Impaired implicit learning in adults with anorexia nervosa.

OBJECTIVE: Cognitive alterations play an important role in the pathophysiology and treatment of anorexia nervosa (AN). Previous studies suggest that some implicit learning processes may be inhibited in AN. However, this has not yet been fully explored. The purpose of this study is to analyze implicit learning in patients with AN in comparison to healthy controls. METHODS: In this pilot-study, a total of 21 patients diagnosed with AN and 21 matched controls were administered the weather prediction task (WPT), a probabilistic implicit category learning task that consists of two sub-variants. During the feedback (FB) version of the task, participants learn associations between tarot cards and weather outcomes via an operant learning model through which they receive immediate FB on their answers, whereas during the paired associate (PA) variant, participants are directly asked to memorize given associations. RESULTS: AN patients showed selective impairment on the FB task where they scored significantly lower both in comparison to controls (p = .001) who completed the same task and when compared to their own performance on the PA variant (p = .006). Clinical measures showed no significant correlations with test scores. DISCUSSION: Our results demonstrate implicit FB learning deficiencies in adult patients with AN. These impairments may have an impact on the effect of psychotherapeutic interventions and could partially explain the lack of treatment response in AN. Further studies are necessary to derive when and through which mechanisms these alterations originate, and to what extent they should be considered during treatment of the disorder. PUBLIC SIGNIFICANCE: Cognitive impairments pose a challenge in the management of anorexia nervosa. Improved comprehension of cognitive alterations could lead to a greater understanding of the disease and adaptation of psychotherapeutic treatments. In this study, we found that implicit feedback learning in anorexia nervosa is impaired compared to healthy controls. This could indicate the necessity of treatment adaptations in the form of therapy tools without feedback and a larger focus on psychoeducation.

Latent Markov Models to Test the Strategy Use of 3-Year-Olds in a Rule-Based Feedback-Learning Task.

This study is the first to investigate how 3-year-olds learn simple rules from feedback using the Toddler Card Sorting Task (TCST). To account for intra- and inter- individual differences in the learning process, latent Markov models were fitted to the time series of accuracy responses using maximum likelihood techniques (Visser et al., 2002). In a first, exploratory study (N = 110, 3- to 5-years olds) a considerable group of 3-year olds applied a hypothesis testing learning strategy. A second study confirmed these results with a preregistered study (3-years olds, N = 60). Under supportive learning conditions, a majority of 3-year- olds was capable of hypothesis testing. Furthermore, older children and those with bigger working memory capacities were more likely to use hypothesis testing, even though the latter group perseverated more than younger children or those with smaller working memory capacities. 3-year-olds are more advanced feedback-learners than assumed.

Heterogeneous Iris One-to-One Certification with Universal Sensors based On Quality Fuzzy Inference and Multi-Feature Fusion Lightweight Neural Network.

Due to the unsteady morphology of heterogeneous irises generated by a variety of different devices and environments, the traditional processing methods of statistical learning or cognitive learning for a single iris source are not effective. Traditional iris recognition divides the whole process into several statistically guided steps, which cannot solve the problem of correlation between various links. The existing iris data set size and situational classification constraints make it difficult to meet the requirements of learning methods under a single deep learning framework. Therefore, aiming at a one-to-one iris certification scenario, this paper proposes a heterogeneous iris one-to-one certification method with universal sensors based on quality fuzzy inference and a multi-feature entropy fusion lightweight neural network. The method is divided into an evaluation module and a certification module. The evaluation module can be used by different devices to design a quality fuzzy concept inference system and an iris quality knowledge concept construction mechanism, transform human logical cognition concepts into digital concepts, and select appropriate concepts to determine iris quality according to different iris quality requirements and get a recognizable iris. The certification module is a lightweight neural network based on statistical learning ideas and a multi-source feature fusion mechanism. The information entropy of the iris feature label was used to set the iris entropy feature category label and design certification module functions according to the category label to obtain the certification module result. As the requirements for the number and quality of irises changes, the category labels in the certification module function were dynamically adjusted using a feedback learning mechanism. This paper uses iris data collected from three different sensors in the JLU(Jilin University) iris library. The experimental results prove that for the lightweight multi-state irises, the abovementioned problems are ameliorated to a certain extent by this method.

