Knowledge Structures In Memory Research Articles

Evaluation Of Development Of Clinical Reasoning Skills In Dental Students Through Diagnostic Thinking Inventory.

To assessthe clinical reasoning skills among dentalstudents, and to compare the diagnostic thinking ability of male and female students. The cross-sectionalstudy was conducted from May to July 2021 at a public-sector dental school in Karachi, and comprised students of both genders from across allthe four years ofdentalschool.Datawas collectedusing thediagnostic thinking inventory which also assessed flexibility in thinking and knowledge structure inmemory.Datawas analysedusing SPSS 18. Of the 111 forms distributed, 108(98.2%) were received duly filled; 32 (29.35%) from male students and 76(69.72) from female students. Participants from the first year were 24(22%), second year 23(21%), third year 33 (30.27%) and the fourth year 29(26.6%).The reliability of diagnostic thinking inventory was 0.906, for knowledge structure in memory 0.661, andflexibility inthinking0.573.The correlationwassignificantforstudentsintheir 2nd, 3rdand4thyearsofstudies(p=0.01) The overall mean score was <150 which was poor. Both the knowledge structure in memory, and flexibility in thinking scores were higher for females compared to males(Significant at the level of 0.01). The clinical reasoning skills of students were low, and the diagnostic thinking ability of female students was better than that of their male counterparts.

An international comparison of student nurse practitioner diagnostic reasoning skills.

Nurse practitioners (NPs) play a pivotal role in health care provision. Diagnostic reasoning is an important core skill of advanced practice. The purpose of this study was to compare diagnostic reasoning skills of NP students. It also identified the variability in clinical teaching components of a sample of international NP curricula. An international group of NP students completed an online survey using a validated diagnostic reasoning scale during the first year of their NP program. Program faculty surveyed provided data on core curricula. The NP students' (n = 152) mean diagnostic thinking inventory (DTI) score was 142, flexibility in thinking subscale score mean of 73 with a knowledge structure in memory of 69. The programs surveyed required bioscience courses. Most programs provided opportunities for students to practice diagnostic thinking using individual precepted clinical hours (range 500-950) and objective structured clinical examinations. The lower scores of this group of NP students were similar to other NP students and first-year medical residents. Higher mean scores in the DTI reflect expertise and are developed over time. Courses providing a foundation of biomedical knowledge were identified in each program, with opportunities for the NP students to practice diagnostic thinking using objective structured clinical examinations and clinical practice hours. The use of the diagnostic reasoning inventory is a useful tool for evaluating student NP's diagnostic reasoning during their NP program. Nurse practitioner programs should consider the provision of dedicated clinical hours, including supervised clinical practice experiences and objective structured clinical examinations to improve diagnostic reasoning.

Model of Self-organizing Knowledge Representation and Organizational Knowledge Transformation

The purpose of the paper is development of a conceptual model for the representation of knowledge as an active intellectual substance and, on this basis, study of metaphysics of knowledge transformation process being produced both individually and collectively in the practice of organizations. The first principle of knowledge engineering, as Edward Albert Feigenbaum noted, says that the power in solving problems that an intellectual subject (person or machine) manifests in the process of activity depends primarily on its knowledge base, and only secondly on the methods of inference used. Strength is hidden in knowledge. The process of producing knowledge is permanent and does not depend on whether an individual is going to use this knowledge or not. Knowledge constantly produces new knowledge regardless of the owner's desire. Besides that, knowledge can’t arise from nothing, but always – from some knowledge obtained earlier. As well as the intelligence, knowledge is an emergent instance arising from the collective interaction of a lot of intellectual atomic elements of knowledge (knowledge quanta). Idiosyncrasy of this interaction is expressed precisely in the creation of new knowledge. Due to postulating the knowledge self-organizing, the hierarchical knowledge structures in memory and the process of thinking as a kind of syntax for the procedure of new knowledge generation are described. This is an effort towards understanding the memory mechanisms, the process of thinking, the sources of heuristic knowledge just through the inner nature of knowledge. Also, based on the knowledge self-organization principle, an archetype of the appropriate knowledge-based system architecture is presented too. As an implementation of the concept, the perceptual act model is described, and on its base, a possible scenario for the behavior of a robot meeting an obstacle in its path is considered. As the mutual transformation of tacit and explicit knowledge makes new knowledge, the impact of the self-organization of knowledge on the transformation process as well as conditions of self-organization of both individual knowledge and organizational knowledge are analyzed in detail. Finally, modification of the known model of knowledge dimensions by Nonaka and Takeuchi is proposed. Because of the native activity of knowledge, it is impossible to build a knowledge management system without considering the internal structure of knowledge and its emergent ability to self-organize. Ensuring the natural process of knowledge development at all ontological levels in an organization is an essential prerequisite for the evolution of values in this organization.

