Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence.

Medical decision-making requires years of experience in order to develop an adequate level of competence to successfully engage in safe practice. While diagnostic and technical skills are essential, an awareness of the extent and limits of our own knowledge and skills is critical. The present study examines clinicians' subjective awareness in a diagnostic cardiac ultrasound task. Clinicians answered diagnostic and treatment related questions for a range of pathologies. Following these questions, clinicians indicated their level of confidence in their response. A comparison of response accuracy and confidence revealed that clinicians were generally overconfident in their responses. Critically, we observed that a clinician's overconfidence was negatively correlated with prior experience: clinicians that had more prior experience expressed less overconfidence in their performance such that some clinicians were in fact underconfident. We discuss the implications for training in medical education and decision-making.

Psychometrics and its discontents: an historical perspective on the discourse of the measurement tradition.

Psychometrics has recently undergone extensive criticism within the medical education literature. The use of quantitative measurement using psychometric instruments such as response scales is thought to emphasize a narrow range of relevant learner skills and competencies. Recent reviews and commentaries suggest that a paradigm shift might be presently underway. We argue for caution, in that the psychometrics approach and the quantitative account of competencies that it reflects is based on a rich discussion regarding measurement and scaling that led to the establishment of this paradigm. Rather than reflecting a homogeneous discipline focused on core competencies devoid of consideration of context, the psychometric community has a history of discourse and debate within the field, with an acknowledgement that the techniques and instruments developed within psychometrics are heuristics that must be used pragmatically.

Vulnerabilities in clinician-parent exchanges and the cascade of communication traps: a review.

This review considers parent-clinician interactions that are associated with vulnerabilities in communication and what we refer to as 'communication traps'. Communication traps are defined by high-stress situations with affect-laden subject matter that can lead to progressively dysfunctional communications/exchanges that are avoidable. While this framework was developed in neonatology, it can be applied to other clinical practices.Communication competencies in paediatrics require the rapid development of a therapeutic alliance between parents and clinicians to ensure the provision of best care to their infants. In order to facilitate parent-clinician communication, our framework focuses clinicians' attention on the affective, behavioural and cognitive (ABC) cues that are indicative of real, apparent or potential communication traps. Strategies are provided to slow down clinicians' responses to more effectively consider ABC cues that suggest if patients/parents have failed to engage or disengage from a situation. This framework is illustrated by presenting a narrative synthesised from a number of experiences that clinicians have encountered. This review identifies key decision points in the communication process that, if left unaddressed, can cascade into communication traps which may be difficult to escape.Using results from communication studies and psychological research, our framework was developed to identify key decision points for ABC cues that can be used to prevent falling into communication traps.

Persuasive Features of Scientific Explanations: Explanatory Schemata of Physical and Psychosocial Phenomena.

Explanations are central to understanding the causal relationships between entities within the environment. Instead of examining basic heuristics and schemata that inform the acceptance or rejection of scientific explanations, recent studies have predominantly examined complex explanatory models. In the present study, we examined which essential features of explanatory schemata can account for phenomena that are attributed to domain-specific knowledge. In two experiments, participants judged the validity of logical syllogisms and reported confidence in their response. In addition to validity of the explanations, we manipulated whether scientists or people explained an animate or inanimate phenomenon using mechanistic (e.g., force, cause) or intentional explanatory terms (e.g., believes, wants). Results indicate that intentional explanations were generally considered to be less valid than mechanistic explanations and that 'scientists' were relatively more reliable sources of information of inanimate phenomena whereas 'people' were relatively more reliable sources of information of animate phenomena. Moreover, after controlling for participants' performance, we found that they expressed greater overconfidence for valid intentional and invalid mechanistic explanations suggesting that the effect of belief-bias is greater in these conditions.

Dissociating affective and cognitive dimensions of uncertainty by altering regulatory focus.

Cognitive uncertainty is evidenced across learning, memory, and decision-making tasks. Uncertainty has also been examined in studies of positive affect and preference by manipulating stimulus presentation frequency. Despite the extensive research in both of these areas, there has been little systematic study into the relationship between affective and cognitive uncertainty. Using a categorization task, the present study examined changes in cognitive and affective uncertainty by manipulating stimulus presentation frequency and processing focus (i.e., promotion v. prevention focus). Following training, participants categorized stimuli and provided ratings of both typicality and negative affect. Results indicated that cognitive uncertainty was influenced by a categorical representation of stimuli whereas affective uncertainty was also influenced by exemplar presentation frequency during training. We additionally found that when the training was framed in terms of the avoidance of errors (i.e., a prevention focus), categorization performance was affected across the stimulus continuum whereas affective ratings remained unchanged.

Performance monitoring during categorization with and without prior knowledge: A comparison of confidence calibration indices with the certainty criterion.

Subjective confidence reports are used in numerous research paradigms to examine the extent to which participants are aware of their performance in a task. By examining the discrepancy between objective performance and subjective confidence ratings, inferences can be made about the conditions in which participants have greater explicit knowledge of the representations and processes used to complete a task. In the current study, we examined the effects of prior knowledge on subjective assessments of performance using a categorisation task wherein lists of features that defined exemplars shared latent feature associations on the basis of prior knowledge or had no prior associations. Using 2 methods for computing confidence, we demonstrate the strengths and limitations of these measures of subjective awareness. Whereas our findings replicated the effect of prior knowledge on learning, our results challenge the role of explicit and implicit knowledge suggested by previous research using a similar paradigm. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Beyond Fidelity: Deconstructing the Seductive Simplicity of Fidelity in Simulator-Based Education in the Health Care Professions.

STATEMENT: Fidelity has become a ubiquitous feature of discourse in simulation studies. Recent studies have highlighted the often ambiguous and contradictory manner in which fidelity has been defined, with each definition emphasizing different physical and functional features of simulation. We suggest that regarding fidelity as an objective property of a simulation obscures the interactive nature of the educator-learner relationship and should be abandoned. Rather than conceiving training as tasks performed by an individual in isolation, we suggest that it is more accurately understood as the social learning of affordances. Affordances represent the functional features of a simulator, which are taken as relevant in a specific learning context by means of analogy. Training is successful to the extent that educators and learners share an understanding of those affordances. Even when explicitly formulated, the concept of fidelity has greater difficulty accounting for the complex, interactional features of the training situation in comparison with accounts based on social learning. We conclude that continued attempts to redefine and use fidelity in the context of training will likely yield little benefit to the field compared with an interactive social learning framework.