Meditation experience predicts negative reinforcement learning and is associated with attenuated FRN amplitude.

Focused attention meditation (FAM) practices are cognitive control exercises where meditators learn to maintain focus and attention in the face of distracting stimuli. Previous studies have shown that FAM is both activating and causing plastic changes to the mesolimbic dopamine system and some of its target structures, particularly the anterior cingulate cortex (ACC) and striatum. Feedback-based learning also depends on these systems and is known to be modulated by tonic dopamine levels. Capitalizing on previous findings that FAM practices seem to cause dopamine release, the present study shows that FAM experience predicts learning from negative feedback on a probabilistic selection task. Furthermore, meditators exhibited attenuated feedback-related negativity (FRN) as compared with nonmeditators and this effect scales with meditation experience. Given that reinforcement learning and FRN are modulated by dopamine levels, a possible explanation for our findings is that FAM practice causes persistent increases in tonic dopamine levels which scale with amount of practice, thus altering feedback processing.

Maneuvering Target Tracking Using Simultaneous Optimization and Feedback Learning Algorithm Based on Elman Neural Network.

Tracking maneuvering targets is a challenging problem for sensors because of the unpredictability of the target's motion. Unlike classical statistical modeling of target maneuvers, a simultaneous optimization and feedback learning algorithm for maneuvering target tracking based on the Elman neural network (ENN) is proposed in this paper. In the feedback strategy, a scale factor is learnt to adaptively tune the dynamic model's error covariance matrix, and in the optimization strategy, a corrected component of the state vector is learnt to refine the final state estimation. These two strategies are integrated in an ENN-based unscented Kalman filter (UKF) model called ELM-UKF. This filter can be trained online by the filter residual, innovation and gain matrix of the UKF to simultaneously achieve maneuver feedback and an optimized estimation. Monte Carlo experiments on synthesized radar data showed that our algorithm had better performance on filtering precision compared with most maneuvering target tracking algorithms.

The role of the cerebellum for feedback processing and behavioral switching in a reversal-learning task.

Previous studies have reported cerebellar activations during error and reward processing. The present study investigated if the cerebellum differentially processes feedback depending on changes in response strategy during reversal learning, as is conceivable given its internal models for movement and thought. Negative relative to positive feedback in an fMRI-based reversal learning task was hypothesized to be associated with increased cerebellar activations. Moreover, increased activations were expected for negative feedback followed by a change in response strategy compared to negative feedback not followed by such a change, and for first positive feedback after compared to final negative feedback before a change, due to updating of internal models. As predicted, activation in lobules VI and VIIa/Crus I was increased for negative relative to positive feedback, and for final negative feedback before a change in response strategy relative to negative feedback not associated with a change. Moreover, activation was increased for first positive feedback after relative to final negative feedback before a change. These findings are consistent with updating of cerebellar internal models to accommodate new behavioral strategies. Recruitment of posterior regions in reversal learning is in line with the cerebellar functional topography, with posterior regions involved in complex motor and cognitive functions.

Decreased feedback learning in anorexia nervosa persists after weight restoration.

OBJECTIVE: Anorexia Nervosa (AN) is a serious disorder, with a mortality rate the highest of any psychiatric illness. It is notoriously challenging to treat and mechanisms of illness are not well understood. Reward system abnormalities have been proposed across theoretical models of the persistence of AN. Feedback learning is an important component of how reward systems shape behavior and we hypothesized that individuals with AN would show poorer learning from feedback. METHODS: We administered the acquired equivalence task to measure both learning from incremental feedback and generalization of that learning to novel stimuli. Participants were individuals with AN (n = 36) before and after intensive weight restoration treatment and healthy comparison participants (HC, n = 26) tested twice. Performance was assessed as accuracy during the Learning and Test phases, for both trained and novel stimuli. The relationship between task performance and eating disorder severity at baseline was also assessed. RESULTS: Both before and after treatment, individuals with AN showed reduced learning from feedback in the Learning phase (F3,180 = 2.75, p = .048) and lower accuracy during the Test phase (F1,60 = 4.29, p = .043), as compared with HC. Individuals with AN did not differ from HC in accuracy for novel stimuli (F1,60 = 1.04, p = .312), indicating no deficit in generalization. Decreased acquisition of feedback learning was associated with longer illness duration and with greater eating disorder symptom severity at baseline. CONCLUSIONS: Individuals with AN show reduced learning from feedback or reinforcement, which may contribute to difficulties in changing maladaptive behaviors.

