Validation of the ViGaTu Immersive Virtual Reality Endoscopy Training System for Physicians and Nurses.

BACKGROUND AND AIMS: Endoscopy simulators are primarily designed to provide training in interventions performed during procedures. Peri-interventional tasks such as checking patient data, filling out forms for team time-out, patient monitoring, and performing sedation are often not covered. This study assesses the face, content, and construct validity of the ViGaTu (Virtual Gastro Tutor) immersive virtual reality (VR) simulator in teaching these skills. METHODS: 71 nurses and physicians were invited to take part in VR training. The participants experienced an immersive VR simulation of an endoscopy procedure, including setting up the endoscopic devices, checking sign-in and team time-out forms, placing monitoring devices, and performing sedation. The actions performed by the participants and their timing were continuously recorded. Face and content validity, as well as the System Usability Scale (SUS), were then assessed. RESULTS: 43 physicians and 28 nurses from 43 centers took a mean of 27.8 min (standard deviation ± 14.42 min) to complete the simulation. Seventy-five percent of the items for assessing face validity were rated as realistic, and 60% of items assessing content validity and usefulness of the simulation for different learning goals were rated as useful by the participants (four out of five on a Likert scale). The SUS score was 70, demonstrating a high degree of usability. With regard to construct validity, experienced endoscopy staff were significantly faster in setting up the endoscope tower and instruments than beginners. CONCLUSIONS: This multicenter study presents a new type of interdisciplinary endoscopy training system featuring peri-interventional tasks and sedation in an immersive VR environment.

It's all metacognitive: The relationship between informal learning and self-regulated learning in the workplace.

Informal workplace learning accounts for a large extent of employees' learning. Informal learning activities such as reflection or keeping up-to-date resemble self-regulated learning strategies that indicate the ability to plan, monitor, and regulate one's learning. However, little is known about the relationship between informal learning behaviors and self-regulated learning strategies. Structural equation modeling with data from 248 employees revealed that the informal learning behaviors of reflection, keeping up-to-date, feedback-seeking, and knowledge-sharing are strongly related to the metacognitive self-regulated learning strategies of monitoring and regulation. However, informal learning behaviors lack the deep-processing strategies of elaboration and organization, and the resource strategies of help-seeking and effort regulation. Only innovative behavior is strongly related to effort regulation. These results suggest a potential deficit in employees' strategy use. Employees should consider further resources to increase their learning effectiveness in the workplace. The results are discussed, and practical implications are outlined.

Analyzing and supporting mental representations and strategies in solving Bayesian problems.

Solving Bayesian problems poses many challenges, such as identifying relevant numerical information, classifying, and translating it into mathematical formula language, and forming a mental representation. This triggers research on how to support the solving of Bayesian problems. The facilitating effect of using numerical data in frequency format instead of probabilities is well documented, as is the facilitating effect of given visualizations of statistical data. The present study not only compares the visualizations of the 2 × 2 table and the unit square, but also focuses on the results obtained from the self-creation of these visualizations by the participants. Since it has not yet been investigated whether the better correspondence between external and internal visualization also has an effect on cognitive load when solving Bayesian tasks, passive and active cognitive load are additionally measured. Due to the analog character and the proportional representation of the numerical information by the unit square, it is assumed that the passive cognitive load is lower when using the unit square as visualization than when using the 2 × 2 table. The opposite is true for active cognitive load.

Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Württemberg primary school study [DRKS-ID: DRKS00000494].

BACKGROUND: Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study. METHODS/DESIGN: The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up. DISCUSSION: At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494.

Learning From Instructional Videos: Learner Gender Does Matter; Speaker Gender Does Not.

