Jeroen Donkers | Maastricht University, Faculty of Arts and Social Sciences (original) (raw)

Papers by Jeroen Donkers

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2015

Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills i... more Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills is an effective and focused approach to competency-based education. Directed self-regulated learning (DSRL) may be an effective and less resource-intensive way to teach ACLS skills. Forty first-year internal medicine residents were randomized to either simulation-based DSRL or simulation-based instructor-regulated learning (IRL) of ACLS skills using a mastery learning model. Residents in each intervention completed pretest, posttest, and retention test of their performance in leading an ACLS response to a simulated scenario. Performance tests were assessed using a standardized checklist. Residents in the DSRL intervention were provided assessment instruments, a debriefing guide, and scenario-specific teaching points, and they were permitted to access relevant online resources. Residents in the IRL intervention had access to the same materials; however, the teaching and debriefing were instructor led. Skills of both the IRL and DSRL interventions showed significant improvement after the intervention, with an average improvement on the posttest of 21.7%. After controlling for pretest score, there was no difference between intervention arms on the posttest [F(1,37) = 0.02, P = 0.94] and retention tests [F(1,17) = 1.43, P = 0.25]. Cost savings were realized in the DSRL intervention after the fourth group (16 residents) had completed each intervention, with an ongoing savings of $80 per resident. Using a simulation-based mastery learning model, we observed equivalence in learning of ACLS skills for the DSRL and IRL conditions, whereas DSRL was more cost effective.

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

ABSTRACT Introduction/Background: Simulation-based mastery learning of Advanced Cardiac Life Supp... more ABSTRACT Introduction/Background: Simulation-based mastery learning of Advanced Cardiac Life Support (ACLS) skills has proven to be effective.1 Traditional ACLS courses incorporate instructor-regulated learning (IRL). Directed self-regulated learning (DSRL), where an educator designs the self-regulated learning,2 may provide an effective and less resource intensive way to teach ACLS skills. This study evaluated ACLS skill performance of participants in a DSRL simulation-based mastery learning course compared to the performance of participants who engaged in an IRL simulation-based mastery learning course. It also examined if DSRL was a cost-effective method to teach mastery learning of ACLS skills. Methods: Forty first year Internal Medicine residents were randomized to either simulation-based DSRL or IRL of ACLS skills using a mastery learning model. The DSRL group was provided simulation scenarios, assessment instruments, instructions to conduct a focused debriefing and access to relevant resources to direct their own learning. The IRL group had access to the same materials but the teaching and feedback provided was at the discretion of the instructor. Each group had two hours dedicated to deliberate practice of ACLS skills. Residents in both groups completed pre-tests and post-tests of their performance in leading an ACLS response to a simulated scenario. All tests were video-recorded and scored by expert raters. The cost of each intervention was also compared. Results: After controlling for pre-test scores of performance, there was no significant difference between post-test scores in the DSRL and IRL groups, F(1,37) = 0.007, p = .935. The costs associated with the IRL intervention were 3600(CAD)andwere3600 (CAD) and were 3600(CAD)andwere3200 (CAD) with the DSRL intervention. Not including startup costs, DSRL was 80perresidentlessexpensivethanIRL.Therefore,despitethehigherupfrontcosts,costsavingswererealizedintheDSRLgroupafterthefourthgrouphadcompletedeachintervention.Thiscostsavingsof80 per resident less expensive than IRL. Therefore, despite the higher upfront costs, cost savings were realized in the DSRL group after the fourth group had completed each intervention. This cost savings of 80perresidentlessexpensivethanIRL.Therefore,despitethehigherupfrontcosts,costsavingswererealizedintheDSRLgroupafterthefourthgrouphadcompletedeachintervention.Thiscostsavingsof80 per resident ($320 per group) can be realized on an ongoing basis. For example, if 20 groups of residents was to complete an IRL session, the cost of the would be 14400,whileif20groupscompletedaDSRLintervention,thecostwouldbe14400, while if 20 groups completed a DSRL intervention, the cost would be 14400,whileif20groupscompletedaDSRLintervention,thecostwouldbe10400. By using a DSRL model, it may be more feasible for educational programs to implement simulation-based mastery learning of ACLS skills or to use the savings associated with DSRL to expand the scope of other educational initiatives. Conclusion: DSRL of ACLS skills is as effective as IRL when using a mastery learning model in simulation-based training. DSRL is a cost-effective effective way to train residents in ACLS skills. Further research is required to examine the mechanisms that make DSRL is effective. References: 1. Wayne, D. B., Butter, J., Siddall, V. J., Fudala, M. J., Wade, L. D., Feinglass, J., & McGaghie, W. C. (2006b). Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. Journal of General Internal Medicine, 21, 251-256. 2. Brydges, R., Dubrowski, A., & Regehr, G. (2010). A new concept of unsupervised learning: directed self-guided learning in the health professions. Academic Medicine, 85(10 Suppl), S49-55. Disclosures: Author is director of Center that manufactures and distributes Harvey simulators. All funds are directly to the University of Miami. No perssonal financial interest are involved.

