Expert Tutors Research Articles

Developing second language sociopragmatic knowledge through concept-based instruction: A microgenetic case study

This article presents a case study of the development of second language (L2) sociopragmatic knowledge in an intermediate-level US university learner of French, Jane (a pseudonym), who participated in a one-hour concept-based instruction (CBI) tutorial. Grounded in a Vygotskian perspective on developmental education, this research focuses on the teaching of scientific, or theoretical, concepts as a way of mediating language learners’ developing understanding of and ability to use the L2 for meaning-making purposes. The focus of the present study is on sociopragmatic concepts related to the choice between French second-person pronouns, TU and VOUS. An in-depth moment-to-moment, microgenetic analysis traces how changes in Jane's cognitive functioning (i.e., conceptual knowledge) arose in and through her engagement in the CBI tutorial, which included collaboration with an expert tutor as well as access to such mediating artifacts as written concept explanations and pedagogical diagrams.

EXPERIMENTAL ENDOSCOPIC SUBMUCOSAL DISSECTION TRAINING IN A PORCINE MODEL: LEARNING EXPERIENCE OF SKILLED WESTERN ENDOSCOPISTS

Endoscopic submucosal dissection (ESD) demands a new level of endoscopic skill in Europe. A 2-day workshop was set up for trainees to carry out five ESD each in order to obtain the skill level required to perform ESD in the stomach or rectum. This study describes: (i) the workshop setup; (ii) the participant's performance; and (iii) the training effect on post-workshop clinical ESD performance. Eighteen very experienced European endoscopists participated in four half-day (4.5 h) training sessions, with everybody rotating daily through six separate training stations (two each with dual, hook, or hybrid knives) with expert tutors. One anesthetized piglet was used per station and session. After 1 year, the clinical ESD performance was surveyed to estimate the training effect of the workshop. Overall, 74 ESD were performed, that is, 4.1 ESD per participant. On average ESD lasted 57 min for 6 cm(2) specimens. We detected a 22% rate of perforation (16 of 74 ESD with perforations), mostly attributable to participants with less experience in ESD. Those who started clinical ESD within 1 year after the workshop performed 144 clinical ESD (median 8 [0-20] per trainee) mostly in the stomach (40%) and large bowel (46%) with an acceptable rate of perforation (9.7%) and surgical repair (3.5%) without mortality or persistent morbidity. Intense skill training for ESD is needed to reduce the risk of perforation, as demonstrated by the results of this workshop. We show that experimental ESD training, however, enables skilled European endoscopists to perform ESD in standard locations with moderate risk of perforation during the clinical learning curve.

Clinical reasoning sessions: back to the patient

Problem-based learning (PBL) was developed as a facilitated small group learning process based around a clinical problem. Originally designed for pre-clinical years of medical education, its application across all years poses a number of difficulties, including the risk of reducing patient contact, providing a learning process that is skewed towards an understanding of pathophysiological processes, which may not be well understood in all areas of medicine, and failing to provide exposure to clinically relevant reasoning skills. Curriculum review identified dissatisfaction with PBLs in the clinical years of the Sydney Medical School's Graduate Medical Program, from both staff and students. A new model was designed and implemented in the Psychiatry and Addiction Medicine rotation, and is currently being evaluated. We describe an innovative model of small-group, student-generated, case-based learning in psychiatry - clinical reasoning sessions (CRS) - led by expert facilitators. The CRS format returns the student to the patient, emphasises clinical assessment skills and considers treatment in the real-world context of the patient. Students practise a more sophisticated reasoning process with real patients modelled upon that of their expert tutor. This has increased student engagement compared with the previous PBL programme.

