Influence of learning strategies and motivation on anatomy test performance of undergraduate medical students.

To learn and comprehend the large amount of information in gross anatomy, undergraduate students must self-regulate their learning to be properly prepared for the exams within the available time. Even though there are many studies on learning strategies and their influence on test results and motivation, the aim of this study is to investigate characteristics of learning strategies in detail and in relation to the anatomy course of first semester students and how their use is related to anatomy test performance. For assessing the learning strategies, we used the short version of the questionnaire "Learning Strategies of University Students" (LIST-K) (Klingsieck, 2018). Further, we investigated potential influences of motivation and resources used during the self-regulated learning process. The participants in this study (N = 108) filled in the above-mentioned questionnaire LIST-K and a written multiple-choice anatomy test. A k-means cluster analysis revealed three groups of students differing in their self-reported use of learning strategies. Students used either (1) predominantly metacognitive and resource-related strategies, (2) predominantly cognitive strategies, or (3) no specific learning strategies at all. We found no significant overall relationships between the use of learning strategies and test performance. A stepwise linear regression identified the use of cognitive learning strategies (ß =.269) as a significant predictor for test performance (R² =.149, p =.003), possibly as these specific learning strategies help with a systematic and effective approach while studying anatomy and retrieving large amount of memorized information. Further, motivation was identified as a negative predictor (ß = -.277), which might be a result of the short time periods students have to study for exams. Overall findings underline the importance of self-regulated learning as a positive predictor on academic performance. By understanding these factors, a more student-centered approach could be adopted by educators to improve medical education and equip students with valuable approaches for their continuous education, even beyond university.

A time slice analysis of dentistry students' visual search strategies and pupil dilation during diagnosing radiographs.

Diagnosing orthopantomograms (OPTs: panoramic radiographs) is an essential skill dentistry students acquire during university training. While prior research described experts' visual search behavior in radiology as global-to-focal for chest radiographs and mammography, generalizability to a hybrid search task in OPTs (i.e., searching for multiple, diverse anomalies) remains unclear. Addressing this gap, this study investigated visual search of N = 107 dentistry students while they were diagnosing anomalies in OPTs. Following a global-to-focal expert model, we hypothesized that students would use many, short fixations representing global search in earlier stages, and few, long fixations representing focal search in later stages. Furthermore, pupil dilation and mean fixation duration served as cognitive load measures. We hypothesized that later stages would be characterized by elaboration and a reflective search strategy, leading to higher cognitive load being associated with higher diagnostic performance in late compared to earlier stages. In line with the first hypothesis, students' visual search comprised of a three-stage process that grew increasingly focal in terms of the number of fixations and anomalies fixated. Contrary to the second hypothesis, mean fixation duration during anomaly fixations was positively associated with diagnostic performance across all stages. As OPTs greatly varied in how difficult it was to identify the anomalies contained therein, OPTs with above-average difficulty were sampled for exploratory analysis. Pupil dilation predicted diagnostic performance for difficult OPTs, possibly capturing elaborative cognitive processes and cognitive load compared to mean fixation duration. A visual analysis of fine-grained time slices indicated large cognitive load differences towards the end of trials, showcasing a richness-resolution-trade-off in data sampling crucial for future studies using time-slicing of eye tracking data.

How to foster STEM learning during Covid-19 remote schooling: Combining virtual and video experiments.

Understanding scientific concepts is a fundamental aim of science education. Conceptual understanding can be fostered through inquiry learning with experiments. However, during the Covid-19 pandemic school closures hands-on experiments could hardly be realized. Fortunately, digital technologies allow for conducting experiments virtually by using interactive simulations or observing video recordings of hands-on experiments. In the present study, 154 seventh graders in remote schooling were involved in inquiry learning using either a combination of virtual and video experiments in two different orders or only virtual experiments. We hypothesized that in general inquiry learning fosters students' conceptual understanding in physics, which could be confirmed. Moreover, we expected the combinations to be more effective than learning with virtual experiments only due to the complementary roles of the prior, which was, however, not the case. We conclude that virtual and video experiments can be recommended to teachers if hands-on experimentation is not possible.

High-quality digital distance teaching during COVID-19 school closures: Does familiarity with technology matter?

