the generalizability and extrapolation evidence for entrustment scales within a program of assessment during anesthesiology training. METHODS: Entrustment scores were collected during the first seven blocks of training for three resident cohorts. Entrustment scores were assessed during daily evaluations using a Clinical Case Assessment Tool (CCAT) within the preoperative, intraoperative, and postoperative setting. The reliability of the entrustment scale was estimated using generalizability theory. Spearman's correlations measured the relationship between median entrustment scores and percentiles scores on the Anesthesia Knowledge Test (AKT)-1 and AKT-6, mean Objective Structured Clinical Examination (OSCE) scores, and rankings of performance by the Clinical Competence Committee (CCC). RESULTS: Analyses were derived from 2,309 CCATs from 35 residents. The reliability or generalizability (G) coefficient of the entrustment scale was 0.73 (95% confidence interval [CI], 0.70 to 0.76), and the internal consistency was 0.86 (95% CI, 0.84 to 0.88). Intraoperative entrustment scores significantly correlated with the AKT-6 (rho = 0.51, P = 0.01), mean OSCE (rho = 0.45, P = 0.04), and CCC performance rankings (rho = 0.52, P = 0.006). CONCLUSION: As part of an assessment program, entrustment scales used early during anesthesiology training showed evidence of validity. Intraoperative entrustment scores had good reliability and showed acceptable internal consistency. Interpreting entrustment scores in this setting may constitute a valuable adjunct complementing traditional summative evaluations.

RéSUMé: INTRODUCTION: La formation médicale fondée sur les compétences nécessite une évaluation rigoureuse dans des environnements cliniques authentiques. Se fondant sur des évaluations basées sur le travail, les échelles de confiance sont apparues comme une méthode pour décrire la capacité d'un résident à performer de façon compétente. Toutefois, les propriétés psychométriques de l'évaluation basée sur la confiance sont relativement peu connues, particulièrement en anesthésiologie. Cette étude a évalué les données de généralisabilité et d'extrapolation des échelles de confiance dans le cadre d'un programme d'évaluation pendant la formation en anesthésiologie. MéTHODE: Les notes sur les échelles de confiance ont été colligées pendant les sept premiers blocs de formation de trois cohortes de résidents. Les notes sur les échelles de confiance ont été évaluées pendant les évaluations quotidiennes à l'aide d'un Outil d'évaluation des compétences cliniques (CCAT ­ Clinical Case Assessment Tool) dans les cadres préopératoire, peropératoire et postopératoire. La fiabilité de l'échelle de confiance a été estimée à l'aide de la théorie de la généralisabilité. Les corrélations de Spearman ont mesuré la relation entre des notes moyennes sur l'échelle de confiance et les scores de percentile aux examens de connaissances en anesthésiologie AKT-1 et AKT-6, les scores moyens à l'Examen clinique objectif structuré (ECOS), et les classements de performance par le Comité de compétences cliniques (CCC). RéSULTATS: Les analyses ont été dérivées à partir de 2309 résultats CCAT de 35 résidents. Le coefficient de fiabilité ou de généralisabilité (G) de l'échelle de confiance était de 0,73 (intervalle de confiance [IC] 95 %, 0,70 à 0,76), et la cohérence interne était de 0,86 (IC 95 %, 0,84 à 0,88). Les scores de confiance peropératoires étaient corrélés de manière significative aux scores sur l'AKT-6 (rho = 0,51, P = 0,01), aux scores moyens à l'ECOS (rho = 0,45, P = 0,04) et aux classements de performance du CCC (rho = 0,52, P = 0,006). CONCLUSION: Dans le cadre d'un programme d'évaluation, la validité des échelles de confiance utilisées en début de la formation en anesthésiologie a été éprouvée. Les scores de confiance peropératoires ont démontré une bonne fiabilité et une cohérence interne acceptable. L'interprétation des scores de confiance dans ce cadre pourrait constituer un ajout précieux qui complèterait les évaluations sommatives.

The disconnect between knowing and doing in health professions education and practice.

