Cognitive perspectives on maintaining physicians' medical expertise: V. Using a motivational framework to understand the benefits and costs of testing.

We apply a motivational perspective to understand the implications of physicians' longitudinal assessment. We review the literature on situated expectancy-value theory, achievement goals, mindsets, anxiety, and stereotype threat in relation to testing and assessment. This review suggests several motivational benefits of testing as well as some potential challenges and costs posed by high-stakes, standardized tests. Many of the motivational benefits for testing can be understood from the equation of having the perceived benefits of the test outweigh the perceived costs of preparing for and taking the assessment. Attention to instructional framing, test purposes and values, and longitudinal assessment frameworks provide vehicles to further enhance motivational benefits and reduce potential costs of assessment.

Cognitive perspectives on maintaining physicians' medical expertise: III. Strengths and weaknesses of self-assessment.

Is self-assessment enough to keep physicians' cognitive skills-such as diagnosis, treatment, basic biological knowledge, and communicative skills-current? We review the cognitive strengths and weaknesses of self-assessment in the context of maintaining medical expertise. Cognitive science supports the importance of accurately self-assessing one's own skills and abilities, and we review several ways such accuracy can be quantified. However, our review also indicates a broad challenge in self-assessment is that individuals do not have direct access to the strength or quality of their knowledge and instead must infer this from heuristic strategies. These heuristics are reasonably accurate in many circumstances, but they also suffer from systematic biases. For example, information that feels easy to process in the moment can lead individuals to overconfidence in their ability to remember it in the future. Another notable phenomenon is the Dunning-Kruger effect: the poorest performers in a domain are also the least accurate in self-assessment. Further, explicit instruction is not always sufficient to remove these biases. We discuss what these findings imply about when physicians' self-assessment can be useful and when it may be valuable to supplement with outside sources.

Cognitive perspectives on maintaining physicians' medical expertise: IV. Best practices and open questions in using testing to enhance learning and retention.

Although tests and assessments-such as those used to maintain a physician's Board certification-are often viewed merely as tools for decision-making about one's performance level, strong evidence now indicates that the experience of being tested is a powerful learning experience in its own right: The act of retrieving targeted information from memory strengthens the ability to use it again in the future, known as the testing effect. We review meta-analytic evidence for the learning benefits of testing, including in the domain of medicine, and discuss theoretical accounts of its mechanism(s). We also review key moderators-including the timing, frequency, order, and format of testing and the content of feedback-and what they indicate about how to most effectively use testing for learning. We also identify open questions for the optimal use of testing, such as the timing of feedback and the sequencing of complex knowledge domains. Lastly, we consider how to facilitate adoption of this powerful study strategy by physicians and other learners.

Cognitive perspectives on maintaining physicians' medical expertise: I. Reimagining Maintenance of Certification to promote lifelong learning.

Until recently, physicians in the USA who were board-certified in a specialty needed to take a summative test every 6-10 years. However, the 24 Member Boards of the American Board of Medical Specialties are in the process of switching toward much more frequent assessments, which we refer to as longitudinal assessment. The goal of longitudinal assessments is to provide formative feedback to physicians to help them learn content they do not know as well as serve an evaluation for board certification. We present five articles collectively covering the science behind this change, the likely outcomes, and some open questions. This initial article introduces the context behind this change. This article also discusses various forms of lifelong learning opportunities that can help physicians stay current, including longitudinal assessment, and the pros and cons of each.

Cognitive perspectives on maintaining physicians' medical expertise: II. Acquiring, maintaining, and updating cognitive skills.

Over the course of training, physicians develop significant knowledge and expertise. We review dual-process theory, the dominant theory in explaining medical decision making: physicians use both heuristics from accumulated experience (System 1) and logical deduction (System 2). We then discuss how the accumulation of System 1 clinical experience can have both positive effects (e.g., quick and accurate pattern recognition) and negative ones (e.g., gaps and biases in knowledge from physicians' idiosyncratic clinical experience). These idiosyncrasies, biases, and knowledge gaps indicate a need for individuals to engage in appropriate training and study to keep these cognitive skills current lest they decline over time. Indeed, we review converging evidence that physicians further out from training tend to perform worse on tests of medical knowledge and provide poorer patient care. This may reflect a variety of factors, such as specialization of a physician's practice, but is likely to stem at least in part from cognitive factors. Acquired knowledge or skills gained may not always be readily accessible to physicians for a number of reasons, including an absence of study, cognitive changes with age, and the presence of other similar knowledge or skills that compete in what is brought to mind. Lastly, we discuss the cognitive challenges of keeping up with standards of care that continuously evolve over time.

