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The Effect of Proximity, Explicitness, and Representation of Basic Science Information on Student Clinical Program-Solving

Author: Kimberly A. Smith, PhD, MT(ASCP) (2010)

Primary Advisor: Robert Vogler, DSN

Committee Members:   Todd R. Johnson, PhD; Craig W. Johnson PhD; Thomas M. Craig DVM, PhD

PhD thesis, The University of Texas School of Health Information Sciences at Houston.


Problem: Medical and veterinary students memorize facts but then have difficulty applying those facts in clinical problem solving. Cognitive engineering research suggests that the inability of medical and veterinary students to infer concepts from facts may be due in part to specific features of how information is represented and organized in educational materials. First, physical separation of pieces of information may increase the cognitive load on the student. Second, information that is necessary but not explicitly stated may also contribute to the student’s cognitive
load. Finally, the types of representations – textual or graphical – may also support or hinder the student’s learning process. This may explain why students have difficulty applying biomedical facts in clinical problem solving.
Purpose: To test the hypothesis that three specific aspects of expository text – the spatial distance between the facts needed to infer a rule, the explicitness of information, and the format of representation  – affected the ability of students to solve clinical problems.  Setting: The study was conducted in the parasitology laboratory of a college of veterinary medicine in Texas.
Sample: The study subjects were a convenience sample consisting of 132 second-year veterinary students who matriculated in 2007. The age of this class upon admission ranged from 20-52, and the gender makeup of this class consisted of approximately 75% females and 25% males.
Results: No statistically significant difference in student ability to solve clinical problems was found when relevant facts were placed in proximity, nor when an explicit rule was stated. Further, no statistically significant difference in student ability to solve clinical problems was found when students were given different representations of material, including tables and concept maps.
Findings: The findings from this study indicate that the three properties investigated – proximity, explicitness, and representation – had no statistically significant effect on student learning as it relates to clinical problem-solving ability. However, ad hoc observations as well as findings from other researchers suggest that the subjects were probably using rote learning techniques such as memorization, and therefore were not attempting to infer relationships from the factual material in the interventions, unless they were specifically prompted to look for patterns. A serendipitous finding unrelated to the study hypothesis was that those subjects who correctly answered questions regarding functional (non-morphologic) properties, such as mode of transmission and intermediate host, at the family taxonomic level were significantly more likely to correctly answer clinical case scenarios than were subjects who did not correctly answer questions regarding functional properties. These findings suggest a strong relationship (p < .001) between well-organized knowledge of taxonomic functional properties and clinical problem solving ability.
Recommendations: Further study should be undertaken investigating the relationship between knowledge of functional taxonomic properties and clinical problem solving ability. In addition, the effect of prompting students to look for patterns in instructional material, followed by the effect of factors that affect cognitive load such as proximity, explicitness, and representation, should be explored.