Comparing Four Instructional Techniques for Promoting Robust Knowledge

Implementation of three knowledge-oriented instructional strategies to teach clinical reasoning: Self-explanation, a concept mapping exercise, and deliberate reflection: AMEE Guide No. 150

The teaching of clinical reasoning is essential in medical education. This guide has been written to provide educators with practical advice on the design, development, and implementation of three knowledge-oriented instructional strategies for the teaching of clinical reasoning to medical students: Self-explanation (SE), a Clinical Reasoning Mapping Exercise (CREsME), and Deliberate Reflection (DR). We first synthesize the theoretical tenets that support the use of these strategies, including knowledge organization, and development of illness scripts. We then provide a detailed description of the key components of each strategy, emphasizing the practical applications of each one by sharing specific examples. We also explore the potential for a combined application of these strategies in a longitudinal and developmental approach to teaching clinical reasoning at the undergraduate level. Finally, we discuss enablers and barriers in the implementation and integration of these teaching strategies while taking into consideration curricular needs, context, and resources. We are aware that many strategies exist and are not arguing that SE, CReSME, and DR are the most effective ones or the only ones to be adopted. Nevertheless, we selected these strategies because of overarching theoretical principles, empirical evidence supporting their use, and our own experience with them. We are hoping to provide practical advice on the implementation of these strategies to practicing educators who aim at developing an integrated approach to the teaching of clinical reasoning to medical students at different stages of their development.

Assessing Metacognitive Regulation during Problem Solving: A Comparison of Three Measures

Metacognition is hypothesized to play a central role in problem solving and self-regulated learning. Various measures have been developed to assess metacognitive regulation, including survey items in questionnaires, verbal protocols, and metacognitive judgments. However, few studies have examined whether these measures assess the same metacognitive skills or are related to the same learning outcomes. To explore these questions, we investigated the relations between three metacognitive regulation measures given at various points during a learning activity and subsequent test. Verbal protocols were collected during the learning activity, questionnaire responses were collected after the learning tasks but before the test, and judgments of knowing (JOKs) were collected during the test. We found that the number of evaluation statements as measured via verbal protocols was positively associated with students' responses on the control/debugging and evaluation components of the questionnaire. There were also two other positive trends. However, the number of monitoring statements was negatively associated with students' responses on the monitoring component of the questionnaire and their JOKs on the later test. Each measure was also related to some aspect of performance, but the particular metacognitive skill, the direction of the effect, and the type of learning outcome differed across the measures. These results highlight the heterogeneity of outcomes across the measures, with each having different affordances and constraints for use in research and educational practice.

Accio Knowledge: Children's Knowledge Acquisition in the Domain of Harry Potter

We conducted a conceptual replication of Chi and Koeske (1983) and Gobbo and Chi's (1986) studies on children's knowledge acquisition. One hundred elementary school students (86 through 159 months of age, in school grades 1 through 7) were asked to recall information about Harry Potter and the Sorcerer's Stone, the first of the books in the Harry Potter series. A quantitative measure of expertise was derived by a summation of factor loadings that were drawn from a free response and trivia task and from the number of Harry Potter books and movies a child reported having read or watched. Different measures of expertise were strongly intercorrelated but were only moderately correlated with age or grade. Although there was a significant correlation between age or grade and knowledge acquisition and expertise, nearly every other measure that correlated with expertise maintained statistical significance, even when we controlled for age or grade. Furthermore, regardless of age or grade, children with higher knowledge acquisition and expertise scores sorted characters more cohesively, with more sophistication, and used more categories that require a deep understanding of the Harry Potter domain. These results reinforce the idea that expertise is an aspect of knowledge that can be separated from a child's level of cognitive development and is associated with a deeper and richer knowledge base.