Advances in Medical Education, 2016

Background A major challenge for clinical supervisors is to encourage their residents to be inde... more Background

A major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents’ preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups.

Methods

We invited 301 residents of all residency programmes of Javeriana University, Bogotá, Colombia, to participate. Each resident was asked to complete a Maastricht Clinical Teaching Questionnaire (MCTQ), which, being based on the teaching methods of CA, asked residents to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why.

Results

A total of 215 residents (71 %) completed the questionnaire. All concurred that all CA teaching methods were important or very important to their learning, regardless of their level of training. However, the reasons for their preferences clearly differed between groups: junior and intermediate residents preferred teaching methods that were more supervisor-directed, such as modelling and coaching, whereas senior residents preferred teaching methods that were more resident-directed, such as exploration and articulation.

Conclusions

The results indicate that clinical supervision (CS) should accommodate to residents’ varying degrees of development by attuning the configuration of CA teaching methods to each level of residency training. This configuration should initially vest more power in the supervisor, and gradually let the resident take charge, without ever discontinuing CS.

The electronic virtual patient project (eViP) is a 3-year pro-gramme co-funded by the European Un... more The electronic virtual patient project (eViP) is a 3-year pro-gramme co-funded by the European Union. One of the major goals of eViP is to enable the sharing of virtual patients (VP) across medical education centres. This addresses a frequent problem in the development of e-learning resources, namely the lack of available time and resources while at the same time a lot of effort is wasted on duplicative work. The foundation of a successful and efficient bank of educational resources is a common interoperability standard that would facilitate the migration of data between diverse systems. A common standard (eViP profile), based on the MedBiquitous specifications for VPs, was implemented by the partners' VP systems in order to support the exchange process. The participating systems are CAMPUS, Casus, OpenLabyrinth and Web-SP, which of-fer a variety of functionalities and each of which has its own technical and didactical approach. All systems implemented the eViP profile at the en...

Background: The eViP programme has created a bank of 320 repurposed and enriched virtual patients... more Background: The eViP programme has created a bank of 320 repurposed and enriched virtual patients available under a Creative Commons Licence. Summary of work: We have created an open access repository of content where teachers can find virtual patients and either play them in situ or download for use locally. Summary of results: Virtual patients are described using a metadata profile based upon the MedBiquitous Virtual Patient and Healthcare/IEEE LOM standards adapted for eViP and indexed by MeSH and ICD terms. Usefulness of the repository will be related to how easily teachers can find virtual patients using metadata. The key to creating useful metadata is to make the data that describes a resource compatible to the terminology familiar and relevant to a user. Although this is apparently obvious, many learning resources are unused because they cannot easily be found. Conclusions: We will present a report of how our repository of content has been used and the search strategies of vi...

Medical teacher, 2015

Professionalism must be explicitly taught, but teaching professionalism is challenging, because m... more Professionalism must be explicitly taught, but teaching professionalism is challenging, because medical teachers are not prepared to teach this content area. This study aims at designing and evaluating a faculty development programme on learning and teaching professionalism in the Arabian context. Programme development: The study used a participatory design, where four authors and 28 teachers shared the responsibility in programme design in three steps: orientation workshop for teachers, vignette development, and teaching professionalism to students. The workshop provided the cognitive base on the salient attributes of professionalism in the Arabian context. After the workshop, authors helped teachers to develop a total of 32 vignettes in various clinical aspects, portraying a blend of professionalism dilemmas. A battery of seven questions/triggers was suggested to guide students' reflection. The programme was evaluated with regard to its "construct" and its "outc...

Studies in health technology and informatics, 2009

Virtual Patients (VPs) have successfully been integrated into medical and healthcare curricula fo... more Virtual Patients (VPs) have successfully been integrated into medical and healthcare curricula for a number of years. Lack of time and resources is a frequently reported problem encountered when developing VPs for teaching and learning. Consequently there is a need for cross-institutional repositories of VPs. The aims of the study were two-fold: to enable interoperability between virtual patient systems and to investigate if (and how) an application profile is implemented in four different types of VP systems. This European collaborative implementation of a blend of several specifications (Medbiquitous VP XML, Medbiquitous Healthcare LOM, and SCORM) is innovative and the study has shown a variation in how the application profile could be implemented.

