ViA-ScAn - Fostering of diagnostic competences in medical history taking: Effects of adaptation of scaffolds in video simulations

DFG研究单位COSIMA的项目4侧重于不同类型的脚手架对诊断活动（学习过程）的影响以及在基于模拟的医学学习中获得诊断能力。在项目的第一个阶段，通过现场模拟、视频模拟和角色扮演，研究了结构化反思和角色扮演对诊断能力获得的影响。对患有呼吸困难的患者进行知识测试和现实模拟，并成功地验证了这一点。一项验证性研究的结果表明，诊断能力可以在病历采集的视频和实时模拟中可靠而有效地测量。在模拟中，战略知识被证明是诊断质量的预测因子。在第一供资阶段正在进行的干预研究中，正在采用略加改进的模拟方法。关于诊断能力的习得，研究单位最近的一项荟萃分析结果表明，低先验知识的学习者从需要低自我调节技能的工作实例中获益更多。然而，具有高先验知识的学习者从需要高度自我调节技能的反思阶段中获益更多。第四阶段第二资助阶段的研究1将调查不同类型的支架，即工作实例和反思阶段，对学生通过视频模拟中的典型案例学习的诊断活动和获得诊断能力的影响。在学习阶段（宏观适应）开始时，根据对参与者先前知识的评估，为他们分配支架的类型。在研究2中，TP 4和TP 7将对第一个资助阶段的数据进行联合再分析，以比较不同领域角色扮演的学习过程和结构化反思的内容。研究3将侧重于病例典型性作为医学诊断能力获得的关键背景因素。与研究1类似，将审查工作实例和反思阶段对诊断活动和诊断能力获得的影响。脚手架的类型将再次根据先前的知识分配，但这次学生将学习非典型案例。最后，研究1和研究3的数据将被汇总和分析，以比较病例典型性对不同先验知识水平的学习者的诊断活动和诊断能力获得的影响，这些学习者使用不同类型的支架。总之，TP 4努力为在基于模拟的学习环境中适应不同类型的支架以获得诊断能力的有效性提供证据。这个项目将是第一个调查上下文因素的影响案例典型性取决于先验知识。

Project 4 of the DFG Research Unit COSIMA focuses on the effects of different types of scaffolding on diagnostic activities (learning processes) and on the acquisition of diagnostic competences in simulation-based learning in medicine. In the first project phase, effects of structured reflection and role-taking on the acquisition of diagnostic competences were examined in live simulations, video simulations, and role-plays. Knowledge tests and realistic simulations of history-taking with patients suffering from dyspnea were created and successfully validated. Results from a validation study indicate that diagnostic competences can be measured reliably and validly in video and live simulations of medical history-taking. Strategic knowledge turned out to be a predictor of diagnostic quality in the simulations. A slightly enhanced simulation is being applied in the ongoing intervention studies of the first funding phase. Regarding the acquisition of diagnostic competences, findings from a recent meta-analysis of the research unit suggest that learners with low prior knowledge benefit more from worked examples that require low self-regulation skills. Learners with high prior knowledge, however, benefit more from reflection phases that require high self-regulation skills. Study 1 of the second funding phase of TP 4 will investigate effects of different types of scaffolds, namely worked examples and reflection phases, on diagnostic activities and on the acquisition of diagnostic competences in students learning with typical cases in video simulations. The type of scaffold will be assigned to study participants based on the assessment of their prior knowledge at the beginning of the learning phase (macro-adaptation). In study 2, TP 4 and TP 7 will conduct a joint reanalyis of data from the first funding phase to compare learning processes and contents of structured reflection from role-plays in different domains. Study 3 will focus on case typicality as a crucial context factor for the acquisition of diagnostic competences in medicine. Analogously to study 1, effects of worked examples and reflection phases on diagnostic activities and the acquisition of diagnostic competences will be examined. The type of scaffold will again be assigned based on prior knowledge, but students will learn with atypical cases this time. Finally, data from studies 1 and 3 will be aggregated and analysed to compare effects of case typicality on diagnostic activities and on the acquisition of diagnostic competences in learners with different levels of prior knowledge who were supported with different types of scaffolds. In summary, TP 4 strives to generate evidence for the effectiveness of the adaptation of different types of scaffolds for the acquisition of diagnostic competences in simulation-based learning environments. This project will be the first to investigate the effects of the context factor case typicality depending on prior knowledge.