Safe and effective healthcare requires that new knowledge or skills, once learned, are incorporated into professional practice. However, this process is not always straightforward. Learning takes place in complex contexts, requiring practitioners to overcome various motivational, systemic, emotional, and social barriers to the application of knowledge. This paper explores the mechanisms through which individuals translate knowledge into action to provide insight into why disconnects between knowledge and action can arise. As a critical review, the aim was to draw on key literature from multiple fields to analyse and synthesize existing schools of thought and lay a strong conceptual foundation on which knowledge to action gaps might be considered. We iteratively consulted clinicians and experts in various fields to guide literature searches focused on theoretical perspectives that could inform educational and research efforts around knowledge-to-action gaps. Key theoretical perspectives on motivation address when and how individuals decide to take action. Literatures from cognitive science address how clinicians and learners self-regulate to (sometimes) overcome barriers to action. Sociocultural theories examine the ways in which action might be prevented by social norms that conflict with what the individual knows and believes, potentially also giving rise to counter-normative action. No single perspective will entirely explain how health professionals and learners implement knowledge in practice. As a result, the authors offer multiple lenses through which to view the problem, and then propose how each of these lenses might better guide educational and research efforts to untangle this challenging but important issue.

Use of the KT-MCC strategy to improve the quality of decision making for multidisciplinary cancer conferences: a pilot study.

BACKGROUND: Multidisciplinary Cancer Conferences (MCCs) are increasingly used to guide treatment decisions for patients with cancer, though numerous barriers to optimal MCC decision-making quality have been identified. We aimed to improve the quality of MCC decision making through the use of an implementation bundle titled the KT-MCC Strategy. The Strategy included use of discussion tools (standard case intake tool and a synoptic discussion tool), workshops, MCC team and chair training, and audit and feedback. Implementation strategies were selected using a theoretically-rooted and integrated KT approach, meaning members of the target population (MCC participants) assisted with the design and implementation of the intervention and strategies. We evaluated implementation quality of the KT-MCC Strategy and initial signals of impact on decision making quality. METHODS: This was a before-and-after study design among 4 MCC teams. Baseline data (before-phase) were collected for a period of 2 months to assess the quality of MCC decision making. Study teams selected the intervention strategies they wished to engage with. Post-intervention data (after-phase) were collected for 4 months. Implementation quality outcomes included reach, adherence/fidelity and adaptation. We also evaluated feasibility of data management. Decision making quality was evaluated on a per-case and per-round level using the MTB-MODe and MDT-OARS tools, respectively. RESULTS: There were a total of 149 cases and 23 MCCs observed in the before phase and 260 cases and 35 MCCs observed in the after phase. Teams implemented 3/5 strategies; adherence to selected strategies varied by MCC team. The per-round quality of MCCs improved by 11% (41.0 to 47.3, p = < 0.0001). The quality of per-case decision-making did not improve significantly (32.3 to 32.6, p = 0.781). CONCLUSION: While per round MCC decision making quality improved significantly, per-case decision-making quality did not. We posit that the limited improvements on decision making quality may be attributed to implementation quality gaps, including a lack of uptake of and adherence to theoretically-identified implementation strategies. Our findings highlight the importance of evaluating implementation quality and processes, iterative testing, and engagement of key gatekeepers in the implementation process.

Use of the theoretical domains framework and behaviour change wheel to develop a novel intervention to improve the quality of multidisciplinary cancer conference decision-making.

BACKGROUND: Multidisciplinary Cancer Conferences (MCCs) are prospective meetings involving cancer specialists to discuss treatment plans for patients with cancer. Despite reported gaps in MCC quality, there have been few efforts to improve its functioning. The purpose of this study was to use theoretically-rooted knowledge translation (KT) theories and frameworks to inform the development of a strategy to improve MCC decision-making quality. METHODS: A multi-phased approach was used to design an intervention titled the KT-MCC Strategy. First, key informant interviews framed using the Theoretical Domains Framework (TDF) were conducted with MCC participants to identify barriers and facilitators to optimal MCC decision-making. Second, identified TDF domains were mapped to corresponding strategies using the COM-B Behavior Change Wheel to develop the KT-MCC Strategy. Finally, focus groups with MCC participants were held to confirm acceptability of the proposed KT-MCC Strategy. RESULTS: Data saturation was reached at n = 21 interviews. Twenty-seven barrier themes and 13 facilitator themes were ascribed to 11 and 10 TDF domains, respectively. Differences in reported barriers by physician specialty were observed. The resulting KT-MCC Strategy included workshops, chair training, team training, standardized intake forms and a synoptic discussion checklist, and, audit and feedback. Focus groups (n = 3, participants 18) confirmed the acceptability of the identified interventions. CONCLUSION: Myriad factors were found to influence MCC decision making. We present a novel application of the TDF and COM-B to the context of MCCs. We comprehensively describe the barriers and facilitators that impact MCC decision making and propose strategies that may positively impact the quality of MCC decision making.