Medical Teacher, 2014

Background: Medical professionalism has been described as a set of attributes and behaviors, yet ... more Background: Medical professionalism has been described as a set of attributes and behaviors, yet the Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries. Aim: This study aims to formulate a professionalism framework for healthcare providers as interpreted by local medical professionals in Arabian countries. Methods: A purposive sample of 17 experts from diverse disciplines participated in a Delphi study in three rounds. Consensus was identified by content analysis and by numerical analysis of responses on the basic attributes of medical professionalism in Arabian context. Results: Eight professional traits were shortlisted and coupled in four themes (Gates): dealing with self, dealing with tasks, dealing with others and dealing with God. Self-accountability and self-motivation were interpreted from a faithful viewpoint as ''taqwa'' and ''ehtesab'', respectively, in Arabic. Discussion: The Four-Gates Model helps in better understanding of medical professionalism as grounded in the minds and culture of Arabs. The model may act as a genuine framework for teaching and learning of medical professionalism in Arab medical schools. Conclusion: The study highlights the divergent interpretation of medical professionalism between Western and Arabian contexts. The Four-Gates Model may work for faith-driven societies, but not for non-Muslims Arabs students or teachers or in institutions with humanistic values.

Boletim da SPM, n ́umero especial Jogos Matem ́aticos, pp. 69–86, 2006

A família de jogos Mancala oferece boas oportunidades para efectuar nova investigação, tanto no d... more A família de jogos Mancala oferece boas oportunidades para efectuar nova investigação, tanto no domínio da Matemática como no da Inteligência Artificial. Para ilustrar este facto, iremos apresentar um resumo de resultados há muito conhecidos e de outros mais recentes sobre estes jogos. Embora os investigadores de jogos de tabuleiro possam conhecer os jogos Mancala, as propriedades gerais desta família de jogos serão explicadas, na medida em que são relevantes para a compreensão dos resultados. Estes reflectem, sobretudo, as características matemáticas dos jogos Mancala, embora as ciências informáticas tenham também desempenhado um papel importante na investigação apresentada. O artigo inclui também investigação no domínio da Inteligência Artificial, terminando depois com uma análise sobre as novas oportunidades de investigação, tanto em Matemática como em Inteligência Artificial. Estas oportunidades não se restringemà investigação teórica pura, incluindo também questões que permitem a cooperação interdisciplinar no domínio da investigação aplicada.

Interoperability of e-learning resources requires the adherence to specific standards. In the dom... more Interoperability of e-learning resources requires the adherence to specific standards. In the domain of virtual patients (VP) a central role is played by the MedBiquitous' MVP specification and its application profile proposed by the eViP (Electronic Virtual Patients) project. An important factor in promoting a standard is the use of metrics for assessing the conformity of the resources to the constraints imposed by the specifications. The overall aim of this study was to explore strategies to test for conformance and investigate the capabilities and limitations of automated conformance testing. A four-level scale of conformance of virtual patient packages to the eViP profile is presented, as well as two implementations of conformance testing applications. The developed tools have been tested upon level two on a sample of four VP cases acquired from the eViP repository of virtual patients.

Studies in Computational Intelligence, 2008

... jeroen.donkers@educ.unimaas.nl, k.tuyls@micc.unimaas.nl ... ek for variable Xk, ie, Xk = ek, ... more ... jeroen.donkers@educ.unimaas.nl, k.tuyls@micc.unimaas.nl ... ek for variable Xk, ie, Xk = ek, then the belief network can be used to compute the beliefs in unobserved variables, which is the conditional probability of the unobserved variables given the evidence: Bel(Xi = xi) = P(Xi ...

Lessons from Problem-based Learning, 2010

... Proceedings of the International Conference of Virtual Patients, Kraków, Poland, 2009 (Specia... more ... Proceedings of the International Conference of Virtual Patients, Kraków, Poland, 2009 (Special issue), Bio-Algorithms and Med-Systems 5–9. Schuwirth, LWT, van der Vleuten, CPM, de Kock, CA, Peperkamp, AGW, and Donkers, HHLM (1996). ...

