Incorporating a situational judgement test in residency selections: clinical, educational and organizational outcomes.

BACKGROUND: Computer-based assessment for sampling personal characteristics (Casper), an online situational judgement test, is a broad measure of personal and professional qualities. We examined the impact of Casper in the residency selection process on professionalism concerns, learning interventions and resource utilization at an institution. METHODS: In 2022, admissions data and information in the files of residents in difficulty (over three years pre- and post- Casper implementation) was used to determine the number of residents in difficulty, CanMEDS roles requiring a learning intervention, types of learning interventions (informal learning plans vs. formal remediation or probation), and impact on the utilization of institutional resource (costs and time). Professionalism concerns were mapped to the 4I domains of a professionalism framework, and their severity was considered in mild, moderate, and major categories. Descriptive statistics and between group comparisons were used for quantitative data. RESULTS: In the pre- and post- Casper cohorts the number of residents in difficulty (16 vs. 15) and the number of learning interventions (18 vs. 16) were similar. Professionalism concerns as an outcome measure decreased by 35% from 12/16 to 6/15 (p < 0.05), were reduced in all 4I domains (involvement, integrity, interaction, introspection) and in their severity. Formal learning interventions (15 vs. 5) and informal learning plans (3 vs. 11) were significantly different in the pre- and post-Casper cohorts respectively (p < 0.05). This reduction in formal learning interventions was associated with a 96% reduction in costs f(rom hundreds to tens of thousands of dollars and a reduction in time for learning interventions (from years to months). CONCLUSIONS: Justifiable from multiple stakeholder perspectives, use of an SJT (Casper) improves a clinical performance measure (professionalism concerns) and permits the institution to redirect its limited resources (cost savings and time) to enhance institutional endeavors and improve learner well-being and quality of programs.

Variation determinants within massage therapists' professional identity.

OBJECTIVES: Individuals have multiple, competing identities that vary in importance to the self. Professional identity is a way in which individuals attribute meaning to their contribution to society and is influenced by complex factors. Globally, the roles and responsibilities of massage therapists (MTs) vary, making it challenging to articulate a cohesive professional identity. This article describes the investigation into the variables which influenced response regarding MTs' professional identity in Ontario, Canada. METHODS: An online questionnaire was distributed to active MTs with available email addresses in the public register of the College of Massage Therapists of Ontario. Chi-square tests of independence were used to compare dependent variables with independent variables. Significance was adjusted post hoc, using Bonferroni's correction, to reduce the chance of a type I error occurring. The threshold for significance was adjusted from p≤0.05 to p≤0.01 as multiple analyses were conducted with a high response rate. RESULTS: The results provided insight into the variables associated with differences in responses. Variation was seen based on gender, primary practice setting, length in practice, additional education, additional roles within the profession, additional designation as a healthcare provider, and membership in the RMTAO (Registered Massage Therapists' Association of Ontario). CONCLUSIONS: While previous studies sought to describe the common and unifying features of MTs' identity, these findings provide insight into variables that determine differences in responses. These findings are valuable for the development of future studies. They provide a priori assumptions regarding the inclusion of these demographic items that can inform decisions regarding enrollment of the sample and data analysis.

Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS: Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS: Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION: Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.

Program directors' reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework.

BACKGROUND: Outcomes of national policy change impact all levels of the organizational hierarchy. The medical education literature is sparse on how reflections from program directors (PDs) on past large-scale policy changes can inform future policy initiatives. To fill this gap, we conducted a national survey on PDs' perceptions of, and reflections on, decision-making in medical education, accreditation procedures, and the CanMEDS framework implementation. METHODS: The survey was distributed to former Canadian specialty medicine PDs (N = 684). Descriptive analysis was performed on quantitative data, thematic analysis was performed on qualitative comments, and comparisons between the quantitative and qualitative findings were performed to identify areas of convergence and/or divergence. RESULTS: A total of 265 (38.7%) former PDs participated. Quantitative analysis revealed that 52.8% of respondents did not feel involved in decision-making regarding policy changes, 45.1% of respondents did not feel prepared to assess the CanMEDS Roles, and PDs were divided on the reasonableness of accreditation documentation. Qualitative analysis produced four themes: communication, resources, expectations of outcomes, and buy-in. Nine sub-themes were also identified. A high level of convergence was identified across the content, with only four areas of divergence identified. CONCLUSIONS: Our findings have the potential to inform future policy and/or accreditation changes. Without the lens of those charged with overseeing the implementation, policy evaluation and quality improvement will remain uninformed. PDs, therefore, bring unique insights into our understanding of national policy changes, and without the voices of these frontline implementers, the true success of policy change implementation will be hindered.