The benefits of testing for learning on later performance.

Testing has been shown to enhance retention of learned information beyond simple studying, a phenomena known as test-enhanced learning (TEL). Research has shown that TEL effects are greater for tests that require the production of responses [e.g., short-answer questions (SAQs)] relative to tests that require the recognition of correct answers [e.g., multiple-choice questions (MCQs)]. High stakes licensure examinations have recently differentiated MCQs that require the application of clinical knowledge (context-rich MCQs) from MCQs that rely on the recognition of "facts" (context-free MCQs). The present study investigated the influence of different types of educational activities (including studying, SAQs, context-rich MCQs and context-free MCQs) on later performance on a mock licensure examination. Fourth-year medical students (n = 224) from four Quebec universities completed four educational activities: one reading-based activity and three quiz-based activities (SAQs, context-rich MCQs, and context-free MCQs). We assessed the influence of the type of educational activity on students' subsequent performance in a mock licensure examination, which consisted of two types of context-rich MCQs: (1) verbatim replications of previous items and (2) items that tested the same learning objective but were new. Mean accuracy scores on the mock licensure exam were higher when intervening educational activities contained either context-rich MCQs (Mean z-score = 0.40) or SAQs (M = 0.39) compared to context-free MCQs (M = -0.38) or study only items (M = -0.42; all p < 0.001). Higher mean scores were only present for verbatim items (p < 0.001). The benefit of testing was observed when intervening educational activities required either the generation of a response (SAQs) or the application of knowledge (context-rich MCQs); however, this effect was only observed for verbatim test items. These data provide evidence that context-rich MCQs and SAQs enhance learning through testing compared to context-free MCQs or studying alone. The extent to which these findings generalize beyond verbatim questions remains to be seen.

Predictable chaos: a review of the effects of emotions on attention, memory and decision making.

Healthcare practice and education are highly emotional endeavors. While this is recognized by educators and researchers seeking to develop interventions aimed at improving wellness in health professionals and at providing them with skills to deal with emotional interpersonal situations, the field of health professions education has largely ignored the role that emotions play on cognitive processes. The purpose of this review is to provide an introduction to the broader field of emotions, with the goal of better understanding the integral relationship between emotions and cognitive processes. Individuals, at any given time, are in an emotional state. This emotional state influences how they perceive the world around them, what they recall from it, as well as the decisions they make. Rather than treating emotions as undesirable forces that wreak havoc on the rational being, the field of health professions education could be enriched by a greater understanding of how these emotions can shape cognitive processes in increasingly predictable ways.

Evaluating the Construct Validity of Competencies: A Retrospective Analysis.

Background: A competency-based framework focuses on alignment between professional standards and assessment design. This alignment implies improved measurement validity, yet it has not been established that competence in one context predicts performance in another context. High-stakes competence assessments offer insights into the relationship between assessment design and competencies. Methods/Analyses: The internationally educated nurses competency assessment program (IENCAP) was developed at Touchstone Institute in collaboration with the College of Nurses of Ontario (CNO) and includes a 12-station OSCE. Each station evaluated the same 10 competencies. We submitted competency scores to a multi-trait multi-method matrix analysis to evaluate the convergent and discriminant validity of competencies. Results/Observations: All correlations were significant and positive; however, we did not find evidence of convergent or discriminant validity. Correlations were higher between different competencies evaluated within the same station (mean correlation = 0.60) compared to identical competencies evaluated across different stations (mean correlation = 0.19). Discussion: The results do not provide evidence of construct validity for competencies. While competency-based approaches emphasize various generalized knowledge, skills, and attitudes, these findings indicate that the clinical context is a major determinant of performance. Conclusion: The context-dependent nature of competencies requires multiple assessments in varied contexts. Performance on a single competency cannot be determined in a single occasion. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01794-z.

Is COVID-19 perceived as a threat to equal career opportunities amongst Swiss medical students? A cross-sectional survey study from Bern and Geneva.