One crucial design characteristic of auditory texts embedded in instructional videos is the speaker gender, which has received some attention from empirical researcher in the recent years. Contrary to the theoretical assumption that similarity between the speaker's and the learner's gender might positively affect learning outcomes, the findings have often been mixed, showing null to contrary effects. Notwithstanding the effect on the outcomes, a closer look at how the speaker's gender and speaker-learner similarities further determine cognitive variables, such as different cognitive load types, is overdue. Moreover, on the part of the learner, the role of situational interest in the learning topic that might be gender related has been neglected so far. Therefore, this study explored the role of speaker and learner gender and their interaction regarding learning outcomes. We broaden our perspective by investigating the effects of gender-related differences concerning situational interest in the topic being taught and by determining different types of cognitive load. In a 2 (female/male speaker) × 2 (female/male learner) within- and between-subject design, 95 students learned about female and male human sexual maturity with an instructional video containing auditory explanations. Analysis results indicate that speaker gender and speaker-learner gender similarity had no impact on learning gains, situational interest, and cognitive load types. However, the results demonstrate that learner's gender, especially for the topic of female sexual maturity, matters the most in line with the assessed variables. Compared with males, females had higher learning gains, reported higher interest in the topic, and invested more germane cognitive resources. Thus, instructional designers may want to consider learner gender-dependent interest and how it can be triggered when creating videos with auditory explanations.

Learning in Virtual Reality: Bridging the Motivation Gap by Adding Annotations.

One challenge while learning scientific concepts is to select relevant information and to integrate different representations of the learning content into one coherent mental model. Virtual reality learning environments (VRLEs) offer new possibilities to support learners and foster learning processes. Whether learning in VR is successful, however, depends to a large extent on the design of the VRLE and the learners themselves. Hence, adding supportive elements in VRLEs, such as annotations, might facilitate the learning process by guiding attention and supporting the selection of relevant information. Additionally, the mapping of pictorial and verbal information is eased by these annotations. The beneficial effect of annotations is highly dependent on learners' intrinsic motivation as intrinsic motivation while learning also affects the information selection and visual search patterns. In our experimental study (N = 61), we compared two conditions: learning in a VRLE with or without annotations. We measured the learning outcome on three different levels (knowledge, comprehension, and application). Additionally, we investigated intrinsic motivation as a moderator for the effect of annotations on learning outcome. We found no significant main effect of annotations on learning outcome. The moderating effect of intrinsic motivation for annotations on the overall learning outcome was significant. Our results imply that learners are either intrinsically motivated or need additional support by annotations as these support the selection of relevant information in the VRLE and therefore enable them to learn successfully. Which type or quantity of annotations supports learning processes best needs to be explored in future research.

Self-Regulation in Informal Workplace Learning: Influence of Organizational Learning Culture and Job Characteristics.

The digital shift leads to increasing changes. Employees can deal with changes through informal learning that enables needs-based development. For successful informal learning, self-regulated learning (SRL) is crucial, i.e., to set goals, plan, apply strategies, monitor, and regulate learning for example by applying resource strategies. However, existing SRL models all refer to formal learning settings. Because informal learning differs from formal learning, this study investigates whether SRL models can be transferred from formal learning environments into informal work settings. More precisely, are all facets relevant, and what are the relational patterns? Because informal workplace learning occurs through interaction with the context, this study investigates the influence of context, i.e., organizational learning culture and job characteristics (autonomy, task identity, and feedback) on SRL. Structural equation modeling of N = 170 employees in various industries showed the relevance of the self-reported metacognitive strategies planning, monitoring, and regulation; the resource strategies help-seeking and effort regulation; and deep processing strategy elaboration. However, there was no evidence for organization strategies. The learning strategies were associated with self-efficacy and mastery-approach goal orientation. Regarding context, results supported indirect effects over self-motivational beliefs of learning strategies. Organizational learning culture was connected with mastery-approach goal orientation, whereas job characteristics autonomy and feedback were related to self-efficacy, which were again related to SRL strategies. Therefore, context can empower employees not only to accomplish their tasks but to develop themselves by applying SRL strategies. The results are discussed, and practical implications are outlined.

Learning From Multiple Representations: Prior Knowledge Moderates the Beneficial Effects of Signals and Abstract Graphics.

