Exploring the dynamics of situational interest in team-based learning in undergraduate medical education.

BACKGROUND: Team-based learning (TBL) is a widely recognized instructional approach in medical education blending direct instruction with active-cooperative learning in small groups. While TBL is known to enhance knowledge acquisition, its impact on student motivation, particularly through situational interest, remains underexplored. This study aimed to investigate the development of situational interest across the distinct phases of TBL, focusing on how each phase (individual readiness assurance test; iRAT, team readiness assurance test; tRAT, and application exercise; AE) influences students' situational interest. The study sought to provide insights into the motivational dynamics underpinning TBL in a medical education setting. METHODS: A total of 88 medical students participated in a TBL session on "Bleeding during Pregnancy." Situational interest was measured after each TBL phase. A one-way repeated-measures analysis of variance (ANOVA) was conducted to assess the fluctuation of situational interest throughout the session. RESULTS: The analysis revealed significant variations in situational interest across different TBL stages. There was a significant increase in situational interest following the tRAT (p = .001). Post-tRAT, situational interest significantly decreased after the AE (p = .007), returning to levels observed at the session's start. Post hoc correlation analysis suggested a negative association between tRAT performance and situational interest, indicating heightened interest in response to awareness of knowledge gaps during the tRAT. CONCLUSIONS: The findings of this study may challenge the traditional view of TBL, suggesting a more integrated and dynamic interplay between knowledge acquisition and application phases. The results highlight the importance of the AE phase in clinical education and suggest that situational interest is one key driver in the learning process within TBL. Future research should focus on replicating these findings and comparing situational interest development between pre-clinical and clinical student cohorts to further understand the effects of situational interest on TBL in medical education.

Team-based learning (TBL) in clinical disciplines for undergraduate medical students-a scoping review.

BACKGROUND: Team-based learning (TBL) is an evidence-based pedagogical method that has been used in undergraduate medical education since 2001. However, its use in clinical disciplines is rarely reported, and the impact of its implementation is not known. The aim of this study was to explore and map the published literature on the impact of implementing TBL in clinical disciplines in undergraduate medical education. METHODS: A comprehensive search of Medline, Education Resources Information Center (ERIC), and Web of Science databases was performed on November 24, 2021 and updated April 6, 2023, using relevant Medical Subject Headings (MeSH) and free-text terms. Original research studies reporting on the implementation of TBL in clinical disciplines in undergraduate medical education published in peer-reviewed English language journals were included irrespective of their methodological design. RESULTS: The initial search identified 2,383 records. Of these, 49 met the inclusion criteria. Most of the studies (n = 44, 90%) described the implementation of a modified version of TBL in which one or more TBL steps were missing, and one study had undefined protocol for the implementation. The most reported outcomes were knowledge acquisition (n = 38, 78%) and students' satisfaction or attitudes toward TBL (n = 34, 69%). Despite some differences in their results, the studies found that implementing TBL is associated with increased knowledge acquisition (n = 19, 39%), student engagement (n = 6, 12%), and student satisfaction (n = 31, 63%). CONCLUSIONS: Most of the studies reported positive results in students' satisfaction and students' engagement, whilst the results on knowledge acquisition and retention were more contradictory. In most of the studies, TBL was implemented in a modified form and diverse comparators were used. The methodological quality also varied. Thus, no unequivocal conclusions could be drawn regarding the value of implementing TBL in clinical disciplines. More studies with rigorous methodologies are needed in this field.

Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments.

BACKGROUND: Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis. METHODS: Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes. RESULTS: In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant. CONCLUSIONS: These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.

Dyadic explanations during preparatory self-study enhance learning: A randomised controlled study.