British Journal of Nutrition, 1995

In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally r... more In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally regulated at a constant level. Changes in FM and FFM are dependent on energy intake (EI) and energy expenditure (EE). The body defends itself against an imbalance between EI and EE by adjusting, within limits, the one to the other. When, at a given EI or EE, energy balance cannot be reached, FM and FFM will change, eventually resulting in an energy balance at a new value. A model is described which simulates changes in FM and FFM using EI and physical activity (PA) as input variables. EI can be set at a chosen value or calculated from dietary intake with a database on the net energy of foods. PA can be set at a chosen multiple of basal metabolic rate (BMR) or calculated from the activity budget with a database on the energy cost of activities in multiples of BMR. BMR is calculated from FFM and FM and, ifnecessary, FFM is calculated from BM, height, sex and age, using empirical equations. The model uses existing knowledge on the adaptation of energy expenditure (EE) to an imbalance between EI and EE, and to resulting changes in FM and FFM. Mobilization and storage of energy as FM and FFM are functions of the relative size of the deficit (EI/EE) and of the body composition. The model was validated with three recent studies measuring EE at a fixed EI during an interval with energy restriction, overfeeding and exercise training respectively. Discrepancies between observed and simulated changes in energy stores were within the measurement precision of EI, EE and body composition. Thus the consequences of a change in dietary intake or a change in physical activity on body weight and body composition can be simulated.

Medical Teacher, 2013

The attributes of the professional physicians varies among cultures. This study aims to develop a... more The attributes of the professional physicians varies among cultures. This study aims to develop and validate a questionnaire that measures attitudes of medical students on professionalism in the Arabian context. Thirty-two experts contributed to item generation in particular domains. The instrument was administered to Arabian medical students and interns and responses were collected using five-point Likert scales. Data were analyzed to estimate the reliability of the instrument. The inventory in its final version was labeled as the Learners' Attitude of Medical Professionalism Scale (LAMPS). A total of 413 medical students and interns responded from two universities in Egypt and Saudi Arabia. Means of item response ranged from 2.38 to 4.72. The highest mainly deals with "Respect to others," while the lowest belong to "Honor/Integrity." The final version of the LAMPS has 28 items in five domains, with a reliability of 0.79. The LAMPS has salient features compared to other similar instrument. It was designed based on a reliable framework in explicit behavioral items, not abstract attributes of professionalism. The LAMPS can help teachers to identify learning gaps regarding professionalism amongst their students and track attitude changes over time or as the result of interventions. To the best of our knowledge, the LAMPS is the first context-specific inventory on medical professionalism attitudes in the Arabian context.

Medical Teacher, 2010

The potential richness of the feedback for learners and teachers is one of the educational advant... more The potential richness of the feedback for learners and teachers is one of the educational advantages of progress tests (PTs). Every test administration yields information on a student's knowledge level in each sub-domain of the test (cross-sectional information), and it adds a next point to the corresponding knowledge growth curve (longitudinal information). Traditional paper-based feedback has severe limitations and requires considerable effort from the learners to give meaning to the data. We reasoned that the PT data should be flexibly accessible in all pathways and with any available comparison data, according to the personal interest of the learner. For that purpose, a web-based tool (Progress test Feedback, the ProF system) was developed. This article presents the principles and features of the generated feedback and shows how it can be used. In addition to enhancement of the feedback, the ProF database of longitudinal PT-data also provides new opportunities for research on knowledge growth, and these are currently being explored.

International Journal of Interactive Mobile Technologies (iJIM), 2013

ABSTRACT Smartphones and Mobile Clinical Decision Support Systems (MCDSS) could help to overcome ... more ABSTRACT Smartphones and Mobile Clinical Decision Support Systems (MCDSS) could help to overcome information overload and support physicians in providing up-to-date medical care. However, would smartphones and MCDSS also be useful for medical students during their clinical clerkships? In this prospective pilot study eight students were asked to use a smartphone during their daily clerkship activities and specifically to evaluate a basic MCDSS. Students were asked to fill out a short survey and exit interviews were conducted. Most students found the smartphone, especially access to the internet, a useful tool during their clerkship. Some students thought that the internet was an easier accessible information source compared to many applications. Several students were not aware of any high-quality applications and most students were not willing to pay more than ten Euros for such an application. In the opinion of most students smartphones should not be used in the presence of a patient. Students expressed a desire for more basic content in the tested MCDSS. In conclusion, smartphones can be a useful tool for medical students during their clerkship. MCDSS for medical students should be designed to their needs. Further research is needed to guide MCDSS development specifically targeted at medical students.

The electronic virtual patient project (eViP) is a 3-year programme co-funded by the European Uni... more The electronic virtual patient project (eViP) is a 3-year programme co-funded by the European Union. One of the major goals of eViP is to enable the sharing of virtual patients (VP) across medical education centres. This addresses a frequent problem in the development of e-learning resources, namely the lack of available time and resources while at the same time a lot of effort is wasted on duplicative work. The foundation of a successful and efficient bank of educational resources is a common interoperability standard that would facilitate the migration of data ...