Multimedia learning research addresses the question of how to design instructional material effectively. Signaling and adding graphics are typical instructional means that might support constructing a mental model, particularly when learning abstract content from multiple representations. Although signals can help to select relevant aspects of the learning content, additional graphics could help to visualize mentally the subject matter. Learners' prior knowledge is an important factor for the effectiveness of both types of support: signals and added graphics. Therefore, we conducted an experimental study situated in a university course of computer science with N = 124 participants. In our 2 × 2 factorial design, we investigated the effects of signals and illustrating graphics on learning outcomes and their potential interplay. Based on our regression analysis, we revealed prior knowledge as a significant moderator. Although learners with low levels of prior knowledge can profit from all types of help but still gain rather weak learning outcomes, learners with medium levels of prior knowledge profit from the synergy of both helps. With higher levels of prior knowledge, signals were particularly hampering. To improve the understanding of these supportive or hampering effects, a more fine-grained analysis of these processes and motivational effects is necessary.

Training for Coherence Formation When Learning From Text and Picture and the Interplay With Learners' Prior Knowledge.

Learning with text and pictures requires learners to integrate the given information into one coherent mental representation. Since learners often fail to integrate text and pictures, the study investigates the effects of a training for text processing strategies, picture processing strategies and strategies to map text and picture onto each other. It was assumed that learners' prior knowledge would affect the effects of such a training with more beneficial effects for learners with high prior knowledge. The training comprised an introduction on how to process, integrate and reflect on texts and pictures with an additional training phase of 3 weeks. The study (N = 30) analyzed the effects of the training with regard to recall and comprehension performance in contrast to the no training group, which received an alternative program that was not related to text-picture integration. A regression analysis showed that the integration training was not overall beneficial but only for learners with increased levels of prior knowledge. Hence, training for coherence formation is beneficial for learning only when adequate knowledge structures are available to conduct the recommended steps of understanding and integrating text and picture.

The Interaction Between Text Modality and the Learner's Modality Preference Influences Comprehension and Cognitive Load.

This study investigates the aptitude-treatment interaction between text modality and learners' modality preference on learning outcomes and cognitive load, which is currently a point of controversy. The Meshing Hypothesis postulates there are better learning outcomes when the modality of a learning environment matches the learner's preference. However, previous research supporting the Meshing Hypothesis shows methodological issues. Therefore, clear empirical support is needed. We tested 42 learners in a between-subject design: Their preferences were either auditive-ambiguous or visual, and half of each preference group randomly learned either with an auditive or a visual text. As expected, we did not find any main effects, but a significant interaction between the text modality and the learner's preference for comprehension outcomes, extraneous cognitive load, and germane cognitive load. Specifically, learners with a preference for visual texts benefit from learning with their preferred modality, they showed higher comprehension scores and less extraneous load when learning from a visual text. Auditive-ambiguous learners showed almost equal results with both text modalities. This might be explained by the fact that most texts in everyday life are presented visually, and therefore learners with an auditive preference needed to develop appropriate reading strategies. Thus, our results partly support the Meshing Hypothesis.

Can Music Foster Learning - Effects of Different Text Modalities on Learning and Information Retrieval.

This study investigates the possibilities of fostering learning based on differences in recall and comprehension after learning with texts which were presented in one of three modalities: either in a spoken, written, or sung version. All three texts differ regarding their processing, especially when considering working memory. Overall, we assume the best recall performance after learning with the written text and the best comprehension performance after learning with the sung text, respectively, compared to both other text modalities. We also analyzed whether the melody of the sung material functions as a mnemonic aid for the learners in the sung text condition. If melody and text of the sung version are closely linked, presentation of the melody during the post-test phase could foster text retrieval. 108 students either learned from a sung text performed by a professional singer, a printed text, or the same text read out loud. Half of the participants worked on the post-test while listening to the melody used for the musical learning material and the other half did not listen to a melody. The written learning modality led to significantly better recall than with the spoken (d = 0.97) or sung text (d = 0.78). However, comprehension after learning with the sung modality was significantly superior compared to when learning with the written learning modality (d = 0.40). Reading leads to more focus on details, which is required to answer recall questions, while listening fosters a general understanding of the text, leading to higher levels of comprehension. Listening to the melody during the post-test phase negatively affected comprehension, irrespective of the modality during the learning phase. This can be explained by the seductive detail effect, as listening to the melody during the post-test phase may distract learners from their main task. In closing, theoretical and practical implications are discussed.

