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Despite the efforts of instructional design (ID) to solve real-life problems, it remains challenging to adapt and be flexible in such situations. In particular, problems that require simultaneous knowledge of multiple domains and contexts are more challenging to solve because real-life problems do not reconstruct the learned experience. This is generally thought to stem from differences between learning and real-life practice, but it also stems from instructional designs that fail to reflect the problem's structure and cognitive processes. This study is based on the 4C/ID model and proposes an instructional design for developing and connecting cognitive processes across multidimensional domains and contexts. It employs a simple-to-complex method that combines emphasis manipulation sequencing with simplifying condition sequencing, exposing students to the entire domain and context from the beginning of the learning process to develop a holistic cognitive process. A quasi-experiment was conducted with 34 sophomore college students majoring in education who were asked to create a lesson plan using different teaching styles. The groups consisted of students learning using emphasis manipulation sequencing and single sequencing (emphasis + condition), and the experimental procedure consisted of a total of five sessions, with between-group and within-group analyses of the effects of cognitive strategies and structural models. In the between-group analysis, cognitive strategies and structural models using the single sequencing method were effective from sessions 2 through 5, while in the within-group analysis, the development of cognitive strategies and structural models occurred from sessions 1 through 3, when the simplifying condition sequencing principle was maintained. While the proposed instructional designs are not a foolproof way to develop cognitive processes, a combined approach that considers the nature of the task provides a starting point that can enhance real-life training.

Background: Task‐based action observation and imitation (AOI) is a promising intervention to enhance upper limb (UL) motor function poststroke. However, whether whole/part task must be trained in the AOI therapy needs further substantiation. Objective: The objective of this study is to assess and compare the mirror neuron activity and UL muscle activity during AOI of reaching task in terms of whole task (complete movement) and part task (proximal arm movements and distal arm movements). Methods: In this cross‐sectional study, 26 participants with first‐time unilateral stroke were asked to observe the prerecorded videos of a reaching task in terms of a whole task and proximal and distal components, followed by imitation of the task, respectively. Electroencephalographic (EEG) mu rhythm suppression and electromyographic amplitude of six UL muscles were measured during the task. Results: The analysis of EEG revealed a statistically significant mu suppression score, indicating mirror neuron system activity, during AOI of the whole task in C3 ( p = <0.001) and C4 ( p = <0.001) electrodes compared to the part task. Percentage maximum voluntary contraction amplitudes of the deltoid ( p = 0.002), supraspinatus ( p = <0.001), triceps brachii ( p = 0.002), brachioradialis ( p = 0.006), and extensor carpi radialis ( p = <0.001) muscles showed a significant increase in muscle activity during AOI of the whole task. Also, there seems to be a task observation–specific activation of muscles following AOI of proximal or distal tasks. Conclusion: The practice of the whole task should be given emphasis while framing the AOI treatment module to enhance reaching in people with stroke. Trial registration: Clinical Trials Registry‐India (CTRI) identifier: CTRI/2018/04/013466 .

Teachers are urged to provide differentiated instruction (DI), that is, deliberately adapting instruction to the learning needs of all students. DI can positively affect students’ academic achievement and their social and emotional development, as well as foster teacher job satisfaction. However, international research, as well as research in the Dutch context, has shown that teachers feel unprepared to provide DI. Hence, the development of teacher professional development (TPD) programs is necessary. In the current paper, the design of a TPD intervention to support DI is presented, in which the content and design approach were deliberately chosen. The intervention content was based on an analysis of the skills and knowledge expert teachers use when providing DI. The design of the intervention was based on the whole-task approach from the 4C/ID model to promote the transfer of learning, among other things. Based on the experiences of the teachers participating in the training pilot (n = 4), we provide our recommendations for future TPD for DI. The next step will be to study the effects of this TPD program on a larger scale to obtain insight into what design characteristics do or do not work, which can be used to further improve this TPD intervention.

This research paper is based on a longitudinal study to find out how long-term embedded whole-task instruction can help students to develop more efficient information problem-solving (IPS) skills that could lead to a better use of internet information for learning and solving digital tasks more effectively. To this end, we designed, implemented and evaluated a three-year instruction programme to promote students’ development of key IPS skills in real-life classroom settings. This research involved sixty-one secondary education students. Forty-two of them received the IPS instruction and their results were analysed longitudinally and subsequently compared to a control group which received the regular courses. The results showed that students who received the IPS instruction improved their performance significantly in tasks in which the use of IPS skills was needed and these students organised and presented the information found on the internet critically and gave personal arguments. The findings also revealed that during the three-year project, the scores of IPS task performance were statistically higher in the instructed students than those obtained in control group students. Our study then provides an insight into how secondary students develop IPS skills throughout long-term instructional support and shows a series of educational implications.