During the COVID-19-related school closures teachers and students were challenged to suddenly switch to digital teaching at a distance. In particular, the challenge was to organize high-quality teaching in which students stay on task. Familiarity with technology may have helped to master the situation. However, only few studies so far have examined the quality of digital distance teaching (e.g., cognitive activation) during school closures and its relation to students' learning (e.g., effort investment). Moreover, systematic research concerning the role of familiarity with technology-enhanced teaching and learning acquired during face-to-face teaching is yet lacking. In our study, we used data from 729 ninth graders to investigate how student-observed learning activities when using technology at a distance were related to students' effort in learning in two subjects (mathematics, German). In addition, we examined whether student-perceived cognitive activation mediated this relation. Finally, the sample provides the unique opportunity to examine the role of familiarity, as some of the classes had been randomly equipped with tablet computers one year before the school closures and thus had the opportunity to gain familiarity with using technology in the classroom. Results from structural equation models showed that student-observed learning activities were associated with students' learning effort in both subjects. Student-perceived cognitive activation mediated this association. Familiarity with face-to-face technology-enhanced teaching gained before the COVID-19 pandemic appeared to be less important for high-quality digital distance teaching. Thus, infrastructural measures, such as equipping schools with digital devices so that teachers and students can familiarize themselves with technology, do not seem to be decisive for high-quality digital (distance) teaching-at least in the case of short-term change from face-to-face to digital distance teaching, as was necessary during the COVID-19 pandemic.

Effects of tablet-based drawing and paper-based methods on medical students' learning of gross anatomy.

The way medical students learn anatomy is constantly evolving. Nowadays, technologies such as tablets support established learning methods like drawing. In this study, the effect of drawing on a tablet on medical students' anatomy learning was investigated compared to drawing or summarizing on paper. The quality of drawings or summaries was assessed as a measure of the quality of strategy implementation. Learning outcome was measured with an anatomy test, both immediately afterward and after 4-6 weeks to assess its sustainability. There were no significant group differences in learning outcome at both measurement points. For all groups, there was a significant medium strength correlation between the quality of the drawings or summaries and the learning outcome (p < 0.05). Further analysis revealed that the quality of strategy implementation moderated outcomes in the delayed test: When poorly implemented, drawing on a tablet (M = 48.81) was associated with lower learning outcome than drawing on paper (M = 58.95); The latter (M = 58.89) was related to higher learning outcome than writing summaries (M = 45.59). In case of high-quality strategy implementation, drawing on a tablet (M = 60.98) outperformed drawing on paper (M = 52.67), which in turn was outperformed by writing summaries (M = 62.62). To conclude, drawing on a tablet serves as a viable alternative to paper-based methods for learning anatomy if students can make adequate use of this strategy. Future research needs to identify how to support student drawing, for instance, by offering scaffolds with adaptive feedback to enhance learning.

How to support learning with multimedia instruction: Implementation intentions help even when load is high.

There is ample evidence that multimedia learning is challenging, and learners often underutilize appropriate cognitive processes. Previous research has applied prompts to promote the use of helpful cognitive processing. However, prompts still require learners to regulate their learning, which may interfere with learning, especially in situations where cognitive demands are already high. As an alternative, implementation intentions (i.e. if-then plans) are expected to help regulate behaviour automatically due to their specific wording, thereby offloading demands. Accordingly, this study aimed at investigating whether implementation intentions compared with prompts improve learning performance, especially under high cognitive load. Students (N = 120) learned either in a control condition without instructional support, with prompts, or with implementation intentions. Within each condition, half of the participants studied the multimedia instruction under conditions of either high or low cognitive load, which was experimentally manipulated by instructing them to perform one of two secondary tasks. In line with our hypotheses, the results showed that under low cognitive load, both prompts and implementation intentions led to better learning than the control condition. By contrast, under high cognitive load, only implementation intentions promoted learning. Thus, implementation intentions are an efficient means to promote learning even under challenging circumstances.

[Technology-enhanced learning and teaching: an overview]. / Lernen und Lehren mit digitalen Medien: Eine Standortbestimmung.