Familiar Strategies Feel Fluent: The Role of Study Strategy Familiarity in the Misinterpreted-Effort Model of Self-Regulated Learning.

Why do learners not choose ideal study strategies when learning? Past research suggests that learners frequently misinterpret the effort affiliated with efficient strategies as being indicative of poor learning. Expanding on past findings, we explored the integration of study habits into this model. We conducted two experiments where learners experienced two contrasting strategies-blocked and interleaved schedules-to learn to discriminate between images of bird families. After experiencing each strategy, learners rated each according to its perceived effort, learning, and familiarity. Next, learners were asked to choose which strategy they would use in the future. Mediation analyses revealed, for both experiments, that the more mentally effortful interleaving felt, the less learners felt they learned, and the less likely learners were to use it in future learning. Further, in this study, strategy familiarity predicted strategy choice, also mediated by learners' perceived learning. Additionally, Study 2 verified that, in contrast to learners' judgments, the less familiar interleaving schedule resulted in better learning. Consequently, learners are making ineffective learning judgments based on their perceptions of effort and familiarity and, therefore, do not make use of optimal study strategies in self-regulated learning decisions.

The role of priming in grammatical acceptability judgements for native versus non-native speakers: Effects of intelligibility.

Comprehenders frequently need to adapt to linguistic variability between talkers and dialects. Previous research has shown, given repeated exposure to quasi-grammatical structures, comprehenders begin to perceive them as more grammatical (Luka & Barsalou 2005, Luka & Choi 2012). We examined whether grammatical acceptability judgements differ for native versus non-native speech. In an exposure phase, native English speakers listened to, retyped, and rated the grammaticality of quasi-grammatical sentences (e.g., What Emily is thankful for is that she is here) spoken by a native or non-native speaker. In a subsequent test phase, participants rated additional sentences, some of which had the same structure as exposure sentences. Participants rated native-accented sentences as more grammatical, demonstrating a role for talker identity in perceptions of grammaticality. Furthermore, structures previously heard during the exposure phase were rated as more grammatical than novel unprimed structures, but only for the native speaker. Subset analyses suggest this effect is driven by speaker intelligibility, which holds implications for communication between native and non-native speakers.

Attentional Competition and Semantic Integration in Low- and High-Span Readers.

The goal of the current study is to investigate the effects of the distractive textual information on the activation of predictive inference online, and how the readers with high or low working memory capacity (WMC) differ in their online activation and text memory. To test the two hypothesis of attentional competition (AC) and semantic integration (SI), we conducted three experiments to investigate whether a local prediction (e.g., "The vase broke") and a global prediction (e.g., "The wife left her husband"), both of which could be derived from the description of a critical event (e.g., "The angry husband throws the delicate porcelain vase against the brick wall"), are generated in the mind of the reader, and how this generation process is influenced by contextual and cognitive factors of the reader (e.g., working memory capacity). The results of Experiment 1 and 2 suggest that the elaboration of the global aspects in the narrative reduces the local prediction, but makes the global prediction more salient to occur. The evidence from Experiment 3 confirms the hypothesis that even automatic processes are constrained by distant contextual factors, in combination with differences in working memory, and examines how referentially local and global predictions are intertwined in text comprehension. Overall, these data support the immediate integration hypothesis across sentence boundaries at different representation levels (cf. Schmalhofer and Perfetti, 2007), as well as interaction assumptions of different processing levels within referentially local and referentially global processing contexts (cf. Yang et al., 2005).

Mapping Pitch Accents to Memory Representations in Spoken Discourse Among Chinese Learners of English: Effects of L2 Proficiency and Working Memory.

