Cognitive psychological views on expertise development; a review Els Boshuizen Educational Technology Expertise Centre Ounl Heerlen.

Cognitive psychological views on expertise

development; a reviewEls Boshuizen

Educational Technology Expertise CentreOunl

Heerlen

Maastricht University, Open University, Erasmus University RotterdamHenk Schmidt, Els Boshuizen, Pie Hobus, Metta Hofstra, Eugène Custers, Margje van de Wiel, Rina Vaatstra, Remy Rikers, Jos Arts, Ilse van Eekelen, Agnes Wagenaar, Fleurie Nievelstein, and moreIn cooperation with Geoff Norman, Vimla Patel, Paul Feltovich, et al.

Cognitive psychological views on professional

expertise development; a review

Professions, professionals and professional expertisel How professions develop

l Developments in the profession, work place and society

l How professionals do their workl ‘Disciplined’ by the peer group and lawl Features of the workplacel Whole group (variability)

l How they become good at it (or not)l How education is/should be organisedl Tensions between individual goals and

professional claims

Difference with Deliberate Practice tradition

l Teaching for the profession has been starting point, not excellent performance

l But we do use performance indicators and criteria

Cognitive psychological approach

Cognitive psychological theory on expertise developmentl ‘Stage’ theory

l Knowledge increase, validation and integrationl Knowledge encapsulationl (Illness) script formationl Episodes

l l Reasoning and decision makingl Performance

Exper-tise level

Knowledge structure

Change process

Problem solving based on

Cognitive control required in clinical reasoning

Demand on cognitive capacity

Novice

Networks (incomplete and loosely linked)

Knowledge accretion, integration and validation

Long chains of detailed reasoning steps through networks

Active monitoring of each reasoning step

High

Inter-media-te

Networks (tightly linked and integrated)

Encapsulation

Reasoning through encapsulated network; abbreviated

Active monitoring of each reasoning step

Medium

Expert Illness scripts Illness script formation

Illness script activation and instantiation

Monitoring of the level of script instantiation

Low

Memory traces of previous cases

Instantiated scripts

Automatic reminding

Check relevance

Low

What is not described?

l Learning processes undertakenl How people organise these learning

processesl How the excellent differ from the rest

(although)

four studiesl Jos Arts (management)l Margje van de Wiel (medicine)l Agnes Wagenaar (clinical psychology)l Fleurie Nievelstein (private law)

Jos Arts

0,0

1,0

2,0

3,0

4,0

5,0

6,0

novices 1 st yrstudents

2 nd yrstudents

3 rd yrstudents

4 th yrstudents

2 yr exp 5 yr exp 12.5 yr exp

25 yr exp

expertise level

qu

alit

y o

f so

luti

on

university

workplace

Subdivided into:

0

0,5

1

1,5

2

2,5

Novices 1st yr

Stud

2nd yr

Stud

3rd yr

Stud

4th yr

Stud

2 yr

Experts

5th yr

Experts

12? yr

Experts

25 yr

Experts

Level of expertise

Mean number of case solutions

Correct

Partially

Incorrect

Van de Wiel study

l Micro-proceses of knowledge encapsulation

l Multiple cases multiple disease processes

Diagnostic accuracy

Case order

987654321

10

9

8

7

6

5

4

3

2

Case type

Kidney failure

Liver cirrhosis

Heart failure

Fillers

Processing time

Case order

987654321

900

800

700

600

500

400

Case type

Kidney failure

Liver cirrhosis

Heart failure

Fillers

Number of words in protocols

Case order

987654321

1300

1200

1100

1000

900

800

700

600

500

Case type

Kidney failure

Liver cirrhosis

Heart failure

Fillers

Further analysis onl Kind cognitive of activityl Nature and quality of knowledge usedl Metacognitive remarks on status of

knowledge l --> Conclusion faster, but not better

diagnosis and decrease in elaborate and detailed (biomedical) reasoning

l Very detailed analysis of selected protocols on how these lines of reasoning developed over time

Agnes Wagenaar

l Knowledge in actionl Video-stimulated post hoc think aloud

protocols

Knowledge in action

0

10

20

30

40

50

60

70

students interns post graduates experts

expertise level

avera

ge n

um

ber

of

thoughts

experience with patients

patient relationcountertransferenceinterview skillstime/interview structuretime management

hypothesis evaluation

history taking in relation with hypothesis

hypothesis formulation

Additional studies on

•Learning from experience

•Stress, coping and learning

Nievelstein

l Knowledge structure and reasoningl Encapsulations/intermediary conceptsl Ontological changel Reasoning style (adversarial reasoning)

Difference with Deliberate Practice tradition

l Focus on development of knowledge structures and reasoning

l With the aim of improving educationl How plus how well tasks are

performedl No differentiation within groups so far

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