This article describes the current state of research on the use of digital media in educational contexts against the background of two research perspectives. The first research perspective, which has been established for some time, deals with technology-enhanced learning. It primarily examines learning processes and outcomes as a function of media characteristics and individual learner characteristics. This research tradition has produced numerous findings. However, the question of how to integrate digital media into the classroom in a way that is effective for learning is not considered here. This is where the second, more recent research perspective on technology-enhanced teaching comes in, which addresses teaching with digital media and the professional competencies of teachers required for this. Finally, the paper argues for combining both research perspectives, especially since they have relevant commonalities in their basic assumptions. Thus, in both research perspectives, digital media are analyzed less on the basis of surface features, but rather in terms of their functions for the promotion of learning and teaching processes.

Does increasing social presence enhance the effectiveness of writing explanations?

Writing explanations has demonstrated to be less effective than providing oral explanations, as writing triggers less amounts of perceived social presence during explaining. In this study, we investigated whether increasing social presence during writing explanations would aid learning. University students (N = 137) read an instructional text about immunology; their subsequent task depended on experimental condition. Students either explained the contents to a fictitious peer orally, wrote their explanations in a text editor, or wrote them in a messenger chat, which was assumed to induce higher levels of social presence. A control group retrieved the material. Surprisingly, we did not obtain any differences in learning outcomes between experimental conditions. Interestingly, explaining was more effortful, enjoyable, and interesting than retrieving. This study shows that solely inducing social presence does not improve learning from writing explanations. More importantly, the findings underscore the importance of cognitive and motivational conditions during learning activities.

[Concerns of teachers during school closings: analyzing communication in the twitter-lehrerzimmer regarding opportunities and challenges of digital teaching]. / Was bewegt Lehrpersonen während der Schulschließungen? ­ Eine Analyse der Kommunikation im Twitter-Lehrerzimmer über Chancen und Herausforderungen digitalen Unterrichts.

Many schools introduced distance learning as a result of the school closings due to the Corona pandemic in March 2020. Such instruction was often organized digitally without much prior preparation. As a result, an increased exchange between teachers in online communities was to be expected. Analyzing the communication of the online community Twitter-Lehrerzimmer provided insight into topics and allowed to compare topics that were discussed before and during school closings. To identify topics, we applied computational linguistic analysis methods on 128,422 tweets and qualitative content analysis of 270 tweets. The results indicated that topics such as (a)synchronous digital teaching had already been discussed previously but was addressed more often and in more breadth during school closings. The Twitter-Lehrerzimmer was used for mutual support and exchange on urgent challenges such as the availability of high-quality software (compliant with data protection). The results reveal deficits in the German digitalization process from the perspective of teachers using Twitter and show the potential of online communities for information exchange and networking.

The intention was good: How promoting strategy use does not improve multimedia learning for secondary students.

BACKGROUND: It is well established that successful learning with multimedia is challenging, especially for younger learners. AIMS: It was investigated whether students would profit from instructional support regarding the use of multimedia learning strategies. SAMPLE: Participants were high school students in 8th , 9th , and 10th grade (N = 168). METHODS: Participants were assigned to a no-support control group or one of four experimental groups. In the experimental groups, students received either only a multimedia strategy training before learning (training group) or the training was enriched by prompts (prompts before or during learning) or if-then plans (implementation intentions). In the training, multimedia learning strategies were introduced (e.g., linking information from text and picture). The prompts and implementation intentions were aimed at enhancing the application of the multimedia strategies conveyed through the training. Students learned about the process of mitosis by studying multimedia instructions and were tested regarding the acquired knowledge. It was expected that solely training students to use adequate multimedia learning strategies would not promote learning compared with the control group, rather, that additional support like prompts or implementation intentions would be necessary to enhance learning. RESULTS: Although in the experimental groups, multimedia learning strategies were used more frequently especially in the beginning of the instructional unit, there were no effects on learning outcome. CONCLUSIONS: Promoting multimedia strategy use did not improve learning. The quality of the different instructional support measures and their suitability for the target groups are discussed as possible explanations for these findings.

Development of Attention and Accuracy in Learning a Categorization Task.