Development and Validation of Two Instruments Measuring Intrinsic, Extraneous, and Germane Cognitive Load.

Cognitive Load Theory is one of the most powerful research frameworks in educational research. Beside theoretical discussions about the conceptual parts of cognitive load, the main challenge within this framework is that there is still no measurement instrument for the different aspects of cognitive load, namely intrinsic, extraneous, and germane cognitive load. Hence, the goal of this paper is to develop a differentiated measurement of cognitive load. In Study 1 (N = 97), we developed and analyzed two strategies to measure cognitive load in a differentiated way: (1) Informed rating: We trained learners in differentiating the concepts of cognitive load, so that they could rate them in an informed way. They were asked then to rate 24 different learning situations or learning materials related to either high or low intrinsic, extraneous, or germane load. (2) Naïve rating: For this type of rating of cognitive load we developed a questionnaire with two to three items for each type of load. With this questionnaire, the same learning situations had to be rated. In the second study (N = between 65 and 95 for each task), we improved the instrument for the naïve rating. For each study, we analyzed whether the instruments are reliable and valid, for Study 1, we also checked for comparability of the two measurement strategies. In Study 2, we conducted a simultaneous scenario based factor analysis. The informed rating seems to be a promising strategy to assess the different aspects of cognitive load, but it seems not economic and feasible for larger studies and a standardized training would be necessary. The improved version of the naïve rating turned out to be a useful, feasible, and reliable instrument. Ongoing studies analyze the conceptual validity of this measurement with up to now promising results.

The Influence of Background Music on Learning in the Light of Different Theoretical Perspectives and the Role of Working Memory Capacity.

This study investigates how background music influences learning with respect to three different theoretical approaches. Both the Mozart effect as well as the arousal-mood-hypothesis indicate that background music can potentially benefit learning outcomes. While the Mozart effect assumes a direct influence of background music on cognitive abilities, the arousal-mood-hypothesis assumes a mediation effect over arousal and mood. However, the seductive detail effect indicates that seductive details such as background music worsen learning. Moreover, as working memory capacity has a crucial influence on learning with seductive details, we also included the learner's working memory capacity as a factor in our study. We tested 81 college students using a between-subject design with half of the sample listening to two pop songs while learning a visual text and the other half learning in silence. We included working memory capacity in the design as a continuous organism variable. Arousal and mood scores before and after learning were collected as potential mediating variables. To measure learning outcomes we tested recall and comprehension. We did not find a mediation effect between background music and arousal or mood on learning outcomes. In addition, for recall performance there were no main effects of background music or working memory capacity, nor an interaction effect of these factors. However, when considering comprehension we did find an interaction between background music and working memory capacity: the higher the learners' working memory capacity, the better they learned with background music. This is in line with the seductive detail assumption.

Perceived Academic Control and Academic Emotions Predict Undergraduate University Student Success: Examining Effects on Dropout Intention and Achievement.

The present study addressed concerns over the high risk of university students' academic failure. It examined how perceived academic control and academic emotions predict undergraduate students' academic success, conceptualized as both low dropout intention and high achievement (indicated by GPA). A cross-sectional survey was administered to 883 undergraduate students across all disciplines of a German STEM orientated university. The study additionally compared freshman students (N = 597) vs. second-year students (N = 286). Using structural equation modeling, for the overall sample of undergraduate students we found that perceived academic control positively predicted enjoyment and achievement, as well as negatively predicted boredom and anxiety. The prediction of dropout intention by perceived academic control was fully mediated via anxiety. When taking perceived academic control into account, we found no specific impact of enjoyment or boredom on the intention to dropout and no specific impact of all three academic emotions on achievement. The multi-group analysis showed, however, that perceived academic control, enjoyment, and boredom among second-year students had a direct relationship with dropout intention. A major contribution of the present study was demonstrating the important roles of perceived academic control and anxiety in undergraduate students' academic success. Concerning corresponding institutional support and future research, the results suggested distinguishing incoming from advanced undergraduate students.