CONTEXTE: Les effets des changements apportés aux politiques nationales se font sentir à tous les niveaux de la hiérarchie organisationnelle. La littérature traite peu du fait que l'opinion des directeurs de programme (DP) concernant les réformes d'envergure intervenues dans les politiques sur l'éducation médicale par le passé peut servir à éclairer les révisions de politiques futures. Afin de combler cette lacune, nous avons mené une enquête nationale pour sonder les DP sur leurs perceptions et réflexions quant à la prise de décision dans l'éducation médicale, aux procédures d'agrément et à la mise en œuvre du cadre CanMEDS. MÉTHODES: Le sondage a été distribué aux anciens DP en médecine spécialisée du Canada (N = 684). Les données quantitatives ont fait l'objet d'une analyse descriptive, les commentaires qualitatifs d'une analyse thématique, et une comparaison entre les résultats quantitatifs et qualitatifs a été effectuée pour repérer les domaines de convergence et de divergence. RÉSULTATS: Un total de 265 (38.7%) anciens DP ont participé au sondage. L'analyse quantitative a révélé que 52.8% des répondants ne se sentaient pas inclus dans la prise de décision en matière de changements de politiques, que 45.1% des répondants ne se sentaient pas en mesure d'évaluer les rôles CanMEDS, et qu'ils étaient partagés sur la question du caractère raisonnable des documents d'agrément. L'analyse qualitative a permis de dégager quatre thèmes: la communication, les ressources, les attentes en matière de résultats et l'adhésion. Neuf sous-thèmes ont également été définis. Nous avons constaté un niveau élevé de convergence sur l'ensemble du contenu, des divergences n'apparaissant que dans quatre domaines. CONCLUSIONS: Nos conclusions peuvent servir à orienter les changements futurs en matière de politiques et d'agrément. Sans le regard de ceux qui sont chargés de superviser leur mise en œuvre, l'évaluation des politiques et l'amélioration de la qualité demeureront mal fondées. La perspective unique des DP est essentielle à notre compréhension des révisions des politiques, et sans la contribution de ces responsables de première ligne de leur application, les réformes ne pourront être mises en œuvre de façon optimale.

Identification of common features within massage therapists' professional identity.

OBJECTIVES: In Ontario, Canada, MTs are regulated and have a common scope of practice. However, diverse practice settings and approaches to care create a need for MTs to articulate their professional identity. This study sought to answer, "what common features are foundational to the professional identity of MTs in Ontario?" METHODS: This quantitative research study was a part of a larger exploratory sequential mixed methods study. An online questionnaire-based cross-sectional study was conducted based on previous qualitative findings. MTs in Ontario, who held an active certificate, were invited to participate. Data were analyzed using descriptive statistics. RESULTS: The analysis revealed 17 common features that were endorsed by most respondents. Participants also reported thinking of themselves as healthcare professionals, rather than service providers, a feeling that was held across practice settings. Interesting and unexpected differences were noted in statements regarding the perception of MTs, areas of profession-specific knowledge, and the establishment of the therapeutic relationship. CONCLUSIONS: This study furthers an understanding of MTs' identity. Specifically, MTs consider themselves to be HCPs who are confident in their knowledge and abilities, especially their communication skills. They believe in providing individualized care and empowering their patients to take charge of their own health. Despite areas of overwhelming agreement, disagreement in endorsement was seen in areas such as MTs perception of their external image, use of evidence in practice, and the establishment of professional boundaries. These areas provide an opportunity for future research to continue to develop a body of knowledge regarding MTs professionalism and identity.