Embedded formative e‐assessment: who benefits, who falters

This research examined the impact of formative quizzes on e‐learning designed to teach volunteers how to tutor struggling readers. Three research questions were addressed: (1) Do embedded quizzes facilitate learning of e‐content? (2) Does the announcement of upcoming quizzes affect learning? (3) Does prior knowledge interact with quizzing and learning? Participants (n=178) were randomly assigned to condition: (1) no warning, no quiz (control), (2) no warning, quiz, and (3) warning, quiz. Users demonstrated significant learning gains. A predicted main effect for quiz warning was not supported. However, the effect of quizzes on learning was significantly moderated by the amount of prior experience. Low experience tutors learned significantly more when quizzes were embedded compared with expert tutors – a classic expertise reversal effect. A new neurocognitive interpretation for this effect is presented, as well as a call for more “stealthy” assessments that take into account novelty and the learner’s zone of proximal development. Eingefügte e‐Bewertungen: Wem nutzen sie, wem nicht Mit dieser Arbeit wurde der Einfluss formativer Ratespiele in Lernsoftware für freiwillige Helfer zur Unterstützung schwacher Leser untersucht. Drei Forschungsfragen wurden gestellt: (1) Erleichtern eingebaute Ratespiele das Lernen des zu vermittelnden Inhalts? (2) Beeinflusst die Vorankündigung von geplanten Ratespielen das Lernen? (3) Wirkt sich Vorwissen zwischen Rätselraten und Lernen aus? Die Teilnehmer (n=178) wurden per Zufallsauswahl nach den folgenden Bedingungen eingeteilt: (1) Keine Vorankündigung, kein Quiz (Kontrollgruppe); (2) Keine Vorankündigung, Quiz; und (3) Vorankündigung, Quiz. Die Anwender zeigten erhebliche Lernzuwächse. Ein vohergesagter Haupteffekt der Quizvorankündigung wurde nicht beobachtet. Der Einfluss von Rätseln auf das Lernen war jedoch deutlich feststellbar abhängig vom Umfang der Vorerfahrung. Wenig erfahrene Tutoren lernten deutlich mehr, verglichen mit erfahrenen Tutoren, wenn die Rätsel eingebaut waren – ein klassischer Umkehreffekt. Eine neue neurokognitive Auslegung dieses Effekts wird vorgestellt, wie auch die Forderung nach mehr "verstohlenen” Bewertungen, die Neuigkeiten und den Bereich der möglichen Entwicklung des Lerners berücksichtigen. L’évaluation formative en ligne intégrée. Qui en bénéficie? Qui flanche? La présente recherche a étudié l’impact des questionnaires formateurs sur les programmes de e‐learning conçus pour apprendre à des bénévoles comment encadrer les personnes ayant des difficultés de lecture. La problématique de la recherche a porté sur trois points: (1) est‐ce que les questionnaires intégrés facilitent l’apprentissage du contenu en ligne? (2) Est ce que l’annonce des questionnaires à venir affecte l’apprentissage? et (3) Est‐ce que les connaissances antérieures interagissent avec le questionnement et l’apprentissage? Les participants (n=178) ont été distribués de manière aléatoire en trois groupes: (1) pas d’avertissement et pas de questionnaire(contrôle); (2) pas d’avertissement mais un questionnaire; et (3)avertissement et questionnaire. Chez les utilisateurs on a trouvé des gains d’apprentissage significatifs. Pas de confirmation par contre pour l’effet principal attendu de l’avertissement « Attention !Test ! » Il faut signaler toutefois que l’effet des questionnaires sur l’apprentissage a été modifié de façon significative par le volume d’expériences antérieures. Les tuteurs peu expérimentés ont appris nettement plus lorsque les questionnaires étaient intégrés par comparaison avec les tuteurs experts.‐effet d’inversion de l’expertise bien connu. On présente une nouvelle interprétation neurocognitive de cet effet ainsi qu’une invitation à produire des modes d’évaluation plus furtifs qui prendraient en compte la nouveauté et la zone de développement proche de l’apprenant. La evaluación formativa en línea integrada. Quien saca provecho? Quien falla? La presente investigación estudia el impacto de los cuestionarios formativos sobre los programas de e‐learning diseñados para enseñar a los voluntarios como ser tutores de las personas que tienen dificultades de lectura. La problemática de la investigación incluye tres preguntas: (1) Son los cuestionarios integrados capaces de facilitar el aprendizaje de contenidos en línea? Hay algun efecto del anuncio de los próximos cuestionarios sobre el aprendizaje? Existe alguna interracción entre los conocimientos previos, los cuestionarios y el aprendizaje? Los participantes (n=178) fueron distribuidos de manera aleatoria en tres categorías: (1) Ningun anuncio, ningun cuestionario (control); (2) ningun anuncio pero un quiz; y (3) anuncio y cuestionario. Entre los participantes se notó ganancias de aprendizaje significativas. No se notó el impacto principal previsto para el anuncio de los cuestionarios. En cambio el impacto de los cuestionarios sobre el aprendizaje fue matizado de manera significativa por la cantidad de experiencia previa. Los tutores con poca experiencia aprendían mucho más cuando los cuestionarios eran integrados en comparación con los tutores expertos‐ un efecto clásico de inversión de la pericia. Presentamos una nueva interpretación neurocognitiva para este efecto además de una llamada para modos de evaluación más furtivos que tomen en cuenta la novedad y la zona de desarrollo próximo del alumno.

