A clinical reasoning curriculum for medical students: an interim analysis

Objectives Diagnostic error is a critical patient safety issue that can be addressed in part through teaching clinical reasoning. Medical schools with clinical reasoning curricula tend to emphasize general reasoning concepts (e.g., differential diagnosis generation). Few published curricula go beyond teaching the steps in the diagnostic process to address how students should structure their knowledge to optimize diagnostic performance in future clinical encounters or to discuss elements outside of individual cognition that are essential to diagnosis. Methods In 2016, the University of California, San Francisco School of Medicine launched a clinical reasoning curriculum that simultaneously emphasizes reasoning concepts and intentional knowledge construction; the roles of patients, families, interprofessional colleagues; and communication in diagnosis. The curriculum features a longitudinal thread beginning in first year, with an immersive three week diagnostic reasoning (DR) course in the second year. Students evaluated the DR course. Additionally, we conducted an audit of the multiyear clinical reasoning curriculum using the Society to Improve Diagnosis in Medicine-Macy Foundation interprofessional diagnostic education competencies. Results Students rated DR highly (range 4.13–4.18/5 between 2018 and 2020) and reported high self-efficacy with applying clinical reasoning concepts and communicating reasoning to supervisors. A course audit demonstrated a disproportionate emphasis on individual (cognitive) competencies with inadequate attention to systems and team factors in diagnosis. Conclusions Our clinical reasoning curriculum led to high student self-efficacy. However, we stressed cognitive aspects of reasoning with limited instruction on teams and systems. Diagnosis education should expand beyond the cognitive- and physician-centric focus of most published reasoning courses.

Epistemic Pollution

The chapter continues the argument for thinking that individual cognition is highly unreliable. It argues that we live in an epistemically polluted environment: deliberately and inadvertently, other agents shape our environments in ways that leave individual cognition even worse off than it might have been. This chapter sketches some of the pollutants and how they work to undermine virtuous cognition. It argues we live in an environment in which the cues we rely on for assessing the expertise of individuals and the reliability of information are deliberately mimicked by people who seek to deceive us. Because we’re unable to assess a great many claims on our own, we’re reliant on these cues; their pollution ensures that individual cognition is even worse off than it might have been. The chapter finishes with some tentative suggestions for cleaning up the epistemic environment.

Dare to Think?

The previous two chapters argued that beliefs are pervasively outsourced to other people and to the environment, and that belief revision often occurs in response to changes in the cues that scaffold our beliefs. In light of these facts, we need to ensure the scaffolding of better beliefs. We need, that is, to manage the epistemic environment. Many people are uncomfortable with this suggestion, and urge that instead we should improve beliefs by promoting better reasons. This chapter examines the prospects for better individual reason, focusing on virtue epistemology. It argues that individual cognition is extremely unreliable, however virtuously it is conducted. Focusing on Quassim Cassam’s recent book on intellectual vices, it works through case studies, from climate denial and from historical scholarship, to show just how limited individual cognition is. It argues that even genuine experts are at severe risk of error when they stray outside their own sphere of expertise, and that spheres of expertise are much narrower than we tend to think.

A Study on Classroom Discourse in Enhancing Metacognition to Develop Writing Skill in Saudi EFL Students

Generally, learning outcomes are not always as expected; instead, they show a degree of variation depending on various factors. Likewise, despite the fact of providing writing instruments in Saudi EFL classrooms, the outcomes are not always as expected. The reasons may range from classroom atmosphere to individual cognition and many other related variants around. However, it is a small attempt in teachers’ perspective to see if anything is lacking in the implementation of ‘teaching writing strategies’ for EFL classrooms. To verify this assumption between practicality and literature, this paper intends to explore ‘the implementation of writing strategies of faculty’ during teaching writing skills. In addition, this paper also attempts to identify what sort of discourse tools and metacognitive strategies university faculty are incorporating in their teaching, and what is ignored or not used up to the mark while enhancing Saudi EFL students’ meta-cognitive awareness. To collect responses for this study, a survey questionnaire was administered among 36 English language educators of the Jazan region. The results of this study revealed that there is a component that was given minor importance during teaching, though teachers used other strategies and tools extensively. Furthermore, one of the aims of the study is to demonstrate how discourse can be used to offer a solution in the present scenario. In a nutshell, this research recommends the significance of the neglected subcomponent and its importance in improving writing metacognition.