Tensions in describing competency-based medical education: a study of Canadian key opinion leaders.

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

"I am a healthcare practitioner": A qualitative exploration of massage therapists' professional identity.

BackgroundA division has been described among massage therapists, some who identify as healthcare providers while others identify as service providers. The perceived division creates confusion about what it means to be a massage therapist. ObjectiveThis qualitative study answered, "How do massage therapists in Ontario describe their professional identity?" MethodsQualitative description (QD) was used and data were collected from 33 massage therapists using semi-structured interviews. ResultsThe resulting description of massage therapists' identity in Ontario is the first of its kind. The identity described includes passion as professional motivation in practice, the importance of confidence and competence, a focus on the therapeutic relationship, individualized care, and patient empowerment, and a desire to be recognized for their role within the healthcare system. ConclusionThere is still much to be investigated about massage therapists' identity. Future research will explore whether this description resonates with a larger sample of massage therapists in Ontario.

Addressing the Diversity-Validity Dilemma Using Situational Judgment Tests.

PURPOSE: To examine the magnitudes of score differences across different demographic groups for three academic (grade point average [GPA], old Medical College Admission Test [MCAT], and MCAT 2015) and one nonacademic (situational judgment test [SJT]) screening measures and one nonacademic (multiple mini-interview [MMI]) interview measure (analysis 1), and the demographic implications of including an SJT in the screening stage for the pool of applicants who are invited to interview (analysis 2). METHOD: The authors ran the analyses using data from New York Medical College School of Medicine applicants from the 2015-2016 admissions cycle. For analysis 1, effect sizes (Cohen d) were calculated for GPA, old MCAT, MCAT 2015, CASPer (an online SJT), and MMI. Comparisons were made across gender, race, ethnicity (African American, Hispanic/Latino), and socioeconomic status (SES). For analysis 2, a series of simulations were conducted to estimate the number of underrepresented in medicine (UIM) applicants who would have been invited to interview with different weightings of GPA, MCAT, and CASPer scores. RESULTS: A total of 9,096 applicants were included in analysis 1. Group differences were significantly smaller or reversed for CASPer and MMI compared with the academic assessments (MCAT, GPA) across nearly all demographic variables/indicators. The simulations suggested that a higher weighting of CASPer may help increase gender, racial, and ethnic diversity in the interview pool; results for low-SES applicants were mixed. CONCLUSIONS: The inclusion of an SJT in the admissions process has the potential to widen access to medical education for a number of UIM groups.

Assessing the Quality of Evidence Presented at Annual General Meetings: A 5-Year Retrospective Study.

INTRODUCTION: Health care professionals rely on annual general meetings (AGMs) to obtain up-to-date information and practice guidelines relevant to their specialty. The majority of such information at meetings is presented through abstract sessions. However, the quality of the evidence presented during such abstract sessions is unclear. Standardized measures were applied to assess the quality of evidence of abstracts presented at the Canadian Society of Nephrology AGM over a 5-year period. METHODS: Two authors independently reviewed all CSN AGM abstracts presented from 2012 to 2016. Using a schema published in 2011 by the Oxford Centre for Evidence-Based Medicine (OCEBM), each abstract was subsequently ranked based on the quality of evidence. Schema categories ranged from level I, representing the highest evidence quality, to level V, representing the lowest. The number of authors and the authors' institution affiliations were also collected from the abstracts, where available, or if affiliations were unclear, an internet search of the author was performed. RESULTS: Six hundred forty-two articles were screened. In total, 70% (n = 450) met the inclusion criteria. When assessed, 15% of articles were level I (highest quality), 17% level II, 53% level III, 12% level IV, and 3% level V (lowest quality). A Jonckheere-Terpstra test demonstrated a significant trend of increasing quality of evidence (P < .05) and collaboration (P < .005) over the 5-year study period. There was a significant correlation between level of evidence and collaboration across years reviewed in the study, rs(98) = -0.226, P < .001. DISCUSSION: The results indicate a consistent increase in quality of evidence and collaborative submissions over time. To the authors' knowledge, this is the first assessment and analysis of AGM presentation quality within internal medicine and its subspecialties. Documenting and monitoring changes in the quality of evidence with a standardized framework may offer valuable insight pertaining to the medical field and the research community.

