About our Department
Our Research
The Institute conducts research across the board of medical education, from selection for the bachelor program to the training of health professionals. Our research contributes to the (inter)national research field of (medical) educational research and generates both direct and indirect effects on (inter)national medical education. Our close connection with teachers and program directors enables us to valorise our knowledge and improve medical education.
We carry out research on two main topics:
- Clinical Reasoning & Patient Safety: Making sure that future doctors learn to diagnose the patient in the right way.
- Selection & Assessment: Enabling all (future) students to become part of a capable, diverse, and healthy workforce.
Principal Investigators
Principal investigators
- Andrea Woltman
Director iMERR, Professor Innovation of Health Professions Education - Sílvia Mamede Studart Soares
Associate Professor - Laura Zwaan
Associate professor - Dario Cecilio-Fernandes
Assistant Professor
Post-docs and PhD candidates
- Justine Staal
Post-doc - Lokke Gennissen
PhD candidate - Jacky Hooftman
PhD candidate - Sofie Jacobse
PhD candidate - Charlotte van Sassen
PhD candidate - Magali Heijkoop
PhD candidate - Rick Roos
PhD candidate - Gustavo Labanca
PhD candidate - Christof Schulz
PhD candidate - Jelle Meerstra
PhD candidate - Fernando Salvetti Valente
PhD candidate - Zhao Xiaoyu
PhD candidate - Helen Driessen
Postdoctoral researcher
Emeritus Professors
- Walter van den Broek
Emeritus Professor Evidence-based Medical Education - Henk Schmidt
Emeritus Professor
iMERR affiliate members
- Jelmer Alsma
- Marco Antonio de Carvalho Filho
- Rianne Brand
- Matthijs de Hoog
- Laura Kalfsvel
- Rob Kickert
- Marloes Nederland
- Fred Paas
- Tuan Phan
- Ligia Maria Cayres Ribeiro
- Floor van Rosse
- Jerome Rotgans
- Jorie Versmissen
Notable Results
Contributions coming from iMERR’s research have been incorporated into the agenda of medical specialties associations and organizations concerned with the improvement of diagnosis in medicine. This speaks for the scientific value and has led our researchers to share their studies in scientific and professional meetings that gather educators, researchers and the leaders in the field worldwide.
Furthermore, our research contributes to current social debates around equity and diversity as it relates to the accessibility of higher education, and student wellbeing in relation to academic dismissal policies in the Netherlands. Our researchers actively participate in these discussions and met with policy makers and politicians, educational directors, students and other stakeholders to improve educational policies. Also at the local level, iMERR contributes to educational innovations and evidence-informed education policies within Erasmus MC.
Publications
Publications
Publications can be found on the personal profiles of the principal investigators.
PhD theses
Research Line Clinical Reasoning & Patient Safety
Why Clinical Reasoning?
One of the most important goals of medical education is to help students become able to effectively diagnose and manage patient problems. This ability depends critically on clinical reasoning, the cognitive processes by which physicians collect and interpret patient information to make diagnostic and treatment decisions. Because the quality of patient care relies on physicians’ clinical reasoning skills, mastering such skills has been much valued at every level of medical education. As concerns with diagnostic error and patient safety increase, the importance attributed to the development of clinical reasoning has grown even further. Studies of real-life diagnostic errors have demonstrated that faults in physicians’ reasoning have played a role in most of the cases. This has stimulated interest in understanding the nature of clinical reasoning, how it operates, what can go wrong and how errors can be prevented. It has also nurtured efforts to investigate how clinical reasoning develops throughout education and what teaching approaches medical schools should apply to help medical students and residents acquire appropriate clinical reasoning skills.
What do we investigate?
These are fascinating issues that have challenged researchers. At iMERR we address these challenges by conducting research on the full spectrum of the clinical reasoning field. Our research ranges from theory building fundamental research around the nature of clinical reasoning till applied research on solutions to improve clinical reasoning in clinical practice and education. In each of the following themes we have several (PhD) projects:
Understanding the Nature of Clinical Reasoning
We study the different modes of (intuitive vs reflective) clinical reasoning by using well-established methods from cognitive psychology research, e.g. eye-tracking, and novel research tools, such as functional near-infrared spectroscopy (fNIRS). We aim to understand how these reasoning modes develop throughout education and practice and how they relate to diagnostic performance. We study the effects of physician-related factors (e.g. expertise level), patient-related factors (e.g., patients’ behaviour) and contextual factors (e.g. time pressure) on diagnostic reasoning and diagnostic performance.