Background Assessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease. Methods ASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey. Results Included were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 ( P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs . 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers. Conclusions Hybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback. Trial registration ClinicalTrials.gov Identifier: NCT05895799

Abstract BACKGROUND Surgical education relies on operative exposure with live patients. Carotid endarterectomy (CEA) demands an experienced surgeon with a very low complication rate. The high-risk nature of this procedure and the decline in number of CEAs performed annually has created a gap in residency training. OBJECTIVE To develop a high-fidelity whole-task simulation for CEA that demonstrates content, construct, and face validity. METHODS Anatomically accurate models of the human neck were created using multilayered poly-vinyl alcohol hydrogels. Graded polymerization of the hydrogel was achieved by inducing crosslinks during freeze/thaw cycles, stiffening the simulated tissues to achieve realistic tactile properties. Venous bleeding was simulated using pressure bags and a ventricular assistive device created pulsatile flow in the carotid. Ten surgeons performed the simulation under operating room conditions, and metrics were compared among experience levels to determine construct validity. Participants completed surveys about realism and usefulness to evaluate face validity. RESULTS A significant difference was found in operative measures between attending and resident physicians. The mean operative time for the expert group was 63.6 min vs 138.8 for the resident group (P = .002). There was a difference in mean internal carotid artery clamp time of 43.4 vs 83.2 min (P = .04). There were only 2 hypoglossal nerve injuries, both in the resident group (P = .009). CONCLUSION The whole-task CEA simulator is a realistic, inexpensive model that offers comprehensive training and allows residents to master skills prior to operating on live patients. Overall, the model demonstrated face and construct validity among neurosurgery and vascular surgeons.

Medical students must gain proficiency with the complex skill of case presentations, yet current approaches to instruction are fragmented and often informal, resulting in suboptimal transfer of this skill into clinical practice. Whole task approaches to learning have been proposed to teach complex skill development. The authors describe a longitudinal case presentation curriculum developed using a whole task approach known as four-component instructional design (4-C/ID). 4‑C/ID is based on cognitive psychology theory, and carefully attends to titrating a learner’s cognitive load, aiming to always keep students in their zone of proximal development. A multi-institutional group of medical educators convened to develop expert consensus regarding case presentation instruction using the 4‑C/ID model. A curriculum consisting of 1) learning tasks, 2) supportive information, 3) just-in-time information, and 4) part-task practice was developed. Domains were identified that make the task of delivering a case presentation complex. A simplifying conditions approach was applied to each domain to develop sequential task class descriptions. Examples of the four components are given to facilitate understanding of the 4‑C/ID model, making it more accessible to medical educators. Applying 4‑C/ID to curriculum development for the complex skill of case presentation delivery may optimize instruction. The provision of the complete curricular outline may facilitate transfer and implementation of this case presentation curriculum, as well as foster the application of 4‑C/ID to other complex skill development in medical education.

This study was designed to investigate the effects of two instructional approaches (whole-task versus part-task) and two levels of learner prior knowledge (lower versus higher) on learner acquisition and transfer of a complex cognitive skill. Participants were 51 undergraduate pre-service teachers. In the part-task condition, a complex skill (preparing a grade book using Excel) was decomposed into a series of smaller tasks, each of which was demonstrated and practiced separately. In the whole-task condition, which was based on the 4C/ID-model (van Merriënboer 1997), learners were exposed to the entire complex skill from the beginning of the instruction and were required to practice performing a series of whole tasks throughout the unit. Results indicated that the whole-task group performed significantly better than the part-task group on a skill acquisition test and a transfer test. Possible reasons for these findings and suggestions for future research are discussed.

This design experiment aimed to answer the question of how to mediate the practices of authentic science inquiries in primary education. An instructional approach based on activity theory was designed and carried out with multi-age students in a small village school. An open-ended learning task was offered to the older students. Their task was to design and implement instruction about the Ice Age to their younger fellows. The objective was collaborative learning among students, the teacher, and outside domain experts. Mobile phones and GPS technologies were applied as the main technological mediators in the learning process. Technology provided an opportunity to expand the learning environment outside the classroom, including the natural environment. Empirically, the goal was to answer the following questions: What kind of learning project emerged? How did the students’ knowledge develop? What kinds of science learning processes, activities, and practices were represented? Multiple and parallel data were collected to achieve this aim. The data analysis revealed that the learning project both challenged the students to develop explanations for the phenomena and generated high quality conceptual and physical models in question. During the learning project, the roles of the community members were shaped, mixed, and integrated. The teacher also repeatedly evaluated and adjusted her behavior. The confidence of the learners in their abilities raised the quality of their learning outcomes. The findings showed that this instructional approach can not only mediate the kind of authentic practices that scientists apply but also make learning more holistic than it has been. Thus, it can be concluded that nature of the task, the tool-integrated collaborative inquiries in the natural environment, and the multiage setting can make learning whole.

The purpose of this project was to evaluate the development and delivery of a hypertext case scenario document to be used as the capstone assessment tool for doctoral-level physical therapy students. The integration of Web-based collaborative tools (PBworks™ and Google Sites™) allowed students in this all-online course to apply their pharmacotherapy knowledge in a physical therapy patient scenario, while working with colleagues to determine the best route of patient care. Students developed digital writing skills imperative to a patient-centered, collaborative health-care field, and practiced evidence-based patient care. The findings demonstrate that the implementation of collaborative digital writing with a hypertext document case scenario assessment as the primary assessment tool in this online pharmacotherapy course delivered to doctoral-level physical therapy students is a feasible and effective educational strategy.