Being able to categorize objects as similar or different is an essential skill. An important aspect of learning to categorize is learning to attend to relevant features (i.e., features that determine category membership) and ignore irrelevant features of the to-be-categorized objects. Feature variability across objects of different categories is informative, because it allows inferring the rules underlying category membership. In this study, participants learned to categorize fictitious creatures (i.e., aliens). We measured attention to the aliens during learning using eye-tracking and calculated the attentional focus as the ratio of attention to relevant versus irrelevant features. As expected, participants' categorization accuracy improved with practice; however, in contrast to our expectations, their attentional focus did not improve with practice. When computing the attentional focus, attention to the aliens' eyes was disregarded, because while eyes attract a lot of attention, they did not vary across aliens (non-informative feature). Yet, an explorative analysis of attention to eyes suggested that participants' attentional focus did become somewhat more efficient in that over time they learned to ignore the eyes. Results are discussed in the context of the need for instructional methods to improve attentional focus in learning to categorize.

How to support dental students in reading radiographs: effects of a gaze-based compare-and-contrast intervention.

In dental medicine, interpreting radiographs (i.e., orthopantomograms, OPTs) is an error-prone process, even in experts. Effective intervention methods are therefore needed to support students in improving their image reading skills for OPTs. To this end, we developed a compare-and-contrast intervention, which aimed at supporting students in achieving full coverage when visually inspecting OPTs and, consequently, obtaining a better diagnostic performance. The comparison entailed a static eye movement visualization (heat map) on an OPT showing full gaze coverage from a peer-model (other student) and another heat map showing a student's own gaze behavior. The intervention group (N = 38) compared five such heat map combinations, whereas the control group (N = 23) diagnosed five OPTs. Prior to the experimental variation (pre-test) and after it (post-test), students in both conditions searched for anomalies in OPTs while their gaze was recorded. Results showed that students in the intervention group covered more areas of the OPTs and looked less often and for a shorter amount of time at anomalies after the intervention. Furthermore, they fixated on low-prevalence anomalies earlier and high-prevalence anomalies later during the inspection. However, the students in the intervention group did not show any meaningful improvement in detection rate and made more false positive errors compared to the control group. Thus, the intervention guided visual attention but did not improve diagnostic performance substantially. Exploratory analyses indicated that further interventions should teach knowledge about anomalies rather than focusing on full coverage of radiographs.

How massed practice improves visual expertise in reading panoramic radiographs in dental students: An eye tracking study.

The interpretation of medical images is an error-prone process that may yield severe consequences for patients. In dental medicine panoramic radiography (OPT) is a frequently used diagnostic procedure. OPTs typically contain multiple, diverse anomalies within one image making the diagnostic process very demanding, rendering students' development of visual expertise a complex task. Radiograph interpretation is typically taught through massed practice; however, it is not known how effective this approach is nor how it changes students' visual inspection of radiographs. Therefore, this study investigated how massed practice-an instructional method that entails massed learning of one type of material-affects processing of OPTs and the development of diagnostic performance. From 2017 to 2018, 47 dental students in their first clinical semester diagnosed 10 OPTs before and after their regular massed practice training, which is embedded in their curriculum. The OPTs contained between 3 to 26 to-be-identified anomalies. During massed practice they diagnosed 100 dental radiographs without receiving corrective feedback. The authors recorded students' eye movements and assessed the number of correctly identified and falsely marked low- and high prevalence anomalies before and after massed practice. Massed practice had a positive effect on detecting anomalies especially with low prevalence (p < .001). After massed practice students covered a larger proportion of the OPTs (p < .001), which was positively related to the detection of low-prevalence anomalies (p = .04). Students also focused longer, more frequently, and earlier on low-prevalence anomalies after massed practice (ps < .001). While massed practice improved visual expertise in dental students with limited prior knowledge, there is still substantial room for improvement. The results suggest integrating massed practice with more deliberate practice, where, for example, corrective feedback is provided, and support is adapted to students' needs.

Correction: Pupil diameter differentiates expertise in dental radiography visual search.

[This corrects the article DOI: 10.1371/journal.pone.0223941.].

Pupil diameter differentiates expertise in dental radiography visual search.

