Immersive virtual reality in STEM: is IVR an effective learning medium and does adding self-explanation after a lesson improve learning outcomes?

The goal of the current study was to investigate the effects of an immersive virtual reality (IVR) science simulation on learning in a higher educational setting, and to assess whether using self-explanation has benefits for knowledge gain. A sample of 79 undergraduate biology students (40 females, 37 males, 2 non-binary) learned about next-generation sequencing using an IVR simulation that lasted approximately 45 min. Students were randomly assigned to one of two instructional conditions: self-explanation (n = 41) or control (n = 38). The self-explanation group engaged in a 10 min written self-explanation task after the IVR biology lesson, while the control group rested. The results revealed that the IVR simulation led to a significant increase in knowledge from the pre- to post-test (ß Posterior = 3.29). There were no differences between the self-explanation and control groups on knowledge gain, procedural, or conceptual transfer. Finally, the results indicate that the self-explanation group reported significantly higher intrinsic cognitive load (ß Posterior = .35), and extraneous cognitive load (ß Posterior = .37), and significantly lower germane load (ß Posterior = - .38) than the control group. The results suggest that the IVR lesson was effective for learning, but adding a written self-explanation task did not increase learning after a long IVR lesson.

How cognitive psychology changed the face of medical education research.

In this article, the contributions of cognitive psychology to research and development of medical education are assessed. The cognitive psychology of learning consists of activation of prior knowledge while processing new information and elaboration on the resulting new knowledge to facilitate storing in long-term memory. This process is limited by the size of working memory. Six interventions based on cognitive theory that facilitate learning and expertise development are discussed: (1) Fostering self-explanation, (2) elaborative discussion, and (3) distributed practice; (4) help with decreasing cognitive load, (5) promoting retrieval practice, and (6) supporting interleaving practice. These interventions contribute in different measure to various instructional methods in use in medical education: problem-based learning, team-based learning, worked examples, mixed practice, serial-cue presentation, and deliberate reflection. The article concludes that systematic research into the applicability of these ideas to the practice of medical education presently is limited and should be intensified.

ABBABB or 1212: Abstract language facilitates children's early patterning skills.

Emerging research demonstrates a central role of early patterning skills in supporting cognitive development. This study focused on the labels used to describe patterns. Children (N = 90; Mage = 5.4 years) solved and explained 10 pattern abstraction tasks (i.e., recreated a model pattern using novel materials). Using a between-participants design, children were taught using one of four labels: letters (AAB, AAB), numbers (112, 112), quantitative grouping labels (two one, two one), or no labels (this part, this part). All three forms of abstract language were beneficial relative to no labels. Grouping labels, which conveyed information about quantity, also aided performance on posttest items. Children's speech and gesture provided further insights into how abstract language may support early patterning skills and attention to structure.

Peer instruction improves comprehension and transfer of physiological concepts: a randomized comparison with self-explanation.

Comprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer instruction (PI) is known to stimulate students' comprehension, but its relative efficacy and working mechanisms remain to be elucidated. In this study, we investigated if and how PI could optimize comprehension of physiological concepts and transfer relative to Self-explanation (SE) which is considered a lower-order type of overt learning. First-year medical students (n = 317) were randomly assigned to either PI or SE in a pre-post test design, followed by a set of near and far transfer questions. In both PI and SE groups post-test scores were significantly improved (p < 0.0001) with PI outperforming SE (+ 35% vs. + 23%, p = 0.006). Interestingly, a substantial number of students with initial incorrect answers even had enhanced scores after discussion with an incorrect peer. Both methods showed higher transfer scores than control (p = 0.006), with a tendency for higher near transfer scores for PI. These findings support PI as a valuable method to enhance comprehension of physiological concepts. Moreover, by comparing the effects of interactive PI with constructive SE we have established new insights that complement educational theories on overt learning activities.

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

BACKGROUND: Self-explanation without feedback has been shown to improve medical students' diagnostic reasoning. While feedback is generally seen as beneficial for learning, available evidence of the value of its combination with self-explanation is conflicting. This study investigated the effect on medical students' diagnostic performance of adding immediate or delayed content-feedback to self-explanation while solving cases. METHODS: Ninety-four 3rd-year students from a Canadian medical school were randomly assigned to three experimental conditions (immediate-feedback, delayed-feedback, control). In the learning phase, all students solved four clinical cases by giving i) the most likely diagnosis, ii) two main arguments supporting this diagnosis, and iii) two plausible alternative diagnoses, while using self-explanation. The immediate-feedback group was given the correct diagnosis after each case; delayed-feedback group received the correct diagnoses only after the four cases; control group received no feedback. One week later, all students solved four near-transfer (i.e., same final diagnosis as the learning cases but different scenarios) and four far-transfer cases (i.e., different final diagnosis from the learning cases and different scenarios) by answering the same three questions. Students' diagnostic accuracy (score for the response to the first question only) and diagnostic performance (combined score of responses to the three questions) scores were assessed in each phase. Four one-way ANOVAs were performed on each of the two scores for near and far-transfer cases. RESULTS: There was a significant effect of experimental condition on diagnostic accuracy on near-transfer cases (p < .05). The immediate-feedback and delayed-feedback groups performed equally well, both better than control (respectively, mean = 90.73, standard deviation =10.69; mean = 89.92, standard deviation = 13.85; mean = 82.03, standard deviation = 17.66). The experimental conditions did not significantly differ on far-transfer cases. CONCLUSIONS: Providing feedback to students in the form of the correct diagnosis after using self-explanation with clinical cases is potentially beneficial to improve their diagnostic accuracy but this effect is limited to similar cases. Further studies should explore how more elaborated feedback combined with self-explanation may impact students' diagnostic performance on different cases.