Cross-modal music integration in expert memory: Evidence from eye movements.

The study investigated the cross-modal integration hypothesis for expert musicians using eye tracking. Twenty randomized excerpts of classical music were presented in two modes (auditory and visual), at the same time (simultaneously) or successively (sequentially). Musicians (N = 53, 26 experts and 27 non-experts) were asked to detect a note modified between the auditory and visual versions, either in the same major/minor key or violating the key. Experts carried out the task faster and with greater accuracy than non-experts. Sequential presentation was more difficult than simultaneous (longer fixations and higher error rates) and the modified notes were more easily detected when violating the key (fewer errors), but with longer fixations (speed/accuracy trade-off strategy). Experts detected the modified note faster, especially in the simultaneous condition in which cross-modal integration may be applied. These results support the hypothesis that the main difference between experts and non-experts derives from the difference in knowledge structures in memory built over time with practice. They also suggest that these high-level knowledge structures in memory contain harmony and tonal rules, arguing in favour of cross-modal integration capacities for experts, which are related to and can be explained by the long-term working memory (LTWM) model of expert memory (e.g. (18; 22).

Application and evaluation of Mini-CEX in training clinical diagnostic thinking ability for interns

Objective To explore the application of mini-clinical evaluation exercise (Mini-CEX) in training the diagnostic thinking ability for clinical interns. Methods 83 interns who came to the First Peo-ple’s Hospital of Lianyungang for clinical practice in June 2015 were divided into the experimental group (45 interns) and the control group (38 interns) according to their schools. The two groups received the same clinical teaching according to internship program of five-year clinical medicine, while the experimental group had to take a weekly Mini-CEX training in clinical sections. The diagnostic thinking ability of the two groups was measured by the Diagnostic Thinking Inventory in Chinese version at the beginning and the end of the in-ternship respectively. SPSS 21.0 was applied to processing the data. Measurement data were ex-pressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results At the end of the internship, the total score of diagnostic thinking, the score of knowledge structure in memory and the score of flexibility in thinking of the experimental group were higher than scores at the beginning sta-tistically, and the experimental group had a statistically higher score than the control groups in knowledge structure in memory [(69.36±4.28) vs. (66.95±4.78), P=0.018]. Conclusion Mini-CEX train-ing can en-hance the clinical diagnostic thinking ability of interns by improving their knowledge structure in memory. Key words: Mini-clinical evaluation exercise; Clinical diagnostic thinking; Interns

Functional neuroimaging correlates of thinking flexibility and knowledge structure in memory: Exploring the relationships between clinical reasoning and diagnostic thinking

Background: Diagnostic reasoning involves the thinking steps up to and including arrival at a diagnosis. Dual process theory posits that a physician’s thinking is based on both non-analytic or fast, subconscious thinking and analytic thinking that is slower, more conscious, effortful and characterized by comparing and contrasting alternatives. Expertise in clinical reasoning may relate to the two dimensions measured by the diagnostic thinking inventory (DTI): memory structure and flexibility in thinking.Aim: Explored the functional magnetic resonance imaging (fMRI) correlates of these two aspects of the DTI: memory structure and flexibility of thinking.Methods: Participants answered and reflected upon multiple-choice questions (MCQs) during fMRI. A DTI was completed shortly after the scan. The brain processes associated with the two dimensions of the DTI were correlated with fMRI phases – assessing flexibility in thinking during analytical clinical reasoning, memory structure during non-analytical clinical reasoning and the total DTI during both non-analytical and analytical reasoning in experienced physicians.Results: Each DTI component was associated with distinct functional neuroanatomic activation patterns, particularly in the prefrontal cortex.Conclusion: Our findings support diagnostic thinking conceptual models and indicate mechanisms through which cognitive demands may induce functional adaptation within the prefrontal cortex. This provides additional objective validity evidence for the use of the DTI in medical education and practice settings.

On Construing Others: Category and Stereotype Activation from Facial Cues

Although the face is unquestionably the most valuable source of information available to social perceivers, quite how humans exploit physiognomic cues to make sense of unfamiliar social targets has yet to be fully elucidated. The present investigation explores the possibility that bottom-up visual processing of faces (e.g., the detection of diagnostic social category features) increases the accessibility of social group knowledge structures in memory. Two experiments were undertaken in which the inevitability and strength of category and stereotype activation were assessed by having participants make judgments on centrally presented words that were flanked by a varying number of congruent or incongruent distracter faces. Results showed that despite perceivers' intentions to ignore them, the mere presence of faces increased the accessibility of sex categories (Experiment 1) and gender stereotypes (Experiment 2). However, whereas category-based responding was modulated by the number of faces present, no such effect was observed for the accessibility of stereotypical knowledge. We consider the implications of these findings for contemporary treatments of person perception.