Introduction: Students frequently rely on part-time jobs to earn a living wage. We sought to evaluate the sociodemographic status of Swiss medical students and their perception regarding equal career opportunities in view of impaired part-time job opportunities under the COVID-19 pandemic. Methods: We conducted an anonymous online survey among Swiss medical students from Bern and Geneva over a period of 4 months between December 2020 and April 2021. We evaluated sociodemographic data, current living situation, part-time job occupation as well as other sources of income to fund living expenses, and, by means of a five-point Likert scale (1=strongly disagree and 5=strongly agree), whether COVID-19 was perceived as impeding equal career opportunities. Results: Of 968 participants, corresponding to around 13.8% of all medical students in Switzerland, 81.3% had part-time jobs. Amongst the employed, 54.8% worked to afford living expenses and 28.9% reported a negative financial impact due to reduced part-time jobs under the pandemic. The loss of part-time jobs was perceived to make medical studies a privilege for students with higher socioeconomic status (4.11±1.0), whose opportunity to study is independent of a regular income. A governmental backup plan was considered crucial to support affected students (4.22±0.91). Discussion: COVID-19 and its sequelae are perceived as a threat for Swiss medical students and lead to a disadvantage for those with lower socioeconomic status. Nationwide measures should be established to foster equal career opportunities.

Self-monitoring and its relationship to medical knowledge.

In the domain of self-assessment, researchers have begun to draw distinctions between summative self-assessment activities (i.e., making an overall judgment of one's ability in a particular domain) and self-monitoring processes (i.e., an "in the moment" awareness of whether one has the necessary knowledge or skills to address a specific problem with which one is faced). Indeed, previous research has shown that, when responding to both short answer and multiple choice questions, individuals are able to assess the likelihood of answering questions correctly on a moment-by-moment basis, even though they are not able to generate an accurate self-assessment of overall performance on the test. These studies, however, were conducted in the context of low-stakes tests of general "trivia". The purpose of the present study was to further this line of research by investigating the relationship between self-monitoring and performance in the context of a high stakes test assessing medical knowledge. Using a recent administration of the Medical Council of Canada Qualifying Examination Part I, we examined three measures intended to capture self-monitoring: (1) the time taken to respond to each question, (2) the number of questions a candidate flagged as needing to be considered further, and (3) the likelihood of changing one's initial answer. Differences in these measures as a function of the accuracy of the candidate's response were treated as indices of each candidate's ability to judge his or her likelihood of responding correctly. The three self-monitoring indices were compared for candidates at three different levels of overall performance on the exam. Relative to correct responses, when examinees initially responded incorrectly, they spent more time answering the question, were more likely to flag the question for future consideration, and were more likely to change their answer before committing to a final answer. These measures of self-monitoring were modulated by candidate performance in that high performing examinees showed greater differences on these indices relative to poor performing examinees. Furthermore, reliability analyses suggest that these difference measures hold promise for reliably differentiating self-monitoring at the level of individuals, at least within a given content area. The results suggest that examinees were self-monitoring their knowledge and skills on a question by question basis and altering their behavior appropriately in the moment. High performing individuals showed stronger evidence of accurate self-monitoring than did low performing individuals and the reliability of these measures suggests that they have the potential to differentiate between individuals. How these findings relate to performance in actual clinical settings remains to be seen.

The Importance of Sociocultural Factors in Moderating the Applicability of Test-Enhanced Learning to Continuing Professional Development.

ABSTRACT: Many studies have shown that repeated testing promotes learning, an effect known as test-enhanced learning. Although test-enhanced learning has been well-established within health care trainees, there are mixed findings of whether testing facilitates learning within continuing professional development (CPD) contexts. This piece argues that for testing to support learning in CPD, there is need to understand the various social, cultural, and structural factors that influence clinicians' willingness to participate in regular testing activities. The solution to this problem is conceptual in nature, whereby CPD programs must consider how learning cultures shape practicing clinicians' perspectives toward testing.

Upbeat and happy: arousal as an important factor in studying attention.

The present study examined the effects of music-induced mood changes on different components of visual attention. Affective valence (positive vs. negative) and arousal (high vs. low) were manipulated by having participants listen to one of four versions of a Mozart Sonata that varied in mode (major or minor) and tempo (fast or slow). Attention was measured in three domains-alerting, orienting, and executive control. Affective valence and arousal had an effect on executive control, but not on alerting or orienting. Individuals who experienced positive valence had less efficient control over their responses than those who experienced negative valence, but only when arousal levels were high. Positive and negative valence did not influence executive control measures when arousal levels were low. These findings demonstrate that affective valence and arousal interact with one another to influence the processing of items in visual attention.