Expert behavior is characterized by rapid information processing abilities, dependent on more structured schemata in long-term memory designated for their domain-specific tasks. From this understanding, expertise can effectively reduce cognitive load on a domain-specific task. However, certain tasks could still evoke different gradations of load even for an expert, e.g., when having to detect subtle anomalies in dental radiographs. Our aim was to measure pupil diameter response to anomalies of varying levels of difficulty in expert and student dentists' visual examination of panoramic radiographs. We found that students' pupil diameter dilated significantly from baseline compared to experts, but anomaly difficulty had no effect on pupillary response. In contrast, experts' pupil diameter responded to varying levels of anomaly difficulty, where more difficult anomalies evoked greater pupil dilation from baseline. Experts thus showed proportional pupillary response indicative of increasing cognitive load with increasingly difficult anomalies, whereas students showed pupillary response indicative of higher cognitive load for all anomalies when compared to experts.

Implementation Intentions Related to Self-Regulatory Processes Do Not Enhance Learning in a Multimedia Environment.

Learners face various obstacles during learning from illustrated texts that can be conceptualized against the backdrop of frameworks of self-regulated learning. According to these frameworks, for learning to be successful, students must use appropriate cognitive strategies, hold adequate self-efficacy beliefs, and invest sufficient effort in learning. We investigated whether implementation intentions (if-then-plans) relating to these self-regulatory processes improve learning in a multimedia environment and whether they differ in their effectiveness depending on the self-regulatory process that they address. Learners were either asked to internalize an implementation intention relating to cognitive strategies, self-efficacy beliefs, or effort, or they did not receive any instructional support (control condition). Then, they learned about a mechanical system from a multimedia message and finally were tested on the learned contents. Contrary to expectations, none of the implementation intentions increased learning outcome, compared with the control condition, nor did the conditions differ from each other. However, implementation intentions interacted with the self-efficacy beliefs that learners already held. Higher self-efficacy beliefs were associated with better learning outcome, unless learners received an implementation intention telling them to use a multimedia-specific cognitive strategy. Interfering cognitive processes are discussed as a possible explanation for this interaction. In summary, implementation intentions should be further investigated and optimized before they can be implemented in real-life learning contexts.

Influences of basic numerical abilities on graph reading performance.

Understanding graphically presented information is an important aspect of modern mathematical and science literacy. In our study, we investigated the influence of basic numerical abilities on students' ability answer mathematical tasks with information presented in graphs. We analyzed data of 750 German students (grades 9-11) and evaluated the determinants of graph reading performance with multiple regression analysis using predictors of basic numerical abilities (such as number line estimation, basic arithmetic operations, etc.), considering also the influences of general cognitive ability, age, and gender. We found that number line estimation, subtraction, and conceptual knowledge were significant predictors of graph reading performance beyond the influences of general cognitive ability. This indicates that basic numerical abilities are still relevant for real-life problem solving in secondary school. We discuss possible mechanisms which directly (through respective arithmetic procedures) as well as indirectly (through mathematization of the problem) effectuate that basic numerical abilities graph reading performance.

Weak Associations of Morningness-Eveningness and Stability with Skin Temperature and Cortisol Levels.

Differences in daytime preferences can be described on the dimension of morningness-eveningness (continuous) or circadian typology (categorical) and are associated with our physiological functioning, which is reflected in body temperature and cortisol levels in the morning. The purpose of the present study was to explore the relationship between morningness-eveningness, stability and physiological markers (body temperature and cortisol) based on a three-dimensional conceptualization of morningness-eveningness using the Morningness-Eveningness-Stability Scale improved (MESSi). In contrast to previously used unidimensional measures, the MESSi determines circadian typology and its amplitude in three dimensions: Morning affect (MA), Eveningness (EV) and Stability/Distinctness (DI). Furthermore, the differences of the cortisol levels between weekday and weekend were examined. The sample (N = 42) consisted of extreme chronotypes (age 18-54 years; M = 24.8 years, SD = 5.83; 22 morning types [5 men and 17 women] and 20 evening types [8 men and 12 women]). The participants were asked to measure their skin temperature for one week and sample four saliva probes for cortisol determination. Morning types showed a better fit in the actual temperature data to the approximating data as compared to Evening types and showed a higher overall temperature. The Stability/Distinctness (DI) component of the MESSi was negatively correlated with the nadir. Morning types also showed higher cortisol levels than Evening types immediately after awakening. The cortisol levels were higher on a weekday compared to the weekend. To conclude, the present findings demonstrate that the skin temperature is weakly associated with morningness-eveningness and the stability of the circadian phase.