Experienced physician descriptions of intuition in clinical reasoning: a typology.

Background Diagnostic intuition is a rapid, non-analytic, unconscious mode of reasoning. A small body of evidence points to the ubiquity of intuition, and its usefulness in generating diagnostic hypotheses and ascertaining severity of illness. Little is known about how experienced physicians understand this phenomenon, and how they work with it in clinical practice. Methods Descriptions of how experienced physicians perceive their use of diagnostic intuition in clinical practice were elicited through interviews conducted with 30 physicians in emergency, internal and family medicine. Each participant was asked to share stories of diagnostic intuition, including times when intuition was both correct and incorrect. Multiple coders conducted descriptive analysis to analyze the salient aspects of these stories. Results Physicians provided descriptions of what diagnostic intuition is, when it occurs and what type of activity it prompts. From stories of correct intuition, a typology of four different types of intuition was identified: Sick/Not Sick, Something Not Right, Frame-shifting and Abduction. Most physician accounts of diagnostic intuition linked this phenomenon to non-analytic reasoning and emphasized the importance of experience in developing a trustworthy sense of intuition that can be used to effectively engage analytic reasoning to evaluate clinical evidence. Conclusions The participants recounted myriad stories of diagnostic intuition that alerted them to unusual diagnoses, previous diagnostic error or deleterious trajectories. While this qualitative study can offer no conclusions about the representativeness of these stories, it suggests that physicians perceive clinical intuition as beneficial for correcting and advancing diagnoses of both common and rare conditions.

Correction to: CASPer, an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores.

In re-examining the paper "CASPer, an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores" published in AHSE (22(2), 327-336), we recognized two errors of interpretation.

Contexts, concepts and cognition: principles for the transfer of basic science knowledge.

CONTEXT: Transfer of basic science aids novices in the development of clinical reasoning. The literature suggests that although transfer is often difficult for novices, it can be optimised by two complementary strategies: (i) focusing learners on conceptual knowledge of basic science or (ii) exposing learners to multiple contexts in which the basic science concepts may apply. The relative efficacy of each strategy as well as the mechanisms that facilitate transfer are unknown. In two sequential experiments, we compared both strategies and explored mechanistic changes in how learners address new transfer problems. METHODS: Experiment 1 was a 2 × 3 design in which participants were randomised to learn three physiology concepts with or without emphasis on the conceptual structure of basic science via illustrative analogies and by means of one, two or three contexts during practice (operationalised as organ systems). Transfer of these concepts to explain pathologies in familiar organ systems (near transfer) and unfamiliar organ systems (far transfer) was evaluated during immediate and delayed testing. Experiment 2 examined whether exposure to conceptual analogies and multiple contexts changed how learners classified new problems. RESULTS: Experiment 1 showed that increasing context variation significantly improved far transfer performance but there was no difference between two and three contexts during practice. Similarly, the increased conceptual analogies led to higher performance for far transfer. Both interventions had independent but additive effects on overall performance. Experiment 2 showed that such analogies and context variation caused learners to shift to using structural characteristics to classify new problems even when there was superficial similarity to previous examples. CONCLUSIONS: Understanding problems based on conceptual structural characteristics is necessary for successful transfer. Transfer of basic science can be optimised by using multiple strategies that collectively emphasise conceptual structure. This means teaching must focus on conserved basic science knowledge and de-emphasise superficial features.

CASPer, an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores.