One Room Schoolhouse: A Novel Intervention for Inspired Academic Half-Day Learning in Distributed Campus Settings.

INTRODUCTION: Some studies on academic half days (AHDs) suggest that learning in this context is associated with a lack of educational engagement. This challenge may be amplified in distributed campus settings, where geographical disadvantages demand reliance on videoconferencing or considerable time spent travelling to in-person learning events. Concerns about the educational effectiveness of AHDs by learners within our distributed campus setting led to the development and evaluation of the One Room Schoolhouse (ORS), a unique, evidence-informed, community-based curriculum that partially replaced the AHD sessions delivered at the main campus. It was hypothesized that creating an AHD experience that was clinically reflective of the community in which residents practiced and where residents were given the autonomy to implement novel pedagogical elements would result in better test scores and improved learner satisfaction among ORS learners. METHODS: The ORS was implemented at McMaster University's Waterloo Regional Campus in 2017. Residents across training cohorts (N = 9) engaged in co-learning based on scenarios co-developed from clinical experiences within the region. The learning approach relied on multiple, evidence-informed pedagogical strategies. A multi-method approach was used to evaluate the ORS curriculum. Between-subject analyses of variance were used to compare scores on practice exams (COPE and PRITE), in-training assessment reports (ITARs), and objective structured clinical exams (OSCEs) between learners who took part in the ORS and learners at the main campus. A semi-structured focus group probing residents' experiences with the ORS was analyzed using interpretive description. RESULTS: ORS learners significantly outperformed learners at the main campus on the November OSCE (p = .02), but not on the COPE, PRITE, ITARs, or September OSCE (p's < .05). Qualitative themes suggested advantages of the ORS in inspiring learning, engaging learners, and improving self-confidence in knowledge acquisition. These findings are aligned with the broader literature on learner agency, social development, and communities of practice. CONCLUSION: While the quantitative data only showed a significant difference between the 2 curricula on 1 measure (ie, the November OSCE), the qualitative findings offered an opportunity for educators to reimagine what medical education might consist of beyond the confines of a "traditional" AHD. Creating opportunities to enhance personal agency when acquiring knowledge, inspiring engagement about patient-related problems, and incorporating interdisciplinary learning through community engagement were critical pedagogical elements that were attributed to the success of the ORS.

Classic test and generalizability theories are both useful for cross-cultural adaptation of an allergic rhinitis health-related quality of life questionnaire.

BACKGROUND: An instrument to assess Allergic Rhinitis (AR) Health-Related Quality of Life (HRQL) in adult patients was developed in Spain. No validated instrument is currently cross-culturally adapted for use in daily practice to assess HRQL in AR patients in Colombia. PURPOSE: The aim of this study was to evaluate the measurement performance of an AR-HRQL specific questionnaire, ESPRINT-15 (Cuestionario ESPañol de Calidad de Vida en RINiTis), in Colombian adult patients with AR using the Classic Test Theory (CTT) and the Generalizability theory (G-theory) frameworks. METHODS: We conducted the cross-cultural adaptation in 2 stages. In stage 1, we evaluated comprehensibility, acceptability, and feasibility of ESPRINT-15 in healthy adults and adult patients with AR. In stage 2, we examined both reliability and validity of ESPRINT-15 scores using CTT and overall reliability applying the G-theory in adult patients with AR. RESULTS: For feasibility and acceptability, all items showed a higher than 95% level of understanding, and modifications in the original questionnaire were unnecessary. Reliability and validity using CTT showed a high internal consistency (Cronbach's alpha and Mc McDonald's omega = 0.95) and test-retest reliability (scores from 0.70 to 0.76). The overall reliability score using G-theory was 0.75, and G-coefficients scores associated with internal consistency and test-retest reliability measures were 0.96 and 0.61, respectively. Validity using exploratory factor analysis (EFA) identified 2 factors instead of the original ESPRINT-15 4 domains. However, confirmatory factor analysis (CFA) showed good fit regarding the original model. CONCLUSIONS: The proposed cross-cultural adaptation of ESPRINT-15 showed good reliability and validity measures. Additionally, it was easy to use and administer. ESPRINT-15 can be used clinically and for research in Colombian adults' patients with AR. CTT and the G-theory can be used in epidemiological studies to adapt AR-HRQL questionnaires cross-culturally in adult patients with AR.