Children's explicit assessments of reliability influence their willingness to learn novel labels.

This study examined how explicitly evaluating another person's performance influences 3.5-year-old children's willingness to learn from that person. Children interacted with a speaker who presented a series of familiar objects and labeled them either accurately or inaccurately. After establishing reliability, the speaker taught nonsense labels for two additional familiar objects. Half of the children were asked to explicitly judge whether the speaker was reliable before the novel labels were presented; half were asked to do so at the end of the experiment. Children who were given an opportunity to verbally assess the speaker's accuracy prior to label learning were more likely than those evaluating afterward to avoid learning from the previously inaccurate labeler. These findings show that explicitly evaluating their knowledge can reduce children's willingness to learn words from an unreliable source, expanding on prior research showing influences of explicit evaluations on children's problem solving.

Examining the effect of self-explanation on cognitive integration of basic and clinical sciences in novices.

Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of self-explanation during learning has the potential to promote and support the development of integrated knowledge by encouraging novices to elaborate on the causal relationship between clinical features and basic science mechanisms. To explore the effect of this strategy, we compared diagnostic efficacy of teaching students (n = 71) the clinical features of four musculoskeletal pathologies using either (1) integrated causal basic science descriptions (BaSci group); (2) integrated causal basic science descriptions combined with self-explanation prompts (SE group); (3) basic science mechanisms segregated from the clinical features (SG group). All participants completed a diagnostic accuracy test immediately after learning and 1-week later. The results showed that the BaSci group performed significantly better compared to the SE (p = 0.019) and SG groups (p = 0.004); however, no difference was observed between the SE and SG groups (p = 0.91). We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic conceptual understanding of each disease. These findings suggest that integration strategies need to be carefully structured and applied in ways that support the holistic story created by integrated basic science instruction in order to foster conceptual coherence and to capitalize on the benefits of cognition integration.

The effect of self-explanation of pathophysiological mechanisms of diseases on medical students' diagnostic performance.

Self-explanation while diagnosing clinical cases fosters medical students' diagnostic performance. In previous studies on self-explanation, students were free to self-explain any aspect of the case, and mostly clinical knowledge was used. Elaboration on knowledge of pathophysiological mechanisms of diseases has been largely unexplored in studies of strategies for teaching clinical reasoning. The purpose of this two-phase experiment was to investigate the effect of self-explanation of pathophysiology during practice with clinical cases on students' diagnostic performance. In the training phase, 39 4th-year medical students were randomly assigned to solve 6 criterion cases (3 of jaundice; 3 of chest pain), either self-explaining the pathophysiological mechanisms of the findings (n = 20) or without self-explaining (n = 19). One-week later, in the assessment phase, all students solved 6 new cases of the same syndromes. A repeated-measures analysis of variance on the mean diagnostic accuracy scores showed no significant main effects of study phase (p = 0.34) and experimental condition (p = 0.10) and no interaction effect (p = 0.42). A post hoc analysis found a significant interaction (p = 0.022) between study phase and syndrome type. Despite equal familiarity with jaundice and chest pain, the performance of the self-explanation group (but not of the non-self-explanation group) on jaundice cases significantly improved between training and assessment phases (p = 0.035) whereas no differences between phases emerged on chest pain cases. Self-explanation of pathophysiology did not improve students' diagnostic performance for all diseases. Apparently, the positive effect of this form of self-explanation on performance depends on the studied diseases sharing similar pathophysiological mechanisms, such as in the jaundice cases.

Selective effects of explanation on learning during early childhood.