Reversing the testing effect by feedback: Behavioral and electrophysiological evidence.

The testing effect refers to the finding that retrieval practice of previously studied information enhances its long-term retention more than restudy practice does. Recent work showed that the testing effect can be dramatically reversed when feedback is provided to participants during final recall testing (Storm, Friedman, Murayama, & Bjork, 2014). Following this prior work, in this study, we examined the reversal of the testing effect by investigating oscillatory brain activity during final recall testing. Twenty-six healthy participants learned cue-target word pairs and underwent a practice phase in which half of the items were retrieval practiced and half were restudy practiced. Two days later, two cued recall tests were administered, and immediate feedback was provided to participants in Test 1. Behavioral results replicated the prior work by showing a testing effect in Test 1, but a reversed testing effect in Test 2. Extending the prior work, EEG results revealed a feedback-related effect in alpha/lower-beta and retrieval-related effects in slow and fast theta power, with practice condition modulating the fast theta power effect for items that were not recalled in Test 1. The results indicate that the reversed testing effect can arise without differential strengthening of restudied and retrieval-practiced items via feedback learning. Theoretical implications of the findings, in particular with respect to the distribution-based bifurcation model of testing effects (Kornell, Bjork, & Garcia, 2011), are discussed.

Feedback learning and behavior problems after pediatric traumatic brain injury.

BACKGROUND: Feedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI). METHOD: Children aged 6-13 years diagnosed with TBI (n = 112; 1.7 years post-injury) were compared with children with traumatic control (TC) injury (n = 52). TBI severity was defined as mild TBI without risk factors for complicated TBI (mildRF- TBI, n = 24), mild TBI with ⩾1 risk factor for complicated TBI (mildRF+ TBI, n = 51) and moderate/severe TBI (n = 37). The Probabilistic Learning Test was used to measure feedback learning, assessing the effects of inconsistent feedback on learning and generalization of learning from the learning context to novel contexts. The relation between feedback learning and behavioral functioning rated by parents and teachers was explored. RESULTS: No evidence was found for an effect of TBI on learning from inconsistent feedback, while the moderate/severe TBI group showed impaired generalization of learning from the learning context to novel contexts (p = 0.03, d = -0.51). Furthermore, the mildRF+ TBI and moderate/severe TBI groups had higher parent and teacher ratings of internalizing problems (p's ⩽ 0.04, d's ⩾ 0.47) than the TC group, while the moderate/severe TBI group also had higher parent ratings of externalizing problems (p = 0.006, d = 0.58). Importantly, poorer generalization of learning predicted higher parent ratings of externalizing problems in children with TBI (p = 0.03, ß = -0.21) and had diagnostic utility for the identification of children with TBI and clinically significant externalizing behavior problems (area under the curve = 0.77, p = 0.001). CONCLUSIONS: Moderate/severe pediatric TBI has a negative impact on generalization of learning, which may contribute to post-injury externalizing problems.

Processing of Positive and Negative Feedback in Patients with Cerebellar Lesions.

It is well accepted that the cerebellum plays a crucial role in the prediction of the sensory consequences of movements. Recent findings of altered error processing in patients with selective cerebellar lesions led to the hypothesis that feedback processing and feedback-based learning might be affected by cerebellar damage as well. Thus, the present study investigated learning from and processing of positive and negative feedback in 12 patients with selective cerebellar lesions and healthy control subjects. Participants performed a monetary feedback learning task. The processing of positive and negative feedback was assessed by means of event-related potentials (ERPs) during the learning task and during a separate task in which the frequencies of positive and negative feedback were balanced. Patients did not show a general learning deficit compared to controls. Relative to the control group, however, patients with cerebellar lesions showed significantly higher ERP difference wave amplitudes (rewards-losses) in a time window between 250 and 450 ms after feedback presentation, possibly indicating impaired outcome prediction. The analysis of the original waveforms suggested that patients and controls primarily differed in their pattern of feedback-related negativity and P300 amplitudes. Our results add to recent findings on altered performance monitoring associated with cerebellar damage and demonstrate, for the first time, alterations of feedback processing in patients with cerebellar damage. Unaffected learning performance appears to suggest that chronic cerebellar lesions can be compensated in behaviour.