We examined L2 learners' interpretation of pitch accent cues in discourse memory and how these effects vary with proficiency and working memory (WM). One hundred sixty-eight L1-Chinese participants learning L2-English listened to recorded discourses containing pairs of contrastive alternatives and then took a later recognition memory test. Their language proficiency and WM were measured through standard tests and the participants were categorized into low, medium, advanced, and high advanced language proficiency groups. We analyzed recognition memory task performance using signal detection theory to tease apart response bias (an overall tendency to affirm memory probes) from sensitivity (the ability to discern whether a specific probe statement is true). The results showed a benefit of contrastive L + H* pitch accents in rejecting probes referring to items unmentioned in a discourse, but not contrastive alternatives themselves. More proficient participants also showed more accurate memory for the discourses overall, as well as a reduced overall bias to affirm the presented statements as true. Meanwhile, that the benefit of L + H* accents in rejecting either contrast probes or unmentioned probes was modulated for people with greater working memory. Participants with higher WM were quite sure that it did not exist in the memory trace as this part of discourse wasn't mentioned. The results support a contrast-uncertainty hypothesis, in which comprehenders recall the contrast set but fail to distinguish which is the correct item. Further, these effects were influenced by proficiency and by working memory, suggesting they reflect incomplete mapping between pitch accent and discourse representation.

Aerobic exercise improves episodic memory in late adulthood: a systematic review and meta-analysis.

Background: Aerobic exercise remains one of the most promising approaches for enhancing cognitive function in late adulthood, yet its potential positive effects on episodic memory remain poorly understood and a matter of intense debate. Prior meta-analyses have reported minimal improvements in episodic memory following aerobic exercise but have been limited by restrictive inclusion criteria and infrequent examination of exercise parameters. Methods: We conducted a meta-analysis of randomized controlled trials to determine if aerobic exercise influences episodic memory in late adulthood (M = 70.82 years) and examine possible moderators. Thirty-six studies met inclusion criteria, representing data from 2750 participants. Results: Here we show that aerobic exercise interventions are effective at improving episodic memory (Hedges'g = 0.28; p = 0.002). Subgroup analyses revealed a moderating effect of age (p = 0.027), with a significant effect for studies with a mean age between 55-68 but not 69-85. Mixed-effects analyses demonstrated a positive effect on episodic memory among studies with a high percentage of females (65-100%), participants with normal cognition, studies reporting intensity, studies with a no-contact or nonaerobic physical activity control group, and studies prescribing >3900 total minutes of activity (range 540-8190 min). Conclusions: Aerobic exercise positively influences episodic memory among adults ≥55 years without dementia, with larger effects observed among various sample and intervention characteristics-the clearest moderator being age. These results could have far-reaching clinical and public health relevance, highlighting aerobic exercise as an accessible, non-pharmaceutical intervention to improve episodic memory in late adulthood.

Selecting effectively contributes to the mnemonic benefits of self-generated cues.

Self-generated memory cues support recall of target information more robustly than memory cues generated by others. Across two experiments, we tested whether the benefit of self-generated cues in part reflects a meta-mnemonic effect rather than a pure generation effect. In other words, can learners select better memory cues for themselves than others can? Participants generated as many possible memory cues for each to-be-remembered target as they could and then selected the cue they thought would be most effective. Self-selected memory cues elicited better cued recall than cues the generator did not select and cues selected by observers. Critically, this effect cannot be attributed to the process of generating a cue itself because all of the cues were self-generated. Further analysis indicated that differences in cue selection arise because generators and observers valued different cue characteristics; specifically, observers valued the commonality of the cue more than the generators, while generators valued the distinctiveness of a cue more than observers. Together, results suggest that self-generated cues are effective at supporting memory, in part, because learners select cues that are tailored to their specific memory needs.

Eye see what you're saying: Contrastive use of beat gesture and pitch accent affects online interpretation of spoken discourse.

Cues to prominence such as beat gesture and contrastive pitch accent play an important role in constraining what is remembered. However, it is currently unclear how beat gesture affects online discourse processing alone and in combination with contrastive accenting. Using an adaptation of the visual world eye-tracking paradigm, we orthogonally manipulated the presence of these cues and their felicity (match) with contrast within local (sentence-level) and global (experiment-level) referential contexts. In Experiment 1, in which beat gesture and contrastive accenting were always globally felicitous with the context of filler referring expressions, beat gesture increased anticipation of both target and competitor referents of locally infelicitous critical referring expressions differing in color and shape, whereas contrastive accenting hindered resolution of these expressions. In Experiment 2, in which beat gesture and contrastive accenting were always globally infelicitous with the context of filler referring expressions, beat gesture increased anticipation of both target and competitor referents of locally felicitous critical referring expressions contrasting in color, whereas contrastive accenting did not affect their interpretation. Taken together, these findings indicate that local and global felicity of cues to prominence with contrast affects their interpretation during online spoken discourse processing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exercise interventions preserve hippocampal volume: A meta-analysis.