Anonymous Peer Assessment of Medication Management Reviews

To investigate whether pharmacy students' anonymous peer assessment of a medication management review (MMR) was constructive, consistent with the feedback provided by an expert tutor, and enhanced the students' learning experience. Fourth-year undergraduate pharmacy students were randomly and anonymously assigned to a partner and participated in an online peer assessment of their partner's MMR. An independent expert graded a randomly selected sample of the MMR's using a schedule developed for the study. A second expert evaluated the quality of the peer and expert feedback. Students also completed a questionnaire and participated in a focus group interview. Student peers gave significantly higher marks than an expert for the same MMR; however, no significant difference between the quality of written feedback between the students and expert was detected. The majority of students agreed that this activity was a useful learning experience. Anonymous peer assessment is an effective means of providing additional constructive feedback on student performance on the medication review process. Exposure to other students' work and the giving and receiving of peer feedback were perceived as valuable by students.

A Pediatrics-Based Instrument for Assessing Resident Education in Evidence-Based Practice

The principles of evidence-based practice (EBP) are a mandated component of the pediatric residency curriculum; however, a pediatrics-based assessment tool validated with pediatric residents does not exist. We designed an assessment instrument composed of items in 4 categories: 1) demographics; 2) comfort level; 3) self-reported practice of EBP; and 4) EBP knowledge. This last section required participants to identify best evidence and most appropriate study design by using pediatric-based scenarios, develop searchable questions, and use existing published research to address diagnostic and treatment issues. Four groups completed the instrument: preclinical medical students (MS-2), incoming pediatric interns (PGY-1), incoming second- and third-year pediatric residents (PGY2-3), and expert tutors (expert). We determined internal consistency, interrater reliability, content validity, item difficulty, and construct validity. Fifty-six subjects completed tests (MS-2, n = 13; PGY-1, n = 13; PGY2-3, n = 22; expert, n = 8). Internal reliability was good, with Cronbach's alpha = .80. Interrater reliability was high (kappa = 0.94). Items were free of floor or ceiling effects. Comfort level and self-reported practice of EBP increased with expertise level and prior EBP experience (P < .01). Scores on the knowledge section (out of 50 +/- SD) rose with training level (MS-2: 14.8 +/- 5.7; PGY-1: 22.2 +/- 3.4; PGY2-3: 31.7 +/- 6.1; experts: 43 +/- 4.0; P < .01). Scores also correlated with prior EBP education. We have developed a reliable and valid instrument to assess knowledge and skill in EBP taught to pediatric residents. This instrument can aid pediatric educators in monitoring the impact of the EBP curriculum.