Learning from facial expressions in individuals with Williams syndrome.

BACKGROUND: Despite high levels of social engagement, the social competence of individuals with Williams syndrome (WS) is frequently compromised. This descriptive study explores the ability of young people with WS to learn from facial expressions when provided as a source of feedback for their actions. METHOD: Using a novel task, the ability to interpret facial expressions and adapt behaviour after receiving feedback in the form of happy or angry faces was assessed in 12 participants with WS aged between 10 and 28 years and with a mean nonverbal mental age of 6.5 years, and in typically developing (TD) children aged between 4 and 7 years. RESULTS: Individuals with WS were able to use facial expressions as feedback in a manner commensurate with their mental age, only when other cognitive demands were low. Their performance profile differed from that of the TD children matched for mental age and from the performance profile of 4 year olds. CONCLUSIONS: Possible explanations for the unique performance profile observed in the participants with WS are discussed. The results highlight the need to examine social competencies in the context of the cognitive demands characteristic of social environments.

Phasic dopamine release induced by positive feedback predicts individual differences in reversal learning.

Striatal dopamine (DA) is central to reward-based learning. Less is known about the contribution of DA to the ability to adapt previously learned behavior in response to changes in the environment, such as a reversal of response-reward contingencies. We hypothesized that DA is involved in the rapid updating of response-reward information essential for successful reversal learning. We trained rats to discriminate between two levers, where lever availability was signaled by a non-discriminative cue. Pressing one lever was always rewarded, whereas the other lever was never rewarded. After reaching stable discrimination performance, a reversal was presented, so that the previously non-rewarded lever was now rewarded and vice versa. We used fast-scan cyclic voltammetry to monitor DA release in the ventromedial striatum. During discrimination performance (pre-reversal), cue presentation induced phasic DA release, whereas reward delivery did not. The opposite pattern was observed post-reversal: Striatal DA release emerged after reward delivery, while cue-induced release diminished. Trial-by-trial analysis showed rapid reinstatement of cue-induced DA release on trials immediately following initial correct responses. This effect of positive feedback was observed in animals that learned the reversal, but not in 'non-learners'. In contrast, neither pre-reversal responding and DA signaling, nor post-reversal DA signaling in response to negative feedback differed between learners and non-learners. Together, we show that phasic DA dynamics in the ventromedial striatum encoding reward-predicting cues are associated with positive feedback during reversal learning. Furthermore, these signals predict individual differences in learning that are not present prior to reversal, suggesting a distinct role for dopamine in the adaptation of previously learned behavior.

Give it a second try? The influence of feedback and performance in the decision of reattempting.

Feedback evaluation can affect behavioural continuation or discontinuation, and is essential for cognitive and motor skill learning. One critical factor that influences feedback evaluation is participants' internal estimation of self-performance. Previous research has shown that two event-related potential components, the Feedback-Related Negativity (FRN) and the P3, are related to feedback evaluation. In the present study, we used a time estimation task and EEG recordings to test the influence of feedback and performance on participants' decisions, and the sensitivity of the FRN and P3 components to those factors. In the experiment, participants were asked to reproduce the total duration of an intermittently presented visual stimulus. Feedback was given after every response, and participants had then to decide whether to retry the same trial and try to earn reward points, or to move on to the next trial. Results showed that both performance and feedback influenced participants' decision on whether to retry the ongoing trial. In line with previous studies, the FRN showed larger amplitude in response to negative than to positive feedback. Moreover, our results were also in agreement with previous works showing the relationship between the amplitude of the FRN and the size of feedback-related prediction error (PE), and provide further insight in how PE size influences participants' decisions on whether or not to retry a task. Specifically, we found that the larger the FRN, the more likely participants were to base their decision on their performance - choosing to retry the current trial after good performance or to move on to the next trial after poor performance, regardless of the feedback received. Conversely, the smaller the FRN, the more likely participants were to base their decision on the feedback received.