The obedient mind and the volitional brain: A neural basis for preserved sense of agency and sense of responsibility under coercion

Milgram’s classical studies famously suggested a widespread willingness to obey authority, even to the point of inflicting harm. Important situational factors supporting obedience, such as proximity with the victim, have been established. Relatively little work has focused on how coercion affects individual cognition, or on identifying the cognitive factors that underlie inter-individual differences in the tendency to yield to coercion. Here, we used fMRI to investigate the neural systems associated with changes in volitional processes associated with sense of agency and sense of responsibility under coercion. Participants either freely chose, or were instructed by the experimenter, to give mildly painful electric shocks to another participant, or to refrain from doing so. We have previously shown that coercion reduces temporal binding, which has been proposed as an implicit proxy measure of sense of agency. We tested how reduced agency under coercion related to differences in neural activity between free choice and coercion. In contrast to previous studies and to participants performing the task outside the MRI scanner, on average there was no effect of coercion on agency for participants in the scanner. However, greater activity in the medial frontal gyrus was reliably associated with greater agency under coercion. A similar association was found using explicit responsibility ratings. Our findings suggest that medial frontal processes, perhaps related to volition during action planning and execution, may help to preserve a sense of accountability under coercion. Further, participants who administered more shocks under free choice showed reduced activity during free choice trials in brain areas associated with social cognition. Possibly, this might reflect participants cognitively distancing themselves from the recipient of the shocks under free choice, whereas this was not observed under coercion.

Understanding Knowledge Sharing Among ICT Professionals

This study aims to examine the knowledge-sharing intention (KSI) of information and communications technology (ICT) professionals in Saudi Arabia. A comprehensive theoretical model was constructed for this study that took into consideration individual cognition, personality traits, and social interaction. Data was collected from 240 ICT professionals and engineers from 19 companies. Data analysis and research model assessment were conducted based on structural equation modelling (SEM) in conjunction with SmartPLS software. Results indicate that social influence, attitude toward knowledge sharing, perceived reputation enhancement, and perceived reciprocal benefit have a significant impact on the variations in the knowledge-sharing behavioural intention of ICT professionals. The study results are both theoretically and empirically valuable, and organisations may find the study results useful for the creation of policies that can foster a culture of knowledge sharing.

Escape Rooms as a Collaborative Problem-Solving Environment

Escape room games are a popular recreative activity that recently started gaining popularity as both a means for conducting research studies and a teaching and learning environment. This paper follows a group of 16- to 17-year-old students in an escape room while they encounter logical challenges in order to escape from the room in a limited amount of time. Their ability to work effectively as a team and complete activities quickly is a key element to success. In this setting, the aim was to examine in what ways this innovative environment might help students benefit in terms of social metacognition. The findings gave evidence that during collaborative problem-solving in an escape room, cognitive demands are distributed among the players. This makes metacognition visible, facilitates shared management thus improving individual cognition, facilitates reciprocal scaffolding, and enhances motivation.