The family of mancala games offers opportunities for new research in both Mathematics and Artific... more The family of mancala games offers opportunities for new research in both Mathematics and Artificial Intelligence. To illustrate this, we will present an overview of long-time known and more recent results on mancala games. Although board-games researchers may be familiar with mancala games, the general properties of this family of board games will be explained as far as they are

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2015

Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills i... more Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills is an effective and focused approach to competency-based education. Directed self-regulated learning (DSRL) may be an effective and less resource-intensive way to teach ACLS skills. Forty first-year internal medicine residents were randomized to either simulation-based DSRL or simulation-based instructor-regulated learning (IRL) of ACLS skills using a mastery learning model. Residents in each intervention completed pretest, posttest, and retention test of their performance in leading an ACLS response to a simulated scenario. Performance tests were assessed using a standardized checklist. Residents in the DSRL intervention were provided assessment instruments, a debriefing guide, and scenario-specific teaching points, and they were permitted to access relevant online resources. Residents in the IRL intervention had access to the same materials; however, the teaching and debriefing were instructor led. Skills of both the IRL and DSRL interventions showed significant improvement after the intervention, with an average improvement on the posttest of 21.7%. After controlling for pretest score, there was no difference between intervention arms on the posttest [F(1,37) = 0.02, P = 0.94] and retention tests [F(1,17) = 1.43, P = 0.25]. Cost savings were realized in the DSRL intervention after the fourth group (16 residents) had completed each intervention, with an ongoing savings of $80 per resident. Using a simulation-based mastery learning model, we observed equivalence in learning of ACLS skills for the DSRL and IRL conditions, whereas DSRL was more cost effective.

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

ABSTRACT Introduction/Background: Simulation-based mastery learning of Advanced Cardiac Life Supp... more ABSTRACT Introduction/Background: Simulation-based mastery learning of Advanced Cardiac Life Support (ACLS) skills has proven to be effective.1 Traditional ACLS courses incorporate instructor-regulated learning (IRL). Directed self-regulated learning (DSRL), where an educator designs the self-regulated learning,2 may provide an effective and less resource intensive way to teach ACLS skills. This study evaluated ACLS skill performance of participants in a DSRL simulation-based mastery learning course compared to the performance of participants who engaged in an IRL simulation-based mastery learning course. It also examined if DSRL was a cost-effective method to teach mastery learning of ACLS skills. Methods: Forty first year Internal Medicine residents were randomized to either simulation-based DSRL or IRL of ACLS skills using a mastery learning model. The DSRL group was provided simulation scenarios, assessment instruments, instructions to conduct a focused debriefing and access to relevant resources to direct their own learning. The IRL group had access to the same materials but the teaching and feedback provided was at the discretion of the instructor. Each group had two hours dedicated to deliberate practice of ACLS skills. Residents in both groups completed pre-tests and post-tests of their performance in leading an ACLS response to a simulated scenario. All tests were video-recorded and scored by expert raters. The cost of each intervention was also compared. Results: After controlling for pre-test scores of performance, there was no significant difference between post-test scores in the DSRL and IRL groups, F(1,37) = 0.007, p = .935. The costs associated with the IRL intervention were 3600(CAD)andwere3600 (CAD) and were 3600(CAD)andwere3200 (CAD) with the DSRL intervention. Not including startup costs, DSRL was 80perresidentlessexpensivethanIRL.Therefore,despitethehigherupfrontcosts,costsavingswererealizedintheDSRLgroupafterthefourthgrouphadcompletedeachintervention.Thiscostsavingsof80 per resident less expensive than IRL. Therefore, despite the higher upfront costs, cost savings were realized in the DSRL group after the fourth group had completed each intervention. This cost savings of 80perresidentlessexpensivethanIRL.Therefore,despitethehigherupfrontcosts,costsavingswererealizedintheDSRLgroupafterthefourthgrouphadcompletedeachintervention.Thiscostsavingsof80 per resident ($320 per group) can be realized on an ongoing basis. For example, if 20 groups of residents was to complete an IRL session, the cost of the would be 14400,whileif20groupscompletedaDSRLintervention,thecostwouldbe14400, while if 20 groups completed a DSRL intervention, the cost would be 14400,whileif20groupscompletedaDSRLintervention,thecostwouldbe10400. By using a DSRL model, it may be more feasible for educational programs to implement simulation-based mastery learning of ACLS skills or to use the savings associated with DSRL to expand the scope of other educational initiatives. Conclusion: DSRL of ACLS skills is as effective as IRL when using a mastery learning model in simulation-based training. DSRL is a cost-effective effective way to train residents in ACLS skills. Further research is required to examine the mechanisms that make DSRL is effective. References: 1. Wayne, D. B., Butter, J., Siddall, V. J., Fudala, M. J., Wade, L. D., Feinglass, J., & McGaghie, W. C. (2006b). Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. Journal of General Internal Medicine, 21, 251-256. 2. Brydges, R., Dubrowski, A., & Regehr, G. (2010). A new concept of unsupervised learning: directed self-guided learning in the health professions. Academic Medicine, 85(10 Suppl), S49-55. Disclosures: Author is director of Center that manufactures and distributes Harvey simulators. All funds are directly to the University of Miami. No perssonal financial interest are involved.