OBJECTIVES: The objective of the present study was to investigate to which extent preparatory self-study can be improved by encouraging students to engage in individual self-explanations or dyadic explanations (ie in pairs). Individual self-explanations refer to an act of metacognition in which students, after having processed a certain amount of information, attempt to explain their understanding to themselves of what was just learned. Dyadic explanations refer to the same process, but instead of explaining to oneself, the student explains his/her understanding to another student. METHOD: An experiment was conducted in which 120 medical students studied a video-recorded lecture on the role of protein synthesis inhibition on memory reconsolidation. Participants were randomly allocated to one of four conditions: (1) a control condition in which they listened to the lecture once; (2) a control condition in which they listened to the lecture twice; (3) an experimental condition in which they had to listen to the lecture and provide self-explanations individually; and (4) an experimental condition in which they had to listen to the lecture and provide dyadic explanations. Participants' knowledge regarding the topic was measured three times: at the start and end of the experiment, and one week after the experiment to determine knowledge retention. Data were analysed by means of a 2 × 2 and 4 × 3 repeated-measures ANOVA. RESULTS: The results suggest that participants who engaged in individual self- or dyadic explanations significantly outperformed participants in the two control conditions in terms of learning and retention (F = 5.67, Wilks Λ = 0.94, P = .019, η2  = 0.05). Moreover, the results suggest that dyadic explanations were more effective than individual self-explanations (F = 3.70, Wilks Λ = 0.83, P = .002, η2  = 0.09). CONCLUSIONS: These outcomes suggest that encouraging students to work in pairs or in small teams to prepare for a learning event results in superior preparation and learning.

Promotion of knowledge transfer and retention in year 2 medical students using an online training exercise.

It was recently shown that novice medical students could be trained to demonstrate the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. However, the effectiveness of this training can only be fully evaluated when considering the extent to which knowledge transfer and long-term retention occur as a result, the former of which is known to be notoriously difficult to achieve. This study aimed to investigate whether knowledge learned during an online training exercise for chest X-ray diagnosis promoted either knowledge transfer or retention, or both. Second year medical students were presented with, and trained to recognise the features of four chest X-ray conditions. Subsequently, they were shown the four trained-for cases again as well as different representations of the same conditions varying in the number of common elements and asked to provide a diagnosis, to test for near-transfer (four cases) and far-transfer (four cases) of knowledge. They were also shown four completely new conditions to diagnose. Two weeks later they were asked to diagnose the 16 aforementioned cases again to assess for knowledge retention. Dependent variables were diagnostic accuracy and time-to-diagnosis. Thirty-six students volunteered. Trained-for cases were diagnosed most accurately and with most speed (mean score = 3.75/4, mean time = 4.95 s). When assessing knowledge transfer, participants were able to diagnose near-transfer cases more accurately (mean score = 2.08/4, mean time = 15.77 s) than far-transfer cases (mean score = 1.31/4, mean time = 18.80 s), which showed similar results to those conditions previously unseen (mean score = 0.72/4, mean time = 19.46 s). Retention tests showed a similar pattern but accuracy scores were lower overall. This study demonstrates that it is possible to successfully promote knowledge transfer and retention in Year 2 medical students, using an online training exercise involving diagnosis of chest X-rays, and is one of the few studies to provide evidence of actual knowledge transfer.

Virtual Clinical Encounter Examination (VICEE): A novel approach for assessing medical students' non-psychomotor clinical competency.

INTRODUCTION: The Corona Virus Disease-19 (COVID-19) pandemic disrupted medical education across the world. Online teaching has grown rapidly under lockdown. Yet the online approach for assessment presents a number of challenges, particularly when evaluating clinical competencies. The aim of this study was to investigate the feasibility, acceptability, reliability and validity of an online Virtual Clinical Encounter Examination (VICEE) to assess non-psychomotor competencies (non-procedure or manual skills) of medical students. METHOD: Sixty-one final year medical students took the VICEE as part of the final summative examination. A panel of faculty experts developed the exam cases and competencies. They administered the test online via real-time interaction with artificial intelligence (AI) based virtual patients, along with faculty and IT support. RESULTS: Student and faculty surveys demonstrated satisfaction with the experience. Confirmatory factor analysis supported convergent validity of VICEE with Direct Observation Clinical Encounter Examination (DOCEE), a previously validated clinical examination. The observed sensitivity was 81.8%, specificity 64.1% and likelihood ratio 12.6, supporting the ability of VICEE to diagnose 'clinical incompetence' among students. CONCLUSION: Our results suggest that online AI-based virtual patient high fidelity simulation may be used as an alternative tool to assess some aspects of non-psychometric competencies.