Understanding the Magnitude of the Problem of Diagnostic Errors, its Origins and Possible Solutions
We aim to identify the prevalence of actual diagnostic errors (e.g. by reviewing liability claims and patient records) to understand the magnitude of the problem, including the diseases and circumstances at high risk for diagnostic errors. We use simulated clinical cases in experimental research to understand causes of diagnostic errors and develop and test approaches to reduce the likelihood of diagnostic error. Examples are studies of conditions that tend to induce cognitive bias in clinical reasoning (e.g. salient distracting features, recent clinical experiences), factors that influence physicians’ susceptibility to bias (e.g. features of mental representations of disease knowledge and the testing of on-the-spot approaches to improve the reasoning process (e.g. deliberate reflection).
Development and Testing of Educational Strategies for the Teaching of Clinical Reasoning
We conduct experimental studies on instructional approaches (e.g. self-explanation, deliberate reflection) to improve physicians’ and medical students’ clinical reasoning, including studies of educational interventions to reduce physicians’ susceptibility to bias in reasoning. Furthermore, we aim to identify the most effective clinical cases that could be used in clinical reasoning education (e.g. malpractice claims cases).
Collaboration
Our research is conducted in collaboration with colleagues from Erasmus MC and the Department of Psychology, Erasmus University. A strong network of collaboration with researchers and stakeholders from (inter)national universities and organizations around the world (e.g. AUMC, Amsterdam; VvAA liability insurer; University of Bern, Switzerland; Nanyang Technological University, Singapore; Baylor College of Medicine, US; McMaster University and Sherbrooke University, Canada; Federal University of Minas Gerais and UNICAMP, Brazil, University of Minnesota, US). These collaborations have created conditions to conduct many of our projects as joint studies in different countries. For more information about the projects conducted by the iMERR clinical reasoning researchers, please consult the researchers' personal pages below.
Research Line Selection & Assessment: Performance, Well-being and Diversity
Why Selection and Assessment?
Worldwide, the number of students applying for medical school is much larger than the available positions. The challenge of medical schools is to attract and select a diverse student population whose interests and abilities match the educational program and societal needs. In addition, medical schools are responsible for optimizing assessment to stimulate learning and reflect study progress in a fair and valid way. Therefore, the selection and assessment of medical students is a high stakes process for both (potential) students and medical programs.
Selection is defined as the process by which medical programs distinguish between potential students. Once students have entered the medical program, the medical program is responsible for ensuring sufficient academic performance. Therefore, medical schools use assessment, which is defined as the process of collecting information to determine whether (future) health professionals have mastered required competences.
This research topic aims to improve educational practice and policy regarding selection and assessment to ensure a diverse pool of resilient health professionals who meet societal needs. Our research covers the whole educational trajectory of medical school: from selection of pre-university candidates to assessment in residency programs, including performance-based assessment.
What do we investigate?
To positively contribute to inclusive selection and assessment policies that stimulate learning, iMERR investigates the characteristics that can affect performance, well-being and diversity of the student population.
Performance
Medical schools are responsible for training their students to become qualified doctors. Therefore, we investigate how selection and assessment can impact that purpose. For example, we study which selection methods are good predictors of academic performance and how assessment policies and student characteristics can affect study progress.
Well-being
The prevalence of mental distress among medical students is high. Consequently, medical schools should monitor how the well-being of their students is affected by the selection and assessment policies. Examples of research conducted at iMERR are the association between selection methods and student well-being during the program, as well as how student and institutional characteristics interact with student well-being.
Diversity
Student diversity is important for promoting excellence in medical education and to ensure high quality health care for a diverse patient population. We focus on how medical schools can attract, select, include and retain underrepresented subgroups such as students with a migration background and/or low socioeconomic status. For instance, we study how selection methods can impact student diversity and potential bias in the assessment of professional skills.
Performance, well-being and student diversity are intertwined. A specific assessment policy can, for example, stimulate academic performance but at the same time harm student well-being and/or hamper student diversity. Hence, we study these topics in a holistic way to ensure a diverse pool of resilient health professionals who meet societal needs.
Collaboration
We collaborate with national and international research groups with advanced expertise in different medical, psychological and social disciplines, which enables multidisciplinary approaches and the application of innovative methods. In addition, we collaborate with educational directors, both locally and (inter)nationally, teachers and policymakers to collect research data and improve educational policy. Furthermore, we participate in expertise panels and networks to share our knowledge and improve educational policy worldwide.