Advances in Medical Education, 2016

Background A major challenge for clinical supervisors is to encourage their residents to be inde... more Background

A major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents’ preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups.

Methods

We invited 301 residents of all residency programmes of Javeriana University, Bogotá, Colombia, to participate. Each resident was asked to complete a Maastricht Clinical Teaching Questionnaire (MCTQ), which, being based on the teaching methods of CA, asked residents to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why.

Results

A total of 215 residents (71 %) completed the questionnaire. All concurred that all CA teaching methods were important or very important to their learning, regardless of their level of training. However, the reasons for their preferences clearly differed between groups: junior and intermediate residents preferred teaching methods that were more supervisor-directed, such as modelling and coaching, whereas senior residents preferred teaching methods that were more resident-directed, such as exploration and articulation.

Conclusions

The results indicate that clinical supervision (CS) should accommodate to residents’ varying degrees of development by attuning the configuration of CA teaching methods to each level of residency training. This configuration should initially vest more power in the supervisor, and gradually let the resident take charge, without ever discontinuing CS.

The electronic virtual patient project (eViP) is a 3-year pro-gramme co-funded by the European Un... more The electronic virtual patient project (eViP) is a 3-year pro-gramme co-funded by the European Union. One of the major goals of eViP is to enable the sharing of virtual patients (VP) across medical education centres. This addresses a frequent problem in the development of e-learning resources, namely the lack of available time and resources while at the same time a lot of effort is wasted on duplicative work. The foundation of a successful and efficient bank of educational resources is a common interoperability standard that would facilitate the migration of data between diverse systems. A common standard (eViP profile), based on the MedBiquitous specifications for VPs, was implemented by the partners' VP systems in order to support the exchange process. The participating systems are CAMPUS, Casus, OpenLabyrinth and Web-SP, which of-fer a variety of functionalities and each of which has its own technical and didactical approach. All systems implemented the eViP profile at the en...

Background: The eViP programme has created a bank of 320 repurposed and enriched virtual patients... more Background: The eViP programme has created a bank of 320 repurposed and enriched virtual patients available under a Creative Commons Licence. Summary of work: We have created an open access repository of content where teachers can find virtual patients and either play them in situ or download for use locally. Summary of results: Virtual patients are described using a metadata profile based upon the MedBiquitous Virtual Patient and Healthcare/IEEE LOM standards adapted for eViP and indexed by MeSH and ICD terms. Usefulness of the repository will be related to how easily teachers can find virtual patients using metadata. The key to creating useful metadata is to make the data that describes a resource compatible to the terminology familiar and relevant to a user. Although this is apparently obvious, many learning resources are unused because they cannot easily be found. Conclusions: We will present a report of how our repository of content has been used and the search strategies of vi...

Medical teacher, 2015

Professionalism must be explicitly taught, but teaching professionalism is challenging, because m... more Professionalism must be explicitly taught, but teaching professionalism is challenging, because medical teachers are not prepared to teach this content area. This study aims at designing and evaluating a faculty development programme on learning and teaching professionalism in the Arabian context. Programme development: The study used a participatory design, where four authors and 28 teachers shared the responsibility in programme design in three steps: orientation workshop for teachers, vignette development, and teaching professionalism to students. The workshop provided the cognitive base on the salient attributes of professionalism in the Arabian context. After the workshop, authors helped teachers to develop a total of 32 vignettes in various clinical aspects, portraying a blend of professionalism dilemmas. A battery of seven questions/triggers was suggested to guide students' reflection. The programme was evaluated with regard to its "construct" and its "outc...

Studies in health technology and informatics, 2009

Virtual Patients (VPs) have successfully been integrated into medical and healthcare curricula fo... more Virtual Patients (VPs) have successfully been integrated into medical and healthcare curricula for a number of years. Lack of time and resources is a frequently reported problem encountered when developing VPs for teaching and learning. Consequently there is a need for cross-institutional repositories of VPs. The aims of the study were two-fold: to enable interoperability between virtual patient systems and to investigate if (and how) an application profile is implemented in four different types of VP systems. This European collaborative implementation of a blend of several specifications (Medbiquitous VP XML, Medbiquitous Healthcare LOM, and SCORM) is innovative and the study has shown a variation in how the application profile could be implemented.