Typically, only a minority of applicants to health professional training are invited to interview. However, pre-interview measures of cognitive skills predict for national licensure scores (Gauer et al. in Med Educ Online 21 2016) and subsequently licensure scores predict for performance in practice (Tamblyn et al. in JAMA 288(23): 3019-3026, 2002; Tamblyn et al. in JAMA 298(9):993-1001, 2007). Assessment of personal and professional characteristics, with the same psychometric rigour of measures of cognitive abilities, are needed upstream in the selection to health profession training programs. To fill that need, Computer-based Assessment for Sampling Personal characteristics (CASPer)-an on-line, video-based screening test-was created. In this paper, we examine the correlation between CASPer and Canadian national licensure examination outcomes in 109 doctors who took CASPer at the time of selection to medical school. Specifically, CASPer scores were correlated against performance on cognitive and 'non-cognitive' subsections of both the Medical Council of Canada Qualifying Examination (MCCQE) Parts I (end of medical school) and Part II (18 months into specialty training). Unlike most national licensure exams, MCCQE has specific subcomponents examining personal/professional qualities, providing a unique opportunity for comparison. The results demonstrated moderate predictive validity of CASPer to national licensure outcomes of personal/professional characteristics three to six years after admission to medical school. These types of disattenuated correlations (r = 0.3-0.5) are not otherwise predicted by traditional screening measures. These data support the ability of a computer-based strategy to screen applicants in a feasible, reliable test, which has now demonstrated predictive validity, lending evidence of its validation for medical school applicant selection.

Exploring the awareness of research among registered massage therapists in Ontario.

BACKGROUND: An increase in available research has highlighted that knowledge changes over time as theories are challenged and adjusted or dismissed. This is particularly important to healthcare practitioners, including massage therapists, who need to frequently review current research and adjust practice accordingly. However, when research findings related to practice are generated, there is considerable delay in implementation. Few studies measure actual knowledge of current evidence for practice. The objectives of the study reported here were to (a) describe current awareness of evidence for practice among registered massage therapists (RMTs) in Ontario and (b) identify the sources of information RMTs use to inform their awareness of current evidence and the reported importance and frequency of use for each source. METHODS: An online questionnaire-based mixed-methods cross-sectional study was conducted. Ontario RMTs were invited to participate. This report focuses on the quantitative analysis. RESULTS: In total, 1,762 questionnaires were included. Of seven sources of information provided, respondents rated cumulative professional experience as most important, followed by recent research studies and education. Cumulative professional experience also rated as most frequently used, followed by other RMTs and education. CONCLUSIONS: There was a tendency for respondents to agree with positive statements about MT, or disagree with negative statements, regardless of correctness. The results suggest that RMTs need to improve their awareness of the current evidence for practice. Furthermore, cumulative professional experience was ranked most frequently used. This has the potential to not include the most current research. Improving communication of research findings to RMTs might improve awareness.

Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians?

PURPOSE: Others have suggested that increased time pressure, sometimes caused by interruptions, may result in increased diagnostic errors. The authors previously found, however, that increased time pressure alone does not result in increased errors, but they did not test the effect of interruptions. It is unclear whether experience modulates the combined effects of time pressure and interruptions. This study investigated whether increased time pressure, interruptions, and experience level affect diagnostic accuracy and response time. METHOD: In October 2012, 152 residents were recruited at five Medical Council of Canada Qualifying Examination Part II test sites. Forty-six emergency physicians were recruited from one Canadian and one U.S. academic health center. Participants diagnosed 20 written general medicine cases. They were randomly assigned to receive fast (time pressure) or slow condition instructions. Visual and auditory case interruptions were manipulated as a within-subject factor. RESULTS: Diagnostic accuracy was not affected by interruptions or time pressure but was related to experience level: Emergency physicians were more accurate (71%) than residents (43%) (F = 234.0, P < .0001) and responded more quickly (54 seconds) than residents (65 seconds) (F = 9.0, P < .005). Response time was shorter for participants in the fast condition (55 seconds) than in the slow condition (73 seconds) (F = 22.2, P < .0001). Interruptions added about 8 seconds to response time. CONCLUSIONS: Experienced emergency physicians were both faster and more accurate than residents. Instructions to proceed quickly and interruptions had a small effect on response time but no effect on accuracy.

The mediating effect of context variation in mixed practice for transfer of basic science.