Evidence supporting dual-process theory of medical diagnosis: a functional near-infrared spectroscopy study.

PURPOSE: The objective of this study was to determine the extent to which the dual-process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored whether neurological correlates of system-2 thinking could be located in the brain. It was hypothesised that system-2 thinking could be observed as the activation of the prefrontal cortex. METHOD: An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest X-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants' prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. RESULTS: The results revealed that participants' diagnostic accuracy in the test phase was significantly higher for the trained cases as compared with the untrained cases (F[1, 21] = 138.80, p < 0.001, η2  = 0.87). Also, their response time was significantly shorter for these cases (F[1, 21] = 18.12, p < 0.001, η2  = 0.46). Finally, the results revealed that only for the untrained cases, could a significant activation of the anterolateral prefrontal cortex be observed (F[1, 21] = 21.00, p < 0.01, η2  = 0.34). CONCLUSION: The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of the dual-process theory are discussed.

Effects of graded versus ungraded individual readiness assurance scores in team-based learning: a quasi-experimental study.

Pre-class preparation is a crucial component of team-based learning (TBL). Lack of preparation hinders both individual learning and team performance during TBL. The purpose of the present study was to explore how the grading of the individual readiness assurance test (iRAT) can affect pre-class preparation, iRAT performance and performance in the end-of-year examination. Using a quasi-experimental design, Year 1 and 2 students' download frequency for their pre-class materials, performance on iRAT and examination were examined under two conditions; (1) under which the iRAT was graded and (2) under which the iRAT was ungraded. Medical students (N = 220) from three cohorts were included in the study. Differences between both conditions were tested by means of six separate ANCOVAs, using medical school entry test scores as the covariate to account for potential cohort effects. Results revealed that students were downloading more pre-class materials prior to their TBL sessions, and were performed significantly better on iRAT when their performance was graded, even after controlling for cohort effects. Analysis of covariance demonstrated that performance on iRAT also appeared to affect performance on their examination scores. The results of the study suggest that grading has a positive effect on students' iRAT scores. Implications for TBL are discussed.

Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.

BACKGROUND: The use of digital education in problem-based learning, or digital problem-based learning (DPBL), is increasingly employed in health professions education. DPBL includes purely digitally delivered as well as blended problem-based learning, wherein digital and face-to-face learning are combined. OBJECTIVE: The aim of this review is to evaluate the effectiveness of DPBL in improving health professionals' knowledge, skills, attitudes, and satisfaction. METHODS: We used the gold-standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). We included studies that compared the effectiveness of DPBL with traditional learning methods or other forms of digital education in improving health professionals' knowledge, skills, attitudes, and satisfaction. Two authors independently screened studies, extracted data, and assessed the risk of bias. We contacted study authors for additional information, if necessary. We used the random-effects model in the meta-analyses. RESULTS: Nine RCTs involving 890 preregistration health professionals were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was delivered fully online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysis of seven studies comparing the effect of DPBL and traditional PBL reported little or no difference in postintervention knowledge outcomes (standardized mean difference [SMD] 0.19, 95% CI 0.00-0.38). The pooled analysis of three studies comparing the effect of DPBL to traditional learning on postintervention knowledge outcomes favored DPBL (SMD 0.67, 95% CI 0.14-1.19). For skill development, the pooled analysis of two studies comparing DPBL to traditional PBL favored DPBL (SMD 0.30, 95% CI 0.07-0.54). Findings on attitudes and satisfaction outcomes were mixed. The included studies mostly had an unclear risk of bias. CONCLUSIONS: Our findings suggest that DPBL is as effective as traditional PBL and more effective than traditional learning in improving knowledge. DPBL may be more effective than traditional learning or traditional PBL in improving skills. Further studies should evaluate the use of digital technology for the delivery of other PBL components as well as PBL overall.