A layered analysis of self-explanation and structured reflection to support clinical reasoning in medical students

Self-explanation and structured reflection have been studied independently with results suggesting that both learning interventions can effectively support medical students' clinical reasoning development. Given this evidence, medical schools may want/begin to implement these interventions in their curricula. Implementing educational interventions requires educators to maintain the core philosophy and principles of the interventions intact while adjusting implementation techniques to the specificities of individual learning contexts. Educational scholars have yet to explicitly articulate the philosophy, principles and techniques of self-explanation and structured reflection. Without such descriptions, educators risk failing to realize self-explanation's and structured reflection's effect to support students' clinical reasoning skill development in their implementations. Relying on the layered analysis approach, we articulate the philosophy, principles and techniques of self-explanation and structured reflection. This description is framed within the context of an actual implementation to illustrate the philosophies underpinning self-explanation and structured reflection, the principles that realize those philosophies, and the techniques that can be used to enact those principles. Building on the similarities between self-explanation and structured reflection, while also harnessing their differences, we identify why and how these interventions can be combined in a single implementation, while preserving their philosophies and principles. The layered analysis of self-explanation and structured reflection offers essential insights into the underpinnings of these interventions. They are articulated in this manuscript in hopes that other scholars will continue to refine these descriptions thereby facilitating effective use of self-explanation and structured reflection for clinical reasoning development.

Metacognitive study strategies in a college course and their relation to exam performance

Several strands of prior work have evaluated students' study strategies and learning activities. In this work, we focus on integrating two of those strands. One has focused on student self-reports of their study practices from a cognitive psychology perspective. The other has focused on classifying student learning activities from a learning sciences perspective using the Interactive, Constructive, Active, and Passive (ICAP) framework (Chi & Wylie, 2014). The current study aims to integrate these two strands of research by testing the implications of the ICAP framework with students' self-reports in a classroom context. Another goal was to address the measurement limitations of the metacognitive study strategy literature by using assessment-specific self-reports with both closed and open-ended questions. Across three noncumulative exams, 342 undergraduates self-reported their study practices before each exam. We then categorized their strategies as either active or constructive in alignment with the ICAP framework. Next, we examined whether these strategies were related to each other and then tested the hypothesis that constructive strategies would be positively associated with better exam performance than active strategies. Students reported using a variety of study practices in which a few active strategies were related to constructive strategies, but constructive strategies were more likely to be related to each other. Lastly, supporting the ICAP framework, many of the constructive strategies were positively related to exam performance, whereas the active strategies were not. This work provides insight into the measurement of students' study strategies and their relations to each other and learning outcomes.

Exploring How Gender and Enjoyment Impact Learning in a Digital Learning Game

In digital learning games, do game mechanics that promote learning and those that promote enjoyment have different effects on students’ experience? Do males or females learn from or enjoy games more? We explored these questions in Decimal Point, a digital learning game that teaches decimal numbers and decimal operations to middle school students. In this work, we conducted a classroom study with two versions of the game, one that encourages students to play to learn and one that encourages students to play for enjoyment. We compared these two conditions to a control condition that is neutral regarding learning and enjoyment. Our results indicated that the enjoyment-focused group learned more efficiently than the control group, and that females had higher learning gains than males across all conditions, particularly on the near and middle transfer learning items. Post hoc analyses also revealed that the learning-focused group engaged in re-practicing the same mini-games, while the enjoyment-focused group demonstrated more exploration of different mini-games. These findings suggest that emphasizing learning or enjoyment can result in distinctive gameplay behaviors from students, and that our game can help bridge the typical gender gap in math education.

Does providing the correct diagnosis as feedback after self-explanation improve medical students diagnostic performance?

BACKGROUND

Self-explanation without feedback has been shown to improve medical students' diagnostic reasoning. While feedback is generally seen as beneficial for learning, available evidence of the value of its combination with self-explanation is conflicting. This study investigated the effect on medical students' diagnostic performance of adding immediate or delayed content-feedback to self-explanation while solving cases.