Medical Teacher, 2014

Background: Medical professionalism has been described as a set of attributes and behaviors, yet ... more Background: Medical professionalism has been described as a set of attributes and behaviors, yet the Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries. Aim: This study aims to formulate a professionalism framework for healthcare providers as interpreted by local medical professionals in Arabian countries. Methods: A purposive sample of 17 experts from diverse disciplines participated in a Delphi study in three rounds. Consensus was identified by content analysis and by numerical analysis of responses on the basic attributes of medical professionalism in Arabian context. Results: Eight professional traits were shortlisted and coupled in four themes (Gates): dealing with self, dealing with tasks, dealing with others and dealing with God. Self-accountability and self-motivation were interpreted from a faithful viewpoint as ''taqwa'' and ''ehtesab'', respectively, in Arabic. Discussion: The Four-Gates Model helps in better understanding of medical professionalism as grounded in the minds and culture of Arabs. The model may act as a genuine framework for teaching and learning of medical professionalism in Arab medical schools. Conclusion: The study highlights the divergent interpretation of medical professionalism between Western and Arabian contexts. The Four-Gates Model may work for faith-driven societies, but not for non-Muslims Arabs students or teachers or in institutions with humanistic values.

Boletim da SPM, n ́umero especial Jogos Matem ́aticos, pp. 69–86, 2006

A família de jogos Mancala oferece boas oportunidades para efectuar nova investigação, tanto no d... more A família de jogos Mancala oferece boas oportunidades para efectuar nova investigação, tanto no domínio da Matemática como no da Inteligência Artificial. Para ilustrar este facto, iremos apresentar um resumo de resultados há muito conhecidos e de outros mais recentes sobre estes jogos. Embora os investigadores de jogos de tabuleiro possam conhecer os jogos Mancala, as propriedades gerais desta família de jogos serão explicadas, na medida em que são relevantes para a compreensão dos resultados. Estes reflectem, sobretudo, as características matemáticas dos jogos Mancala, embora as ciências informáticas tenham também desempenhado um papel importante na investigação apresentada. O artigo inclui também investigação no domínio da Inteligência Artificial, terminando depois com uma análise sobre as novas oportunidades de investigação, tanto em Matemática como em Inteligência Artificial. Estas oportunidades não se restringemà investigação teórica pura, incluindo também questões que permitem a cooperação interdisciplinar no domínio da investigação aplicada.

Interoperability of e-learning resources requires the adherence to specific standards. In the dom... more Interoperability of e-learning resources requires the adherence to specific standards. In the domain of virtual patients (VP) a central role is played by the MedBiquitous' MVP specification and its application profile proposed by the eViP (Electronic Virtual Patients) project. An important factor in promoting a standard is the use of metrics for assessing the conformity of the resources to the constraints imposed by the specifications. The overall aim of this study was to explore strategies to test for conformance and investigate the capabilities and limitations of automated conformance testing. A four-level scale of conformance of virtual patient packages to the eViP profile is presented, as well as two implementations of conformance testing applications. The developed tools have been tested upon level two on a sample of four VP cases acquired from the eViP repository of virtual patients.

Studies in Computational Intelligence, 2008

... jeroen.donkers@educ.unimaas.nl, k.tuyls@micc.unimaas.nl ... ek for variable Xk, ie, Xk = ek, ... more ... jeroen.donkers@educ.unimaas.nl, k.tuyls@micc.unimaas.nl ... ek for variable Xk, ie, Xk = ek, then the belief network can be used to compute the beliefs in unobserved variables, which is the conditional probability of the unobserved variables given the evidence: Bel(Xi = xi) = P(Xi ...

Lessons from Problem-based Learning, 2010

... Proceedings of the International Conference of Virtual Patients, Kraków, Poland, 2009 (Specia... more ... Proceedings of the International Conference of Virtual Patients, Kraków, Poland, 2009 (Special issue), Bio-Algorithms and Med-Systems 5–9. Schuwirth, LWT, van der Vleuten, CPM, de Kock, CA, Peperkamp, AGW, and Donkers, HHLM (1996). ...

British Journal of Nutrition, 1995

In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally r... more In adults, body mass (BM) and its components fat-free mass (FFM) and fat mass (FM) are normally regulated at a constant level. Changes in FM and FFM are dependent on energy intake (EI) and energy expenditure (EE). The body defends itself against an imbalance between EI and EE by adjusting, within limits, the one to the other. When, at a given EI or EE, energy balance cannot be reached, FM and FFM will change, eventually resulting in an energy balance at a new value. A model is described which simulates changes in FM and FFM using EI and physical activity (PA) as input variables. EI can be set at a chosen value or calculated from dietary intake with a database on the net energy of foods. PA can be set at a chosen multiple of basal metabolic rate (BMR) or calculated from the activity budget with a database on the energy cost of activities in multiples of BMR. BMR is calculated from FFM and FM and, ifnecessary, FFM is calculated from BM, height, sex and age, using empirical equations. The model uses existing knowledge on the adaptation of energy expenditure (EE) to an imbalance between EI and EE, and to resulting changes in FM and FFM. Mobilization and storage of energy as FM and FFM are functions of the relative size of the deficit (EI/EE) and of the body composition. The model was validated with three recent studies measuring EE at a fixed EI during an interval with energy restriction, overfeeding and exercise training respectively. Discrepancies between observed and simulated changes in energy stores were within the measurement precision of EI, EE and body composition. Thus the consequences of a change in dietary intake or a change in physical activity on body weight and body composition can be simulated.