A Study on Classroom Discourse in Enhancing Metacognition to Develop Writing Skill in Saudi EFL Students

Generally, learning outcomes are not always as expected; instead, they show a degree of variation depending on various factors. Likewise, despite the fact of providing writing instruments in Saudi EFL classrooms, the outcomes are not always as expected. The reasons may range from classroom atmosphere to individual cognition and many other related variants around. However, it is a small attempt in teachers’ perspective to see if anything is lacking in the implementation of ‘teaching writing strategies’ for EFL classrooms. To verify this assumption between practicality and literature, this paper intends to explore ‘the implementation of writing strategies of faculty’ during teaching writing skills. In addition, this paper also attempts to identify what sort of discourse tools and metacognitive strategies university faculty are incorporating in their teaching, and what is ignored or not used up to the mark while enhancing Saudi EFL students’ meta-cognitive awareness. To collect responses for this study, a survey questionnaire was administered among 36 English language educators of the Jazan region. The results of this study revealed that there is a component that was given minor importance during teaching, though teachers used other strategies and tools extensively. Furthermore, one of the aims of the study is to demonstrate how discourse can be used to offer a solution in the present scenario. In a nutshell, this research recommends the significance of the neglected subcomponent and its importance in improving writing metacognition.

Do corporate volunteering programs and perceptions of corporate morality impact perceived employer attractiveness?

Purpose Rather recently, corporate volunteering (CV) has become a relevant topic of academic research. Nonetheless, there is still uncertainty about several aspects of the relationship between volunteerism and the corporate realm and research on the relationship between CV and employer attractiveness is scarce. This study aims to attempt to fill this gap by studying the influence that the perceived importance attributed by prospective applicants to the opportunity of engaging in CV programs may have on employer attractiveness while also pondering the existence of an indirect relationship between CV and employer attractiveness mediated by the individual cognition of corporate morality (CM). Design/methodology/approach To fulfill the objectives of this research, and test its hypothesized model, the authors opted to use a quantitative methodology via survey by questionnaire of Portuguese students who are close to entering the job-seeking process or are currently involved in it, either passively and actively. Data on 238 Portuguese students was collected mainly through social media channels such as LinkedIn and Facebook and was analyzed with the IBM SPSS Statistics 25 software and the IBM SPSS AMOS extension, using a structural equation model to test the hypotheses and obtain insight into the relationships between the variables. Findings A theoretical model was elaborated based on the literature reviewed and was used to validate the existence of a positive direct relationship between CV and employer attractiveness, CV and CM and between CM and employer attractiveness. Finally, it was observed that CV could prompt an indirect effect on the socioethical perception of employer attractiveness, mainly due to the mediating mechanism of the individual cognition of CM. Research limitations/implications This study has some limitations that should be acknowledged and considered in future studies, namely, the diversity of the sample, as it was essentially formed by students enrolled in the University of Porto and studying mainly in the areas of social sciences, trade and law. It is also worth noting that a global analysis of the employer attractiveness attributes was not considered, focusing instead on the social and ethical spectrum of employer attractiveness. Nonetheless, it is important to keep in mind that different individuals prioritize distinct attractiveness attributes. Practical implications Through the present study, it was understood that CV programs constitute a desired and pertinent tool that should be adopted by firms (employers) to establish a strong position in the job market. These findings are particularly useful for the area of human resources management, which is in charge of finding the most adequate applicants in the job market. Furthermore, for the variable of CM, the authors noticed that there is a theoretical lack of measurement instruments. Consequently, the measure advanced in this study represents an important theoretical and methodologic contribution to the literature. Social implications CV is a concept that is yet maturing within the Portuguese business environment. As such, this study delivers useful insights regarding Portuguese applicants’ growing interest around CV, their concerns about the social, ethical and humanitarian attributes of firms and their beliefs regarding the morality of firms’ social policies and actions. Hence, it allowed us to comprehend that by developing a structured CV program, an employer may be able to enhance other essential concepts for Portuguese prospective applicants, respectively, employer attractiveness and CM. Originality/value This study corroborates the premise that corporate community involvement activities, namely, CV, hold a positive effect in terms of perceived employer attractiveness. Moreover, it is consistent with the idea that CV programs foment a feeling of intimacy between individuals and firms, consequently creating a perception of morality as part of the firms’ intrinsic traits. Finally, it corroborates and extends for the case of prospective applicants the conclusion that individuals may be relatively more concerned with the motives behind firms’ corporate social responsibility practices than with the content of such practices.