Learning new words via feedback-Association between feedback-locked ERPs and recall performance-An exploratory study.

Feedback learning is thought to involve the dopamine system and its projection sites in the basal ganglia and anterior cingulate cortex (ACC), regions associated with procedural learning. Under certain conditions, such as when feedback is delayed, feedback-locked activation is pronounced in the medial temporal lobe (MTL), which is associated with declarative learning. In event-related potential research, the feedback-related negativity (FRN) has been linked to immediate feedback processing, while the N170, possibly reflecting MTL activity, has been related to delayed feedback processing. In the current study, we performed an exploratory investigation on the relation between N170 and FRN amplitude and memory performance in a test for declarative memory (free recall), also exploring the role of feedback delay. To this end, we adapted a paradigm in which participants learned associations between non-objects and non-words with either immediate or delayed feedback, and added a subsequent free recall test. We indeed found that N170, but not FRN amplitudes, depended on later free recall performance, with smaller amplitudes for later remembered non-words. In an additional analysis with memory performance as dependent variable, the N170, but not the FRN amplitude predicted free recall, modulated by feedback timing and valence. This finding shows that the N170 reflects an important process during feedback processing, possibly related to expectations and their violation, but is distinct from the process reflected by the FRN.

Development and Implementation of a Quick Response (QR) Code System to Streamline the Process for Fellows' Evaluation in the Pediatric Intensive Care Unit (PICU) and the Neonatal Intensive Care Unit (NICU) at a Large Academic Center.

BACKGROUND/OBJECTIVE: Useful feedback and evaluation are critical to a medical trainee's development. While most academic physicians understand that giving feedback to learners is essential, many do not consider the components of feedback to be truly useful, and there are barriers to implementation. We sought to use a quick reader (QR) system to solicit feedback for trainees in two pediatric subspecialties (pediatric critical care and neonatal-perinatal medicine) at one institution to increase the quality and quantity of feedback received. METHODS: New valuations were modified from the existing evaluations and imported into online systems with QR code capability. Each fellow was given a QR code linking to evaluations and encouraged to solicit feedback and evaluations in a variety of clinical settings and scenarios. Evaluation numbers and quality of evaluations were assessed and compared both pre- and post-intervention. RESULTS: There were increases in the number of evaluations completed for both the pediatric critical care fellows and the neonatal-perinatal medicine fellows. There was no overall change in the quality of written evaluations received. Satisfaction with the evaluation system improved for both faculty and fellows of both training programs. CONCLUSION: In our critical care units, we were successfully able to implement a QR code-driven evaluation for our fellows that improved access for the faculty and offered the ability of the learner to solicit evaluations, without compromising the number or quality of evaluations. What's new: Quick reader (QR) codes can be used by learners to solicit evaluations and feedback from faculty. They can increase the quantity of written evaluations received without affecting their quality.

'The Last Shot'-the shared and distinct brain regions involved in processing unexpectedness of success and failure in the context of social cooperation.

Individual success and failure in social cooperation matter not only to oneself but also to teammates. However, the common and distinct neural activities underlying salient success and failure in social cooperation are unclear. In this functional magnetic resonance imaging (fMRI) study, participants in the social group (Experiment one) cooperated with two human beings during a dice-gambling task, whereas those in the nonsocial group (Experiment two) cooperated with two computers. The social group reported more pride in success and more guilt in failure. The fMRI results in Experiment one demonstrate that left temporoparietal junction (LTPJ) activation increased exclusively with linearly changing unexpected success, whereas increasing anterior cingulate cortex (ACC) activation was only coupled with increasing unexpectedness of failure. Moreover, the dorsal medial prefrontal cortex (dMPFC) and left anterior insula were recruited in both success and failure feedback conditions. Dynamic causality model analysis suggested that the dMPFC first received information from the LTPJ and ACC separately and then returned information to these regions. The between-experiment comparison showed more dMPFC activity in social vs nonsocial contexts irrespective of success and failure feedback. Our findings shed light on the common and distinct neural substrates involved in processing success and failure feedback in social cooperation.