Promoting the use of outcome measures by an educational programme for physiotherapists in stroke rehabilitation: a pilot randomized controlled trial

Objective: To determine the influence of tutor expertise on the uptake of a physiotherapists’ educational programme intended to promote the use of outcome measures in the management of patients with stroke. Design: Pilot randomized controlled trial. Methods: Thirty physiotherapists involved in stroke management were randomized into two groups and participated in five tutor-guided educational sessions (the Physiotherapists’ Educational Programme on Clinimetrics in Stroke, PEPCiS). Groups differed from each other with respect to tutors: one experienced and one inexperienced in stroke care. Primary outcome was ‘actual use’ (the frequencies of data of seven recommended outcome measures in the patient records of the participating physiotherapists). Results: The actual use of instruments shifted from a median of 3 to 6 in the expert tutor group and from 3 to 4 in the non-expert tutor group (P = 0.07). Physiotherapists educated by the expert tutor used a broader variety of instruments and appreciated the educational programme, their own knowledge gain and all three scales of tutor style aspects significantly more than their colleagues of the non-expert tutor group (all P<0.05). Univariate analysis on the entire set of data revealed eight factors, including tutors’ performance, that were associated with a change score of the use of two or more outcome measures by individual physiotherapists after the educational programme. Conclusion: In this pilot trial it was not proven that tutor expertise in stroke care influences the actual use of outcome measures, but it warrants a future study with sufficient power to investigate the influence of the tutor.

A model of clinical problem-based learning for clinical attachments in medicine

Problem-based learning (PBL) has been widely adopted in medical curricula for early-years training, but its use during clinical attachments has not been extensively explored. Objectives This study aimed to develop and evaluate a new model, 'clinical problem-based learning' (CPBL), to promote learning skills, attitudes and knowledge during clinical attachments. The CPBL model takes the principles of PBL and applies them to learning during clinical attachments. Real patient encounters are guided by a list of broadly defined case types to ensure curriculum coverage. By discussing history taking and examination in the context of differential diagnosis and problem listing, students generate learning objectives relating to clinical skills, disease mechanisms and clinical management. These are explored through self-directed learning before the second tutorial, in which the tutor takes the role of 'expert', demonstrating how learned material translates into clinical practice. We evaluated which components contributed most to the success of the model using semi-structured questionnaires, focus groups and a consensus (Delphi process) method. Students found CPBL a positive learning experience. Identification of suitable cases for discussion was readily achieved, although follow-up was sometimes difficult. The tutor's level of expertise and a non-threatening learning environment, conducive to student questioning, were highly rated contributors to successful CPBL. Comments reinforced the view that CPBL is a parallel teaching approach that helps structure the teaching week, but does not replace traditional bedside teaching. Clinical problem-based learning was well received in clinical placements. Key elements were the learning interval, the involvement of expert tutors and a non-threatening learning environment.

Sonographic Imaging of the Fetal Hard Palate During the Second-Trimester Pregnancy Scan

Cleft lip and cleft palate are among the more common congenital abnormalities, representing the fourth most common birth defect in the United States, with an incidence of 1 in 700 live births. The study of fetal secondary palate has reached new potential due to new 3D applications— namely, tomographic sonography imaging and volume contrast imaging (VCI). The aim of this review is to describe the 3D sonographic setting for a systematic study of the fetal secondary palate during second-trimester pregnancy. Sonographers can easily achieve appropriate training in 3D scanning of the fetal face under expert tutoring. The sonographic study of the fetal secondary palate should become an integral part of the second-trimester scan. Technically, the axial and coronal sections are those that better display the 3D reconstruction, especially when the fetus is facing the transducer (profile section). The use of static VCI may enhance tomographic sonography imaging of the fetal secondary palate and should therefore be integrated in this target examination.

Being an expert mathematics online tutor: what does expertise entail?

This article is derived from the qualitative portion of a larger study conducted on mathematics websites that provide expert volunteer help. Data consist of tutoring logs of five expert tutors from two help sites, plus interviews with these tutors. The researcher has employed theories about expertise in the educational domain to elicit details of individual coping strategies with challenges posed by the online environment, including students’ non‐responsiveness and issues of academic honesty. One of the participants, a recent online tutor who was also a teacher, experienced conflict of professional interests between these two roles. Tutors, who were also students, felt a conflict of liability – towards the tutees on one hand and towards the website administration on the other. Except for one tutor who demonstrated a highly developed expert performance, other tutors exhibited characteristics of both novices and experts, thus placing themselves within temporary and context‐dependent locations on the novice‐expert continuum. Recommendations are offered herein for future research and for the organization of online tutoring environment. It is suggested that best practices must include both pedagogical and tutor training/support considerations.