Relationship between ratings of performance in the simulated and workplace environments among emergency medicine residents.

OBJECTIVES: The Emergency Medicine (EM) Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) specifies that resuscitation entrustable professional activities (EPAs) can be assessed in the workplace and simulated environments. However, limited validity evidence for these assessments in either setting exists. We sought to determine if EPA ratings improve over time and whether an association exists between ratings in the workplace v. simulation environment. METHODS: All Foundations EPA1 (F1) assessments were collected for first-year residents (n = 9) in our program during the 2018-2019 academic year. This EPA focuses on initiating and assisting in the resuscitation of critically ill patients. EPA ratings obtained in the workplace and simulation environments were compared using Lin's concordance correlation coefficient (CCC). To determine whether ratings in the two environments differed as residents progressed through training, a within-subjects analysis of variance was conducted with training environment and month as independent variables. RESULTS: We collected 104 workplace and 36 simulation assessments. No correlation was observed between mean EPA ratings in the two environments (CCC(8) = -0.01; p = 0.93). Ratings in both settings improved significantly over time (F(2,16) = 18.8; p < 0.001; η2 = 0.70), from 2.9 ± 1.2 in months 1-4 to 3.5 ± 0.2 in months 9-12. Workplace ratings (3.4 ± 0.1) were consistently higher than simulation ratings (2.9 ± 0.2) (F(2,16) = 7.2; p = 0.028; η2 = 0.47). CONCLUSIONS: No correlation was observed between EPA F1 ratings in the workplace v. simulation environments. Further studies are needed to clarify the conflicting results of our study with others and build an evidence base for the validity of EPA assessments in simulated and workplace environments.

From good to great: learners' perceptions of the qualities of effective medical teachers and clinical supervisors in psychiatry.

BACKGROUND: The shift in postgraduate medical training towards a competency-based medical education framework has inspired research focused on medical educator competencies. This research has rarely considered the importance of the learning environment in terms of both setting and specialty-specific factors. The current study attempted to fill this gap by examining narrative comments from psychiatry faculty evaluations to understand learners' perceptions of educator effectiveness. METHODS: Data consisted of psychiatry faculty evaluations completed in 2015-2016 by undergraduate and postgraduate learners (N = 324) from McMaster University. Evaluations were provided for medical teachers and clinical supervisors in classroom and clinical settings. Narrative comments were analyzed using descriptive qualitative methodology by three independent reviewers to answer: "What do undergraduate and postgraduate medical learners perceive about educator effectiveness in psychiatry?" RESULTS: Narrative comments were provided on 270/324 (83%) faculty evaluation forms. Four themes and two sub- themes emerged from the qualitative analysis. Effective psychiatry educators demonstrated specific personal characteristics that aligned with previous research on educator effectiveness. Novel themes included the importance of relationships and affective factors, including learner security and inspiration through role modeling. CONCLUSION: Contemporary discussions about educator effectiveness in psychiatry have excluded the dynamic, relational and affective components of the educational exchange highlighted in the current study. This may be an important focus for future educational research.

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

PURPOSE: Training to become a physician is an emotionally laden experience. Research in cognitive psychology indicates that emotions can influence learning and performance, but the materials used in such research (e.g., word lists) rarely reflect the complexity of material presented in medical school. The present study examined whether emotions influence learning of basic science principles. METHOD: Fifty-five undergraduate psychology students were randomly assigned to write about positive, negative, or neutral life events for nine minutes. Participants were then taught three physiological concepts, each in the context of a single organ system. Testing consisted of 13 clinical cases, 7 presented with the same concept/organ system pairing used during training ("near transfer") and 6 with novel pairings ("far transfer"). Testing was repeated after one week with 13 additional cases. RESULTS: Forty-nine students provided complete data. Higher test scores were found when the concept/organ system pairing was held constant (near transfer = 51% correct vs. far = 33%; P < .001). Emotion condition influenced participants' overall performance, with individuals in the neutral condition (50.1%) performing better than those in the positive (38.2%, P < .05) and negative (37.7%, P < .001) emotion conditions. CONCLUSIONS: These data suggest that regardless of whether the emotion is positive or negative, mild affective states can impair learning of basic science concepts by novices. Demands on working memory and subsequent cognitive load provide a potential explanation. Future work will examine the extent to which these findings generalize to medical trainees.