Applying a previously learned concept to a novel problem is an important but difficult process called transfer. Practicing multiple concepts together (mixed practice mode) has been shown superior to practicing concepts separately (blocked practice mode) for transfer. This study examined the effect of single and multiple practice contexts for both mixed and blocked practice modalities on transfer performance. We looked at performance on near transfer (familiar contexts) cases and far transfer (unfamiliar contexts) cases. First year psychology students (n = 42) learned three physiological concepts in a 2 × 2 factorial study (one or two practice contexts and blocked or mixed practice). Each concept was practiced with two clinical cases; practice context was defined as the number of organ systems used (one system per concept vs. two systems). In blocked practice, two practice cases followed each concept; in mixed practice, students learned all concepts before seeing six practice cases. Transfer testing consisted of correctly classifying and explaining 15 clinical cases involving near and far transfer. The outcome was ratings of quality of explanations on a 0-3 scale. The repeated measures analysis showed a significant near versus far by organ system interaction [F(1,38) = 3.4, p < 0.002] with practice with a single context showing lower far transfer scores than near transfer [0.58 (0.37)-0.83 (0.37)] compared to the two contexts which had similar far and near transfer scores [1.19 (0.50)-1.01 (0.38)]. Practicing with two organ contexts had a significant benefit for far transfer regardless of mixed or blocked practice; the single context mixed practice group had the lowest far transfer performance; this was a large effect size (Cohen's d = 0.81). Using only one practice context during practice significantly lowers performance even with the usually superior mixed practice mode. Novices should be exposed to multiple contexts and mixed practice to facilitate transfer.

Comparing the traditional and Multiple Mini Interviews in the selection of post-graduate medical trainees.

BACKGROUND: The traditional, panel style interview and the multiple mini interview (MMI) are two options to use in the selection of medical trainees with each interview format having inherent advantages and disadvantages. Our aim was to compare the traditional and MMI on the same cohort of postgraduate applicants to the Department of Otolaryngology - Head & Neck Surgery at the University of Toronto. METHOD: Twenty-seven applicants from the 2010 Canadian Residency Matching Service selected for interview at the University of Toronto, Department of Otolaryngology - Head & Neck Surgery were included in the study. Each applicant participated in both a traditional interview and MMI. RESULTS: Traditional interviews marked out of a total maximum score of 570. On the traditional interview, scores ranged from 397-543.5 (69.6 - 95.3%), the mean was 460.2. The MMI maximum score was out of 180. MMI scores ranged from 93 - 146 (51.7 - 81.1%) with a mean of 114.8. Traditional interview total scores were plotted against MMI total scores. Scores correlated reasonably well, Pearson Correlation = 0.315 and is statistically significant at p = 0.001. Inter-interview reliability for the two interview methods was 0.038, with poor overall agreement 0.07%. CONCLUSIONS: MMI and traditional interview scores are correlated but do not reliably lead to the same rank order. We have demonstrated that these two interview formats measure different characteristics. One format may also be less reliable leading to greater variation in final rank. Further validation research is certainly required.

Cognitive Load Theory: Implications for Nursing Education and Research.

This article provides an overview of cognitive load theory (CLT) and explores applications of CLT to health profession and nursing education research, particularly for multimedia and simulation-based applications. The article first reviews the 3 components of cognitive load: intrinsic, extraneous, and germane. It then discusses strategies for manipulating cognitive load variables to enhance instruction. Examples of how CLT variables can be modulated during instruction are provided. Lastly, the article discusses current applications of CLT to health profession and nursing education research and presents future research directions, focusing on the areas of multimedia and simulation-based learning.

Le présent article offre un aperçu de la théorie de la charge cognitive (TCC) et explore les applications de la TCC dans la recherche sur la formation des professionnels de la santé et des soins infirmiers, plus particulièrement les applications multimédias et fondées sur la simulation. L'article revoit tout d'abord les trois types de charge cognitive: intrinsèque, extrinsèque et germane. Il examine ensuite les stratégies permettant de manipuler les variables de la charge cognitive en vue d'améliorer l'enseignement. Des exemples montrant comment les variables de la TCC peuvent être modulées pendant l'enseignement sont fournis. Enfin, l'article discute les applications actuelles de la TCC dans le domaine de la recherche sur la formation des professionnels de la santé et des soins infirmiers et présente les orientations futures de la recherche, l'accent étant mis sur les secteurs de l'apprentissage multimédia et fondé sur la simulation.