Accommodating differences: variations in differentiated literacy instruction in Grade 2/3 classrooms

AbstractAlthough teachers are acutely aware of variance in students' literacy needs, many are unsure exactly how to support these needs in the dynamic classroom. This study reports on compelling evidence from Grade 2/3 classrooms in which teachers differentiated instruction in a variety of ways to benefit all students. In particular, teachers provided additional scaffolding for struggling literacy learners by offering a menu of tiered work products, expert tutoring and additional supports. At the base of instruction were common essential understandings grounded in best literacy practices: shared reading and writing, guided reading, excellent texts and literacy centres. The article emphasises the critical importance of responding to the needs of diverse and at‐risk learners in the regular classroom. Differentiated instruction is suggested as a powerful organising framework in the language arts classroom.

Do Tutor Expertise and Experience Influence Student Performance in a Problem‐Based Curriculum?

The purpose of this study was to evaluate the association between student performance and tutor expertise and experience in the Restorative Treatment course in a problem-based learning (PBL) dental curriculum. This retrospective study evaluated a cohort of 206 third-year dental students at Harvard School of Dental Medicine who were enrolled in the Restorative Treatment course between 2000 and 2005. Tutor expertise in prosthodontics and prior tutoring experience were measured against student performance in five areas: 1) tutorial session, 2) midterm examination, 3) final examination, 4) preclinical laboratory, and 5) overall cumulative course grade. Student performance in each of the five areas measured against combinations of tutor subject matter expertise and tutoring experience level showed no statistically significant difference between the groups in the overall course grade. However, student performance in the expert group showed a significant difference in the final examination compared to the nonexpert group (p<0.05). Also, students in the group consisting of expert tutors with no experience performed better on the final examination compared to those students who had expert tutors with experience (p<0.05). The results indicate that overall student performance in the problem-based Restorative Treatment course is not affected by tutor expertise or prior tutoring experience.

TEACHING MATH SKILLS TO AT‐RISK STUDENTS USING HOME‐BASED PEER TUTORING

Home-based peer tutoring was used to teach math skills to 4 girls with deficits in mathematics and histories of abuse or neglect. Girls living in the same home formed tutoring dyads, and each participant served as both the peer tutor and the tutee during the course of the study. At the initiation of the tutoring intervention, an expert tutor provided multiple 3-min tutoring sessions to the designated peer tutor on three or four mathematics skills. The peer tutor concurrently provided 3-min tutoring sessions on the same skills to the tutee using a multiple baseline design. Results showed that participants improved their performance on all target skills. Additional interventions were implemented for some skills to improve accuracy further. Maintenance tests were also administered after 3 to 5 months of no practice on the skills. Results showed that tutors and tutees maintained their accuracy on 7 of the 12 skills assessed.

Drama Research in Sweden: Mapping the Field

A review of drama research in Sweden is presented, based on a descriptive analysis of Swedish doctoral dissertations. Bourdieu's field concept is used as a framework and the results are discussed in relation to the perceived need for a research discipline in drama. The author asks: How can Swedish drama research be described? Which theoretical perspectives and research methods are being used? This overview shows the academic disciplines that are hosting research of drama in education. Influences from their theoretical perspectives are briefly discussed. It is found that there is no autonomous field but rather a domain of drama research which includes dissertations within the disciplines of Education and Literature. It is put forward that conditions in Sweden are not as good as other Nordic countries, where subject specific education and expert tutors are available at the research level. Taking into account the general tendencies to work in inter- and cross-disciplinary ways and around ‘knowledge areas’ within higher education, the author wonders if an autonomous research discipline is unnecessary or even impossible to achieve.

