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Why Content and Cognition Matter: Integrating Conceptual Knowledge to Support Simulation-Based Procedural Skills Transfer

  • Jeffrey J. H. CheungEmail author
  • Kulamakan M. Kulasegaram
  • Nicole N. Woods
  • Ryan Brydges
Original Research

Abstract

Background

Curricular constraints require being selective about the type of content trainees practice in their formal training. Teaching trainees procedural knowledge about “how” to perform steps of a skill along with conceptual knowledge about “why” each step is performed can support skill retention and transfer (i.e., the ability to adapt knowledge to novel problems). However, how best to organize how and why content for procedural skills training is unknown.

Objectives

We examined the impact of different approaches to integrating why and how content on trainees’ skill retention and transfer of simulation-based lumbar puncture (LP).

Design and Participants

We randomized medical students (N = 66) to practice LP for 1 h using one of three videos. One video presented only the how content for LP (Procedural Only). Two other videos presented how and why content (e.g., anatomy) in two ways: Integrated in Sequence, with why content followed by how content, or Integrated for Causation, with how and why content integrated throughout.

Main Measures

Pairs of blinded raters scored participants’ retention and transfer LP performances on a global rating scale (GRS), and written tests assessed participants’ procedural and conceptual knowledge.

Key Results

Simple mediation regression analyses showed that participants receiving an integrated instructional video performed significantly better on transfer through their intervention’s positive impact on conceptual knowledge (all p < 0.01). Further, the Integrated for Causation group performed significantly better on transfer than the Integrated in Sequence group (p < 0.01), again mediated by improved conceptual knowledge. We observed no mediation of participants’ skill retention (all p > 0.01).

Conclusions

When teaching supports cognitive integration of how and why content, trainees are able to transfer learning to new problems because of their improved conceptual understanding. Instructional designs for procedural skills that integrate how and why content can help educators optimize what trainees learn from each repetition of practice.

KEY WORDS

basic science clinical skills training instructional design simulation cognition/problem solving transfer 

Notes

Acknowledgements

The authors extend their thanks and appreciation to the Currie Fellowship program at the Wilson Centre, University Health Network and the Canada Graduate Scholarship program at the Natural Sciences and Engineering Research Council for funding JJHC’s PhD studies. We thank the staff at the Surgical Skills Centre, Mount Sinai Hospital, Toronto, for sharing equipment and resources, Thomas Sun at Sun Innovations for his ongoing innovation and technical support of our projects, and the Wilson Centre for providing space to conduct the experiment.

Funding Information

We are very grateful for the funding from the Bank of Montreal Chair in Health Professions Education Research and from the Department of Medicine, University of Toronto.

Compliance with Ethical Standards

We received institutional ethics approval from the University of Toronto prior to participant recruitment. All participants provided informed consent prior to engaging in the study protocol.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4959_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 13 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jeffrey J. H. Cheung
    • 1
    • 2
    Email author
  • Kulamakan M. Kulasegaram
    • 1
    • 3
  • Nicole N. Woods
    • 1
    • 3
  • Ryan Brydges
    • 1
    • 2
    • 4
  1. 1.The Wilson Centre, University Health Network and University of TorontoTorontoCanada
  2. 2.Allan Waters Family Simulation CentreSt. Michael’s HospitalTorontoCanada
  3. 3.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of MedicineUniversity of TorontoTorontoCanada

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