Factors underlying suboptimal diagnostic performance in physicians under time pressure.

CONTEXT: Time pressure has been implicated in the suboptimal diagnostic performance of doctors and in increases in diagnostic errors. However, the reasons underlying these effects are not clear. The aim of this study was to investigate the influence of time pressure on physicians' diagnostic accuracy and to explore the mediating effects of perceived stress (emotional pathway) and number of plausible diagnostic hypotheses (cognitive pathway) on the proposed relationship. METHODS: We conducted a randomised controlled experiment. A total of 75 senior internal medicine residents completed eight written clinical cases under conditions with (n = 40) or without (n = 35) time pressure. They were then asked to: (i) rate the overall stress experienced, and (ii) write down any alternative hypotheses they had thought of when diagnosing the cases. In a post hoc analysis, a mediation path analysis was performed to test the causal relationships between time pressure, perceived stress and number of alternative diagnoses. RESULTS: Participants who were under time pressure spent less time diagnosing the cases (85.54 seconds versus 181.81 seconds; p< 0.001) and had a lower mean diagnostic accuracy score (0.44 versus 0.53; p = 0.01). In addition, they reported more stress (5.80 versus 4.69; p = 0.01) and generated fewer plausible tentative hypotheses (0.37 versus 0.51; p = 0.01). Two path coefficients were found to be statistically significant; the first path coefficient referred to the relationship between time pressure and perceived stress (standardised ß = 0.25, p = 0.029), and the second negative path coefficient referred to the relationship between time pressure and number of plausible alternative hypotheses (standardised ß = -0.32, p< 0.01). CONCLUSIONS: Time pressure adversely influences physicians' diagnostic accuracy by increasing their stress response and reducing the number of plausible hypotheses as mediators.

How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement.

The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (ß = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.

Implementation of team-based learning on a large scale: Three factors to keep in mind.

Team-based learning (TBL) is a structured form of small group learning that can be scaled up for delivery in large classes. The principles of successful TBL implementation are well established. TBL has become widely practiced in medical schools, but its use is typically limited to certain courses or parts of courses. Implementing TBL on a large scale, across different courses and disciplines, is the next logical step. The Lee Kong Chian School of Medicine (LKCMedicine), a partnership between Nanyang Technological University, Singapore and Imperial College London, admitted its first students in 2013. This new undergraduate medical program, developed collaboratively by faculty at both institutions, uses TBL as its main learning and teaching strategy, replacing all face-to-face lectures. TBL accounts for over 60% of the curriculum in the first two years, and there is continued learning through TBL during campus teaching in the remaining years. This paper describes our experience of rolling out TBL across all years of the medical curriculum, focusing on three success factors: (1) "team-centric" learning spaces, to foster active, collaborative learning; (2) an e-learning ecosystem, seamlessly integrated to support all phases of the TBL process and (3) teaching teams in which experts in pedagogical process (TBL Facilitators) co-teach with experts in subject matter (Content Experts).

Inducing System-1-type diagnostic reasoning in second-year medical students within 15 minutes.

Purpose: Diagnostic reasoning literature debates the significance of "dual-process theory" and the importance of its constituent types of thinking: System-1and System-2. This experimental study aimed to determine whether novice medical students could be trained to utilize System-1 thinking when making diagnoses based on chest X-rays. Method: Second-year medical students were recruited and presented with a series of eight online chest X-rays cases. Participants were shown half of the cases repeatedly during a training phase and the other half only twice. During the final test phase, they were shown all eight cases, providing a diagnosis as a free text answer. Dependent variables were diagnostic accuracy and response time. Results: Thirty-two students participated. During the test phase, students responses were significantly more accurate and faster for cases which had been seen repeatedly during the training phase (mean score = 3.56/4, mean time = 2.34 s) compared with cases which had been seen only twice (mean score = 1.59/4, mean time = 7.50 s). Conclusion: This study demonstrates that it is possible to induce in novice students the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. The full experimental design and the chest X-rays used may provide new opportunities to explore some of the issues surrounding dual-process theory.