Hippocampal volume is a marker of brain health and is reduced with aging and neurological disease. Exercise may be effective at increasing and preserving hippocampal volume, potentially serving as a treatment for conditions associated with hippocampal atrophy (e.g., dementia). This meta-analysis aimed to identify whether exercise training has a positive effect on hippocampal volume and how population characteristics and exercise parameters moderate this effect. Studies met the following criteria: (a) controlled trials; (b) interventions of physical exercise; (c) included at least one time-point of hippocampal volume data before the intervention and one after; (d) assessed hippocampal volume using either manual or automated segmentation algorithms. Animal studies, voxel-based morphometry analyses, and multi-modal interventions (e.g., cognitive training or meditation) were excluded. The primary analysis in n = 23 interventions from 22 published studies revealed a significant positive effect of exercise on total hippocampal volume. The overall effect was significant in older samples (65 years of age or older) and in interventions that lasted over 24 weeks and had less than 150 min per week of exercise. These findings suggest that moderate amounts of exercise for interventions greater than 6 months have a positive effect on hippocampal volume including in older populations vulnerable to hippocampal atrophy.

Contrast Is in the Eye of the Beholder: Infelicitous Beat Gesture Increases Cognitive Load During Online Spoken Discourse Comprehension.

We investigated how two cues to contrast-beat gesture and contrastive pitch accenting-affect comprehenders' cognitive load during processing of spoken referring expressions. In two visual-world experiments, we orthogonally manipulated the presence of these cues and their felicity, or fit, with the local (sentence-level) referential context in critical referring expressions while comprehenders' task-evoked pupillary responses (TEPRs) were examined. In Experiment 1, beat gesture and contrastive accenting always matched the referential context of filler referring expressions and were therefore relatively felicitous on the global (experiment) level, whereas in Experiment 2, beat gesture and contrastive accenting never fit the referential context of filler referring expressions and were therefore infelicitous on the global level. The results revealed that both beat gesture and contrastive accenting increased comprehenders' cognitive load. For beat gesture, this increase in cognitive load was driven by both local and global infelicity. For contrastive accenting, this increase in cognitive load was unaffected when cues were globally felicitous but exacerbated when cues were globally infelicitous. Together, these results suggest that comprehenders' cognitive resources are taxed by processing infelicitous use of beat gesture and contrastive accenting to convey contrast on both the local and global levels.

Cross-Linguistic Word Recognition Development Among Chinese Children: A Multilevel Linear Mixed-Effects Modeling Approach.

The effects of psycholinguistic variables on reading development are critical to the evaluation of theories about the reading system. Although we know that the development of reading depends on both individual differences (endogenous) and item-level effects (exogenous), developmental research has focused mostly on average-level performance, ignoring individual differences. We investigated how the development of word recognition in Chinese children in both Chinese and English is affected by (a) item-level, exogenous effects (word frequency, radical consistency, and curricular grade level); (b) subject-level, endogenous individual differences (orthographic awareness and phonological awareness); and (c) their interactive effect. We tested native Chinese (Putonghua)-speaking children (n = 763) in grades 1 to 6 with both Chinese character and English word identification (lexical) decision tasks. Our findings show that (a) there were effects of both word frequency and age of acquisition in both Chinese and English, but these item-level effects generally weakened with increasing age; (b) individual differences in phonological and orthographic awareness each contributed to successful performance; and (c) in Chinese, item-level effects were weaker for more proficient readers. We contend that our findings can be explained by theoretical models that incorporate cumulative learning as the basis for development of item-level effects in the reading system.

Character and child factors contribute to character recognition development among good and poor Chinese readers from grade 1 to 6.

In light of the dramatic growth of Chinese learners worldwide and a need for a cross-linguistic research on Chinese literacy development, this study investigated (a) the effects of character properties (i.e., orthographic consistency and transparency) on character acquisition, and (b) the effects of individual learner differences (i.e., orthographic awareness and phonological awareness) on character recognition. Chinese native-speaking children (over N = 100 for each of grade 1 to 6) completed a lexical decision task. Crossed random effects models suggested (a) character-level orthographic and phonological effects contributed to character recognition development in an asymptotic way from grade 1 to 6, with a moderate effect at earlier ages of acquisition and a stronger facilitation after grade 3; (b) child-level effects of orthographic awareness and character-reading level contributed to all types of characters; (c) the interaction between orthographic consistency and orthographic awareness grew more pronounced among typically developing children progressively from grade 1 to grade 6; and (d) this interaction of character- and child-level factors was not significantly associated with literacy development among children with poor reading skills. We discuss theoretical and practical implications for character development among typically and nontypically developing children.

