Tamara van Gog

Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners. Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples. Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners’ prior ability and learning condition on conceptual knowledge but not on near and far transfer performance. Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.

Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning. Ninety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps. Pre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P < .001) in the concept map study condition (68.8 ± 21.8%) compared to the concept map completion (52.8 ± 17.0%) and self-explanation (52.2 ± 21.7%) conditions. Post-test problem-solving performance was higher (P < .05) in the self-explanation (63.2 ± 16.0%) condition compared to the concept map study (53.3 ± 16.4%) and concept map completion (51.0 ± 13.6%) conditions. Students in the self-explanation condition also invested less mental effort in the post-test. Studying model concept maps led to greater conceptual knowledge, whereas self-explanation led to higher transfer performance. Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection.

Research has shown that for acquiring problem-solving skills, instruction consisting of studying worked examples is more effective and efficient for novice learners than instruction consisting of problem-solving. This study investigated whether worked examples would also be a useful instructional format for the acquisition of visual perceptual skills, which play an important role in many domains, and especially in health sciences (e.g. in radiology, dermatology, or cardiology). All novice participants were first given a general explanation of the basics of electrocardiogram (ECG) interpretation and the features of four cardiac disorders. Then they engaged in 12 practice tasks that presented them with ECG waveforms with abnormalities, which they either had to describe themselves (“problem-solving”) or a description of which they had to study (worked example), depending on the condition to which they had been randomly assigned. Results showed that participants in the worked-examples conditions reached higher performance on the retention test, though not on the transfer test.

Summary: Subjective mental effort rating scales are widely used in research on learning, instruction and training. However, the timing and frequency of application of those rating scales differ between studies. Some apply a rating scale repeatedly after every task in a learning or test phase, whereas others do so only once at the end of a phase. Four experiments are presented that investigated how timing and frequency of mental effort measurements affect the results obtained. The findings from Experiment 1 (between‐subjects) and 2 (within‐subjects), using different arrangements of simple and complex tasks, showed that a single rating after a series of tasks resulted in a higher mental effort score than the average of ratings provided immediately after every task. A similar result was obtained in Experiment 3 with series of complex tasks, but not with simple tasks. Experiment 4 showed that knowing beforehand that mental effort rating will be required after completing all tasks results in lower scores, but average retrospective ratings per task still differed from a single retrospective rating. Taken together, these experiments suggest that timing and frequency of effort ratings do affect the results obtained and that repeatedly measuring mental effort after each task in the series seems to be preferable. Copyright © 2012 John Wiley & Sons, Ltd.