The compactEASIE ® is a feasible training model for endoscopic novices: A prospective randomised trial

Background The objective benefit of a training using the compact Erlangen Active Simulator for Interventional Endoscopy-simulator was demonstrated in two prospective educational trials (New York, France). The present study analysed whether endoscopic novices are able to reach a comparable level of endoscopic skills as in the above-described projects. Methods Twenty-seven endoscopic novices (medical students, first year residents) were enrolled in this prospective, randomised trial. The compact Erlangen Active Simulator for Interventional Endoscopy-simulator with an upper GI-organ package and blood perfusion system was used as a training tool. Basic evaluation of endoscopic skills was performed after a practical and theoretical course in diagnostic upper GI endoscopy followed by a stratified randomisation according to the rating in endoscopic skills into intensive ( n = 14) and control group ( n = 13). The intensive group was trained 12 times every second week over 7 months in 4 endoscopic disciplines (manual skills, injection therapy, haemoclip, band ligation) by skilled endoscopist (three trainees/simulator). Assessment was performed (single steps/overall) using an analogue scale from 1 to 10 (1 = worst, 10 = optimal performance) by expert tutors. The control group was not trained. Blinded final evaluation of all participants was performed in January 2003. Results We observed in all techniques applied a significant improvement of endoscopic skills and of the performance time in the intensive group compared to the control group ( p < 0.001). The comparison with the previous projects showed that the intensively trained novices achieved comparable levels of performance to the GI fellows in the New York and France Project (at least 80% of the median score in three out of four techniques). Conclusion Endoscopic novices acquired notable skills in interventional endoscopy in the simulator by an intensive, periodical training using the compactEASIE ®.

Modeling the Problem-based Learning Preferences of McMaster University Undergraduate Medical Students Using a Discrete Choice Conjoint Experiment

To use methods from the field of marketing research to involve students in the redesign of McMaster University's small group, problem-based undergraduate medical education program. We used themes from a focus group conducted in an electronic decision support lab to compose 14 four-level educational attributes. Undergraduate medical students completed a discrete choice experiment composed of 15 web-administered, partial-profile, conjoint-choice tasks. Latent class analysis revealed two segments with different preferences. Segment 1, (86% of students), preferred a problem-based approach with more small group tutorial sessions led by expert tutors who facilitated the tutorial process without teaching didactically. Segment 2, (14% of students), preferred more large group lectures, explicit learning objectives, expert tutors who taught didactically, and streaming options based on learning preferences. Although Segment 1 preferred smaller tutorial groups, simulations predicted these students would trade increases in tutorial group size for a conceptually integrated program that included tutorial problems based on core curriculum concepts, greater integration of the content of clinical skills training sessions and the tutorial curriculum, and a link between clerkship patient selection and the program's curriculum. A majority of both segments would accept a more conceptually integrated program if the savings associated with increases in tutorial group size was reinvested in web-enhanced tutorial processes and computer-simulated health care problems. Most students preferred a small group, web-supported, problem-based learning approach led by content experts who facilitated group process. Students favored a program in which tutorial group problems, clinical skills training sessions and the patients selected for clerkship activities were more closely linked to core curriculum concepts.

Annotation of Tutorial Dialogue Goals for Natural Language Generation

We annotated transcripts of human tutoring dialogue for the purpose of constructing a dialogue-based intelligent tutoring system, CIRCSIM-Tutor. The tutors were professors of physiology who were also expert tutors. The students were 1st year medical students who communicated with the tutors using typed communication from separate rooms. The tutors made use of a rich variety of strategies, some specific to particular content areas and others more general, such as showing that the student holds contradictory beliefs about the domain. In this article, we describe our model of hierarchical goal structure for tutorial dialogues. We catalog each major pedagogical method we found in the dialogues, showing its structure and illustrating the features needed to represent each subgoal in its correct narrative and interpersonal context. We compare our goal structure with other analyses of tutorial dialogues.