Updating false beliefs: The role of misplaced vs. well-placed certainty.

People can update their misconceptions or false beliefs by learning from corrective sources. However, research has shown that people vary drastically in the extent to which they learn from feedback and update their false beliefs accordingly. That past work drew attention to cognitive and motivational factors such as cognitive rigidity and closed-mindedness as inhibitors of belief updating. Here we examined a novel epistemic structure, misplaced certainty, a subjective sense of certainty while recognizing uncertainty in oneself or most people (e.g., I feel certain although I recognize X is technically uncertain or it is technically uncertain according to most people), as a unique predictor of lower belief updating. In a preregistered study, we hypothesized that those with high chronic misplaced certainty would be less likely to learn from feedback and revise their misconceptions in a feedback-learning task. In our analyses, we controlled for well-placed certainty-certainty while recognizing no doubt in oneself or most others. We also controlled for variables associated with closed-minded cognition. Consistent with our predictions, those with high misplaced certainty were less likely to revise their false beliefs in response to corrective feedback. In contrast, those with high well-placed certainty were more likely to learn from corrective feedback and revise their false beliefs. By shedding light on the nuances of different forms of subjective certainty, the present work aims to pave the way for further research on epistemic factors in the perseverance and correction of false beliefs.

Effectiveness of Individual Feedback and Coaching on Shared Decision-making Consultations in Oncology Care: Protocol for a Randomized Clinical Trial.

BACKGROUND: Shared decision-making (SDM) is particularly important in oncology as many treatments involve serious side effects, and treatment decisions involve a trade-off between benefits and risks. However, the implementation of SDM in oncology care is challenging, and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM but is considered time consuming. OBJECTIVE: This study aims to address the effectiveness of an individual SDM training program using the concept of deliberate practice. METHODS: This multicenter, single-blinded randomized clinical trial will be performed at 12 Dutch hospitals. Clinicians involved in decisions with oncology patients will be invited to participate in the study and allocated to the control or intervention group. All clinicians will record 3 decision-making processes with 3 different oncology patients. Clinicians in the intervention group will receive the following SDM intervention: completing e-learning, reflecting on feedback reports, performing a self-assessment and defining 1 to 3 personal learning questions, and participating in face-to-face coaching. Clinicians in the control group will not receive the SDM intervention until the end of the study. The primary outcome will be the extent to which clinicians involve their patients in the decision-making process, as scored using the Observing Patient Involvement-5 instrument. As secondary outcomes, patients will rate their perceived involvement in decision-making, and the duration of the consultations will be registered. All participating clinicians and their patients will receive information about the study and complete an informed consent form beforehand. RESULTS: This trial was retrospectively registered on August 03, 2021. Approval for the study was obtained from the ethical review board (medical research ethics committee Delft and Leiden, the Netherlands [N20.170]). Recruitment and data collection procedures are ongoing and are expected to be completed by July 2022; we plan to complete data analyses by December 2022. As of February 2022, a total of 12 hospitals have been recruited to participate in the study, and 30 clinicians have started the SDM training program. CONCLUSIONS: This theory-based and blended approach will increase our knowledge of effective and feasible training methods for clinicians in the field of SDM. The intervention will be tailored to the context of individual clinicians and will target the knowledge, attitude, and skills of clinicians. The patients will also be involved in the design and implementation of the study. TRIAL REGISTRATION: Netherlands Trial Registry NL9647; https://www.trialregister.nl/trial/9647. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35543.

An observational study of learning effects of peer-assisted learning tests in COVID-19 pandemic times.

PURPOSE: This study aimed to determine whether peer-assisted learning (PAL) is a more effective learning and test method in terms of oral- and maxillofacial surgery. MATERIAL AND METHODS: In July 2020, a total of 267 students took a PAL-based exam on fictional patients with surgical issues, in which they had to evaluate two fellow students and were themselves evaluated by two fellow students. The students evaluated their experience with the PAL-based exam through a questionnaire which consisted of five given statements (answer possibilities: agree, disagree, neutral) and two questions (answer possibilities: better, equal, worse) to rate. RESULTS: In the survey, 77.9% of the students rated PAL as a better learning method and 21% rated it as at least equally effective to the known multiple-choice (MC) test. A total of 74.9% of the students indicated that they learned more content with PAL and 20.2% said they learned the same amount; 83.7% said that their "clinical thinking has improved" through PAL. In the comments, 73% of the students noted that they think PAL is a good learning method, and at least 22% rated it as useful but in need of improvements. Only 5% did not see PAL as an acceptable learning method. In contrast to this, 1.3% saw PAL as a "bad alternative to MC tests." CONCLUSION: PAL, especially peer assessment, might represent a better learning method as it might encourage students to deal more intensively with the learning content and to improve clinical thinking.