Medical Teacher, 2013

The attributes of the professional physicians varies among cultures. This study aims to develop a... more The attributes of the professional physicians varies among cultures. This study aims to develop and validate a questionnaire that measures attitudes of medical students on professionalism in the Arabian context. Thirty-two experts contributed to item generation in particular domains. The instrument was administered to Arabian medical students and interns and responses were collected using five-point Likert scales. Data were analyzed to estimate the reliability of the instrument. The inventory in its final version was labeled as the Learners' Attitude of Medical Professionalism Scale (LAMPS). A total of 413 medical students and interns responded from two universities in Egypt and Saudi Arabia. Means of item response ranged from 2.38 to 4.72. The highest mainly deals with "Respect to others," while the lowest belong to "Honor/Integrity." The final version of the LAMPS has 28 items in five domains, with a reliability of 0.79. The LAMPS has salient features compared to other similar instrument. It was designed based on a reliable framework in explicit behavioral items, not abstract attributes of professionalism. The LAMPS can help teachers to identify learning gaps regarding professionalism amongst their students and track attitude changes over time or as the result of interventions. To the best of our knowledge, the LAMPS is the first context-specific inventory on medical professionalism attitudes in the Arabian context.

Medical Teacher, 2010

The potential richness of the feedback for learners and teachers is one of the educational advant... more The potential richness of the feedback for learners and teachers is one of the educational advantages of progress tests (PTs). Every test administration yields information on a student's knowledge level in each sub-domain of the test (cross-sectional information), and it adds a next point to the corresponding knowledge growth curve (longitudinal information). Traditional paper-based feedback has severe limitations and requires considerable effort from the learners to give meaning to the data. We reasoned that the PT data should be flexibly accessible in all pathways and with any available comparison data, according to the personal interest of the learner. For that purpose, a web-based tool (Progress test Feedback, the ProF system) was developed. This article presents the principles and features of the generated feedback and shows how it can be used. In addition to enhancement of the feedback, the ProF database of longitudinal PT-data also provides new opportunities for research on knowledge growth, and these are currently being explored.

International Journal of Interactive Mobile Technologies (iJIM), 2013

ABSTRACT Smartphones and Mobile Clinical Decision Support Systems (MCDSS) could help to overcome ... more ABSTRACT Smartphones and Mobile Clinical Decision Support Systems (MCDSS) could help to overcome information overload and support physicians in providing up-to-date medical care. However, would smartphones and MCDSS also be useful for medical students during their clinical clerkships? In this prospective pilot study eight students were asked to use a smartphone during their daily clerkship activities and specifically to evaluate a basic MCDSS. Students were asked to fill out a short survey and exit interviews were conducted. Most students found the smartphone, especially access to the internet, a useful tool during their clerkship. Some students thought that the internet was an easier accessible information source compared to many applications. Several students were not aware of any high-quality applications and most students were not willing to pay more than ten Euros for such an application. In the opinion of most students smartphones should not be used in the presence of a patient. Students expressed a desire for more basic content in the tested MCDSS. In conclusion, smartphones can be a useful tool for medical students during their clerkship. MCDSS for medical students should be designed to their needs. Further research is needed to guide MCDSS development specifically targeted at medical students.

The electronic virtual patient project (eViP) is a 3-year programme co-funded by the European Uni... more The electronic virtual patient project (eViP) is a 3-year programme co-funded by the European Union. One of the major goals of eViP is to enable the sharing of virtual patients (VP) across medical education centres. This addresses a frequent problem in the development of e-learning resources, namely the lack of available time and resources while at the same time a lot of effort is wasted on duplicative work. The foundation of a successful and efficient bank of educational resources is a common interoperability standard that would facilitate the migration of data ...

The family of mancala games offers opportunities for new research in both Mathematics and Artific... more The family of mancala games offers opportunities for new research in both Mathematics and Artificial Intelligence. To illustrate this, we will present an overview of long-time known and more recent results on mancala games. Although board-games researchers may be familiar with mancala games, the general properties of this family of board games will be explained as far as they are