METHODS

Ninety-four 3rd-year students from a Canadian medical school were randomly assigned to three experimental conditions (immediate-feedback, delayed-feedback, control). In the learning phase, all students solved four clinical cases by giving i) the most likely diagnosis, ii) two main arguments supporting this diagnosis, and iii) two plausible alternative diagnoses, while using self-explanation. The immediate-feedback group was given the correct diagnosis after each case; delayed-feedback group received the correct diagnoses only after the four cases; control group received no feedback. One week later, all students solved four near-transfer (i.e., same final diagnosis as the learning cases but different scenarios) and four far-transfer cases (i.e., different final diagnosis from the learning cases and different scenarios) by answering the same three questions. Students' diagnostic accuracy (score for the response to the first question only) and diagnostic performance (combined score of responses to the three questions) scores were assessed in each phase. Four one-way ANOVAs were performed on each of the two scores for near and far-transfer cases.

RESULTS

There was a significant effect of experimental condition on diagnostic accuracy on near-transfer cases (p < .05). The immediate-feedback and delayed-feedback groups performed equally well, both better than control (respectively, mean = 90.73, standard deviation =10.69; mean = 89.92, standard deviation = 13.85; mean = 82.03, standard deviation = 17.66). The experimental conditions did not significantly differ on far-transfer cases.

CONCLUSIONS

Providing feedback to students in the form of the correct diagnosis after using self-explanation with clinical cases is potentially beneficial to improve their diagnostic accuracy but this effect is limited to similar cases. Further studies should explore how more elaborated feedback combined with self-explanation may impact students' diagnostic performance on different cases.

Cognitive Training Does Not Enhance General Cognition

Due to potential theoretical and societal implications, cognitive training has been one of the most influential topics in psychology and neuroscience. The assumption behind cognitive training is that one's general cognitive ability can be enhanced by practicing cognitive tasks or intellectually demanding activities. The hundreds of studies published so far have provided mixed findings and systematic reviews have reached inconsistent conclusions. To resolve these discrepancies, we carried out several meta-analytic reviews. The results are highly consistent across all the reviewed domains: minimal effect on domain-general cognitive skills. Crucially, the observed between-study variability is accounted for by design quality and statistical artefacts. The cognitive-training program of research has showed no appreciable benefits, and other more plausible practices to enhance cognitive performance should be pursued.

A contrastive account of explanation generation

In this article, we propose a contrastive account of explanation generation. Though researchers have long wrestled with the concepts of explanation and understanding, as well as with the procedures by which we might evaluate explanations, less attention has been paid to the initial generation stages of explanation. Before an explainer can answer a question, he or she must come to some understanding of the explanandum-what the question is asking-and of the explanatory form and content called for by the context. Here candidate explanations are constructed to respond to the particular interpretation of the question, which, according to the pragmatic approach to explanation, is constrained by a contrast class-a set of related but nonoccurring alternatives to the topic that emerge from the surrounding context and the explainer's prior knowledge. In this article, we suggest that generating an explanation involves two operations: one that homes in on an interpretation of the question, and a second one that locates an answer. We review empirical work that supports this account, consider the implications of these contrastive processes, and identify areas for future study.

Generating explanations via analogical comparison

Generating explanations can be highly effective in promoting learning in both adults and children. Our interest is in the mechanisms that underlie this effect and in whether and how they operate in early learning. In adult reasoning, explanation may call on many subprocesses-including comparison, counterfactual reasoning, and reasoning by exclusion; but it is unlikely that all these processes are available to young children. We propose that one process that may serve both children and adults is comparison. In this study, we asked whether children would use the results of a comparison experience when asked to explain why a model skyscraper was stable. We focused on a challenging principle-that diagonal cross-bracing lends stability to physical structures (Gentner et al., Cognitive Science, 40, 224-240, 2016). Six-year-olds either received no training or interacted with model skyscrapers in one of three different conditions, designed to vary in their potential to invite and support comparison. In the Single Model condition, children interacted with a single braced model. In the comparison conditions (Low Alignability and High Alignability), children compared braced and unbraced models. Following experience with the models, children were asked to explain why the braced model was stable. They then received two transfer tasks. We found that children who received highly alignable pairs were most likely to (a) produce brace-based explanations and (b) transfer the brace principle to a dissimilar context. This provides evidence that children can benefit from analogical comparison in generating explanations and also suggests limitations on this ability.