Perceiving effort as poor learning: The misinterpreted-effort hypothesis of how experienced effort and perceived learning relate to study strategy choice.

How do learners make decisions about how, what, and when to study, and why are their decisions sometimes ineffective for learning? In three studies, learners experienced a pair of contrasting study strategies (Study 1: interleaved vs. blocked schedule; Studies 2 & 3: retrieval practice vs. restudy) and rated their perceptions of each strategy before choosing one for future use. In all three studies, mediation analysis revealed that participants who perceived a strategy as more effortful rated it as less effective for learning and, in turn, were less likely to choose it for future study. Further, choosing the more effortful strategy was associated with better long-term retention (Study 3), contrary to participants' judgments. A final fourth study suggested that these relationships were not driven by the mere act of providing ratings. Our results thus support a misinterpreted-effort hypothesis in which the mental effort associated with many normatively effective learning strategies (desirable difficulties; Bjork & Bjork, 1992) leads learners to misinterpret them as ineffective for learning and consequently not to employ them in self- regulated learning.

Listeners consider alternative speaker productions in discourse comprehension and memory: Evidence from beat gesture and pitch accenting.

Cues to emphasis, such as beat gesture and contrastive pitch accenting, play an important role in constraining what comprehenders remember from a discourse. One possibility is that these cues are used in a purely bottom-up manner in which additional attention is devoted to emphasized material. Another possibility is that comprehenders use top-down expectations of what cues might be expected in the current communicative context, such that the absence of an expected cue may serve as an indicator that material is unimportant. We independently manipulated two cues conveying emphasis - beat gesture and contrastive pitch accenting - to examine how they affected memory for information in a discourse. When beat gesture was present in some cases (Experiment 1), contrastive pitch accenting facilitated memory when beat gesture was present but not when beat gesture was absent. By contrast, when beat gesture was never present (Experiment 2), contrastive pitch accenting facilitated memory even though stimuli were identical to those in which beat gesture was absent in Experiment 1. Together, these results indicate that which cues could be produced affects interpretation even when these cues are absent, indicating that top-down expectations influence cue integration, consistent with emerging data-explanation views of language processing.

The complex interactions of context availability, polysemy, word frequency, and orthographic variables during lexical processing.

In this study we examined the interactions of context availability, polysemy, word frequency, and orthographic neighborhood variables during lexical processing. Context availability and polysemy interacted, in that words that were both lower in context availability and had fewer related senses were especially disadvantaged, as was originally reported by Tokowicz and Kroll (2007). Word frequency interacted with both polysemy and context availability, in that the effects of polysemy and context availability were stronger for lower-frequency words. Finally, orthographic neighborhood size and frequency both interacted with polysemy: the effect of polysemy was greater for words with smaller orthographic neighborhoods and a greater number of higher-frequency neighbors. These findings provide support for the context availability hypothesis (Schwanenflugel & Shoben, 1983). Specifically, the feedback activation account (Hino & Lupker, 1996) offers a mechanistic explanation of our findings that is rooted in feedback from semantic to orthographic representations.

Aging and recognition memory: A meta-analysis.

Recognizing a stimulus as previously encountered is a crucial everyday life skill and a critical task motivating theoretical development in models of human memory. Although there are clear age-related memory deficits in tasks requiring recall or memory for context, the existence and nature of age differences in recognition memory remain unclear. The nature of any such deficits is critical to understanding the effects of age on memory because recognition tasks allow fewer strategic backdoors to supporting memory than do tasks of recall. Consequently, recognition may provide the purest measure of age-related memory deficit of all standard memory tasks. We conducted a meta-analysis of 232 prior experiments on age differences in recognition memory. As an organizing framework, we used signal-detection theory (Green & Swets, 1966; Macmillan & Creelman, 2005) to characterize recognition memory in terms of both discrimination between studied items and unstudied lures (d') and response bias or criterion (c). Relative to young adults, older adults showed reduced discrimination accuracy and a more liberal response criterion (i.e., greater tendency to term items new). Both of these effects were influenced by multiple, differing variables, with larger age deficits when studied material must be discriminated from familiar or related material, but smaller when studying semantically rich materials. These results support a view in which neither the self-initiation of mnemonic processes nor the deployment of strategic processes is the only source of age-related memory deficits, and they add to our understanding of the mechanisms underlying those changes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).