The themes, institutions, and people of medical education research 1988-2010: content analysis of abstracts from six journals.

The present study aimed at providing an overview of the most common themes of research into medical education. Changes in frequency of occurrence of these themes over time and differences between US and European journals were studied. The most productive institutions and researchers in the field were examined. A content analysis was carried out on 10,168 abstracts extracted from the six most influential journals in medical education published since 1988. Twenty-nine major themes were identified, of which student assessment, clinical and communication skills, clinical clerkships, and problem-based learning were the most prominent ones. Some of these themes, such as multiple-choice examinations or computer-assisted instruction seemed to have had their day, whereas other topics, such as the study of clinical clerkships, clinical reasoning, and scholarship in education were on their way up. Medical education research turned out to be a thoroughly international affair to which both US and European research centers contribute. The medical education literature shows an overwhelming emphasis on the preparation of medical students for professional practice. Moreover, the emphasis is very much on the individual student; most research seems to have been conducted with a psychological perspective in mind. It is argued that medical education research would profit from broadening its scope, including sociological, economical, ecological, and system perspectives. These perspectives might bring answers to new questions relevant to the quality of medical education. It is suggested that medical education is in need of moving beyond the conventional effectiveness-driven research approach to a more theory- and discovery-driven approach.

Effective Learning in Virtual Conferences: The Application of Five Principles of Learning.

In this article, we examine the adaptation of learning among scientists and healthcare professionals in conferences and symposia from face-to-face to fully virtual meetings accelerated in the last years. Advantages and limitations for both settings have been described in different research studies but the effectiveness of learning can be reflected similarly by applying five fundamental principles of learning, which are based on empirical research in cognitive psychology. From a practical context, we compared the individual learning outcomes from two satellite symposia conducted face-to-face in 2019 and virtually in 2021 at the European Congress of Urology, EAU. Although both conference formats were almost identical, the five principles of learning were applied in both symposia. There were also some differences due to adaptation to online conferences, and our findings suggest that the virtual conference was perceived as significantly more effective than the face-to-face conference on all five criteria, and digital learning is a valid alternative to face-to-face conferences. What still needs to be better understood and analysed is the informal learning that is taking place during conferences, but suggesting an active design of any digital event by combining "technical literacy· with "learning literacy" will enable us to better analyse and study the impact of learning using the five learning principles in the design of other events in the future.

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools.

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser-Meyer-Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of x 2 (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.

The process of problem-based learning: what works and why.

OBJECTIVES: In this review, we portray the process of problem-based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation-elaboration hypothesis and a situational interest hypothesis. METHODS: Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new 'micro-analytical' methodology was used to trace the process of PBL in the natural classroom setting. CONCLUSIONS: We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small-group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long-term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to 'hard' scaffolding represented by, for instance, worksheets or questions added to problems. Small-group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self-study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.

Cognitive engagement in the problem-based learning classroom.

The objective of the present study was to examine to what extent autonomy in problem-based learning (PBL) results in cognitive engagement with the topic at hand. To that end, a short self-report instrument was devised and validated. Moreover, it was examined how cognitive engagement develops as a function of the learning process and the extent to which cognitive engagement determines subsequent levels of cognitive engagement during a one-day PBL event. Data were analyzed by means of confirmatory factor analysis, repeated measures ANOVA, and path analysis. The results showed that the new measure of situational cognitive engagement is valid and reliable. Furthermore, the results revealed that students' cognitive engagement significantly increased as a function of the learning event. Implications of these findings for PBL are discussed.