Efficacy and costs of a one-day hands-on EASIE endoscopy simulator train-the-trainer workshop

The efficacy of an intensive hands-on training in endoscopic hemostasis on the compactEASIE simulator has been previously demonstrated in a randomized prospective trial. In the current study, we evaluated how quickly and effectively new tutors, without simulator training experience, are able to acquire teaching skills in endoscopic hemostasis. Five tutors with prior Erlangen Active Simulator for Interventional Endoscopy (EASIE) teaching experience instructed 7 endoscopists without prior EASIE experience on how to teach when using the model. These new tutors then independently conducted a workshop for 8 fellows in 4 hemostasis techniques. Results were compared with a historical control trained similarly by experienced tutors. Two one-day workshops in endoscopic hemostasis on the compactEASIE ex vivo endoscopy simulator were conducted in a category A hospital in New York City, New York. Skill scores at the end of training were compared with baseline skills assessments, and qualitative ratings of the new tutors were obtained from both the trainees and the experienced tutors. Significant improvement was achieved by the fellows in all 4 skills areas. Both the expert tutors and the trainees consistently rated the teaching skill of the new tutors highly. Fellows' skill acquisition using new tutors was of similar magnitude to that achieved in the prior EASIE trial using experienced trainers teaching the fellows. It is feasible to conduct an effective EASIE train-the-trainer course in one day. Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to experts who have conducted many hands-on workshops.

Using a course management system (CMS) to meet the challenges of large lecture classes

Purpose – This paper aims to describe the process and the outcome of a situation in which a professor of anatomy and physiology made supplemental use of a course management system (CMS) to assist with the instruction of 242 students. The purpose of this instructor's use of WebCT was to: increase student autonomy and improve access to information; improve student learning and achievement through the expert use of student “Self‐Tests”, which are an ungraded, interactive tutoring/quizzing feature; create a more active, student‐centered learning environment. Design/methodology/approach – Features that were provided in the WebCT site include: student self‐tests are ungraded, but act as a basic form of expert system or informative tutor by providing very specific feedback to answers students selected in this multiple choice experience. The feedback to each question was designed by the instructor, who advised students to use the system as a tutor by clicking on a variety of possible answers to gather new information. Comments on answers were designed to demonstrate to the student the “way of thinking” of a professional in the field. Current grade information for individual students. Schedule‐related information on labs, due dates, etc. syllabus lecture audio. Findings – Findings suggest that the implementation of the WebCT self‐tests contributed to the substantial increase in student test scores. Research limitations/implications – The implications are very exciting and far‐reaching in that – through a fairly unobtrusive course re‐design – the use of a CMS yielded a measurable improvement in student achievement. Practical implications – The use of these expert‐system‐like self‐tests, gradebooks, and other CMS features has the potential to improve teaching and learning in all manner of courses, including those that are on‐ground, blended, and fully online. Originality/value – This paper uses concrete data to demonstrate how a course management system was used to re‐design traditional courses and how this re‐design resulted in improved student achievement.

Objective Benefit of a 1-day Training Course in Endoscopic Hemostasis Using the “compactEASIE” Endoscopy Simulator

The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 as a training model for interventional endoscopy. Objective evidence of the benefits of training with this model has not previously been published. As part of two long-term projects, the benefits of a 1-day training course with the "compactEASIE" simulator were evaluated. Fourteen American and 18 French gastroenterology fellows were enrolled. These fellows were participants in the intensive groups performing training in endoscopic hemostasis, with a total number of 28 fellows in New York and 36 in France. Gastrointestinal endoscopy faculty members in New York and France evaluated and timed the fellows in four disciplines to establish baseline skills (manual skills; injection and coagulation; Hemoclip application; and variceal ligation) with the compactEASIE simulator. The trainees were reevaluated after an intensive 1-day course (with two or three fellows and one instructor per station), also including preparation and assistance for each procedure. The assessment (overall and parts) was done by expert tutors using an ordinal scale ranging from 1 to 10 (1 = poorest, 10 = best), recording also mistakes and performance time. The compactEASIE simulator, equipped with an upper gastrointestinal organ package and an artificial blood perfusion system, was used as the training tool. A highly significant improvement ( P < or = 0.001) was observed in the performance of all endoscopic techniques. A significant reduction in performance time was also observed with three of the four endoscopic techniques. Successful hemostasis was significantly improved in two out of three techniques. A 1-day training course on endoscopic hemostasis using the compactEASIE simulator is capable of improving the performance of hemostasis procedures. Long-term effects of repeated training sessions are currently subject of collaborative studies in New York and France.