Effect of diagnostic score reporting following a structured clinical assessment of dental hygiene student performance.

Background: Diagnostic score reporting is one method of providing feedback to all students following a structured clinical assessment but its effect on learning has not been studied. The objective of this study was to assess the impact of this feedback on student reflection and performance following a dental hygiene assessment. Methods: In 2016, dental hygiene students at the University of Alberta participated in a mock structured clinical assessment during which they were randomly assigned to receive a diagnostic score report (intervention group) or an overall percentage grade of performance (control group). The students later reflected upon their performance and took their regularly scheduled structured clinical assessment. Reflections underwent content analysis by diagnostic domains (eliciting essential information, effective communication, client-centred care, and interpreting findings). Results were analysed for group differences. Results: Students performed best on eliciting essential information (92%) and poorest on interpreting findings (42%). The intervention group was more likely to view interpreting findings as a weakness, p = 0.007, while the control group was more likely to view eliciting essential information as a weakness, p = 0.04. No differences were found on the actual assessment scores, p > 0.05. Discussion: Students who received diagnostic score reporting appeared to reflect more accurately upon their weaknesses. However, this knowledge did not translate into improved performance. Modifications and enhancements to the report may be necessary before an effect on performance will be seen. Conclusion: Diagnostic score reporting is a promising feedback method that may aid student reflection. More research is needed to determine if these reports can improve performance.

Contexte: Le suivi de la notation des diagnostics est une des méthodes utilisées pour fournir de la rétroaction aux étudiants à la suite d'une évaluation clinique structurée, mais ses effets sur l'apprentissage n'ont pas été étudiés. La présente étude visait à évaluer l'effet de cette rétroaction sur la réflexion et la performance des étudiants à la suite d'une évaluation en hygiène dentaire. Méthodologie: Les étudiants en hygiène dentaire de l'Université de l'Alberta ont participé à une évaluation clinique structurée fictive pendant laquelle ils étaient désignés de façon aléatoire pour recevoir un suivi de la notation des diagnostics (groupe d'intervention) ou une note globale en pourcentage de leur performance (groupe témoin). Les étudiants ont plus tard réfléchi à leur performance et ont fait leur évaluation clinique structurée déjà à l'horaire. Une analyse de contenu a été effectuée sur les réflexions selon les domaines de diagnostics (obtention de renseignements essentiels, communication efficace, prestation de soins axés sur le client et interprétation des constatations). Les résultats ont été analysés pour déterminer les différences entre les groupes. Résultats: Les étudiants ont le mieux réussi sur l'obtention d'information essentielle (92 %) et ont le moins bien réussi sur l'interprétation des constatations (42 %). Le groupe d'intervention était plus susceptible de réfléchir à l'interprétation des constatations en tant que faiblesse, p = 0,007, alors que le groupe témoin était plus susceptible de réfléchir à l'obtention de l'information essentielle en tant que faiblesse, p = 0,04. Aucune différence n'a été trouvée sur les notations actuelles de l'évaluation, p > 0,05. Discussion: Les étudiants qui ont reçu un suivi de la notation des diagnostics semblaient réfléchir plus précisément sur leurs faiblesses. Cependant, cette connaissance ne s'est pas traduite par une performance améliorée. Des modifications et des améliorations du suivi peuvent être nécessaires avant qu'un effet sur la performance soit constaté. Conclusions: Le suivi de la notation des diagnostics présente une méthode de rétroaction prometteuse qui pourrait aider à la réflexion des étudiants. D'autres recherches sont nécessaires pour déterminer si ces rapports peuvent améliorer la performance.