Appraisal of medical students' diagnostic ability in relation to their learning achievement and self-confidence as a learner

What kind of factors may influence medical students' development of the diagnostic reasoning process? This retrospective study is based on a 6-year historical series of consecutive classes. It comprised two phases, one before and another after some changes in course processes. Diagnostic reasoning was assessed with the diagnostic-thinking inventory (DTI) that measures two aspects: degree of flexibility in thinking and degree of knowledge structure in memory. This instrument was applied in the sixth semester to a total of 362 students of both sexes, by consecutive sampling over the 6-year series. Learner's descriptors and measures of academic achievement were also obtained. The results revealed average DTI scores equivalent to 68% of the maximum sum, without significant gender differences in the group. Two indicators were more significantly associated with the total score: the level of the learner's self-confidence and the mark obtained in a problem-solving clinical test. Students belonging to the course renewal phase (last biennium) showed significantly higher scores when compared with the students in the previous phase. A multiple regression analysis identified three predicting factors that independently explained 16% of the variation of the total DTI score: level of self-confidence, problem-solving mark, and study phase. The findings confirm the usefulness of the inventory for a quick appraisal of diagnostic reasoning. They also suggest that learner's characteristics and contextual factors in learning contribute to the score of diagnostic ability with that instrument.

The Role of Problem Representation Shifts in Auditor Decision Processes in Analytical Procedures

In audit analytical procedures, research has shown that auditors have difficulty proposing possible explanations for financial statement discrepancies (Bedard and Biggs 1991a). One source of this difficulty is that auditors may represent analytical procedures problems incorrectly; that is, their mental image of the problem does not contain the underlying cause of the discrepancies. Because shifting initial representations of problems is difficult, auditor decision processes are affected. The purpose of this study is to investigate how problem representation shifts can lead auditors to better insight into possible explanations of discrepancies, and thus improve auditor decision processes in analytical procedures. To accomplish this purpose, verbal protocol data from Bedard and Biggs (1991a) were used to develop a series of problem representations and prompts for the analytical procedures task used in that study. The prompts were given to activate relevant knowledge structures in memory and encourage successive shifts toward the correct representation. Think-aloud verbal protocols were collected from 12 senior auditors with three to five years' experience to provide evidence of problem representation shifts and decision processes. The results indicate that: (1) all subjects initially formulated an unproductive problem representation; (2) only one subject shifted to a productive problem representation and solved the case without prompts; and (3) even with prompts two subjects were unable to solve the case. These findings suggest that shifting to a productive problem representation was critical in achieving effective decision processes and identifying the seeded error in this analytical procedures task. Auditors who developed a thorough understanding of the financial relationships in the case prior to proposing potential solutions were better able to shift problem representations and solve the case. In addition, two processes related to an explanation inherited from client management, “wheel spinning” and truncated hypothesis generation, inhibited problem representation shifts.

Quantitative assessment of diagnostic ability

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56-item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6-point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first- and third-year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual student's and clinician's diagnostic thinking and to plan ways of improving their diagnostic thinking.

Reliability of retrieving information from knowledge structures in memory: Scripts

Research has shown that the reliability of retrieving information from knowledge structures in memory is surprisingly low. For many knowledge structures only about half the information retrieved in one session is the same information retrieved in a second session 1 week later. A number of theorists have argued that knowledge structures known as scripts are particularly important and well-organized knowledge structures. The purpose of the two experiments reported here was to determine the reliability of retrieving script information from memory. In Experiment 1, 10 scripts were tested. It was found that the reliability of retrieving information from scripts had a mean value of.50, which is no larger a value than values found for many other knowledge structures. On the other hand, any script information recalled in both sessions was almost always recalled in the same relative order. The mean output-output correlation was.92. The results of Experiment 2 demonstrated that the strict ordering of script actions by the subjects was not the result of ordering instructions.

Reliability of retrieving information from knowledge structures in memory: Self information

It has been proposed that information about the self is better organized and more salient in memory than is information about other domains of knowledge. Yet, the data reported by Green-wald, Bellezza, and Banaji (in press) suggest that the reliability with which information about the self can be retrieved from memory is not particularly high. In the present experiment, the verbal prompts used in requesting self information from subjects were made more explicit than those used by Greenwald et al. by the addition of subcategories and examples of the self information requested. Using a test-retest procedure, only.58 of the items from six self categories that were retrieved from memory during an experimental session were again retrieved 1 week later. This value is comparable to the value of.56 found by Greenwald et al. The reliability value for the two common categories, fruit and fish, included in the experiment was.76, which was significantly greater than the value found for the self categories. These results suggest that information about the self is not particularly well-organized and salient in memory.