Two studies examined the specificity of effects of explanation on learning by prompting 3- to 6-year-old children to explain a mechanical toy and comparing what they learned about the toy's causal and non-causal properties with children who only observed the toy, both with and without accompanying verbalization. In Study 1, children were experimentally assigned to either explain or observe the mechanical toy. In Study 2, children were classified according to whether the content of their response to an undirected prompt involved explanation. Dependent measures included whether children understood the toy's functional-mechanical relationships, remembered perceptual features of the toy, effectively reconstructed the toy, and (for Study 2) generalized the function of the toy when constructing a new one. Results demonstrate that across age groups, explanation promotes causal learning and generalization but does not improve (and in younger children can even impair) memory for causally irrelevant perceptual details.

An alternative time for telling: when conceptual instruction prior to problem solving improves mathematical knowledge.

BACKGROUND: The sequencing of learning materials greatly influences the knowledge that learners construct. Recently, learning theorists have focused on the sequencing of instruction in relation to solving related problems. The general consensus suggests explicit instruction should be provided; however, when to provide instruction remains unclear. AIMS: We tested the impact of conceptual instruction preceding or following mathematics problem solving to determine when conceptual instruction should or should not be delayed. We also examined the learning processes supported to inform theories of learning more broadly. SAMPLE: We worked with 122 second- and third-grade children. METHOD: In a randomized experiment, children received instruction on the concept of math equivalence either before or after being asked to solve and explain challenging equivalence problems with feedback. RESULTS: Providing conceptual instruction first resulted in greater procedural knowledge and conceptual knowledge of equation structures than delaying instruction until after problem solving. Prior conceptual instruction enhanced problem solving by increasing the quality of explanations and attempted procedures. CONCLUSIONS: Providing conceptual instruction prior to problem solving was the more effective sequencing of activities than the reverse. We compare these results with previous, contrasting findings to outline a potential framework for understanding when instruction should or should not be delayed.

Learning by thinking in natural and artificial minds.

Canonical cases of learning involve novel observations external to the mind, but learning can also occur through mental processes such as explaining to oneself, mental simulation, analogical comparison, and reasoning. Recent advances in artificial intelligence (AI) reveal that such learning is not restricted to human minds: artificial minds can also self-correct and arrive at new conclusions by engaging in processes of 'learning by thinking' (LbT). How can elements already in the mind generate new knowledge? This article aims to resolve this paradox, and in so doing highlights an important feature of natural and artificial minds - to navigate uncertain environments with variable goals, minds with limited resources must construct knowledge representations 'on demand'. LbT supports this construction.

Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain.

OBJECTIVES: To improve diagnostic ability, educators should employ multifocal strategies. One promising strategy is self-explanation, the purposeful technique of generating self-directed explanations during problem-solving. Students self-explain information in ways that range from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. In a previous phase of research, unique ways that family nurse practitioner (NP) students self-explain during diagnostic reasoning were identified and described. This study aims to (a) explore relationships between ways of self-explaining and diagnostic accuracy levels and (b) compare differences between students of varying expertise in terms of ways of self-explaining and diagnostic accuracy levels. Identifying high-quality diagnostic reasoning self-explanation types may facilitate development of more refined self-explanation educational strategies. METHODS: Thirty-seven family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern university diagnosed three written case studies while self-explaining. During the quantitative phase of a content analysis, associational and comparative data analysis techniques were applied. RESULTS: Expert students voiced significantly more clinical and biological inference self-explanations than did novice students. Diagnostic accuracy scores were significantly associated with biological inference scores. Clinical and biological inference scores accounted for 27% of the variance in diagnostic accuracy scores, with biological inference scores significantly influencing diagnostic accuracy scores. CONCLUSIONS: Not only were biologically focused self-explanations associated with diagnostic accuracy, but also their spoken frequency influenced levels of diagnostic accuracy. Educational curricula should support students to view patient presentations in terms of underlying biology from the onset of their education.

Ways that nurse practitioner students self-explain during diagnostic reasoning.

OBJECTIVES: An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners' memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning? METHODS: Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis. RESULTS: Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students' understanding of clinical data and reflect shallow information processing. CONCLUSIONS: Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

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

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

Analyzing Self-Explanations in Mathematics: Gestures and Written Notes Do Matter.

When learners self-explain, they try to make sense of new information. Although research has shown that bodily actions and written notes are an important part of learning, previous analyses of self-explanations rarely take into account written and non-verbal data produced spontaneously. In this paper, the extent to which interpretations of self-explanations are influenced by the systematic consideration of such data is investigated. The video recordings of 33 undergraduate students, who learned with worked-out examples dealing with complex numbers, were categorized successively including three different data bases: (a) verbal data, (b) verbal and written data, and (c) verbal, written and non-verbal data. Results reveal that including written data (notes) and non-verbal data (gestures and actions) leads to a more accurate analysis of self-explanations than an analysis solely based on verbal data. This influence is even stronger for the categorization of self-explanations as adequate or inadequate.

Teaching clinical reasoning through hypothetico-deduction is (slightly) better than self-explanation in tutorial groups: An experimental study.

BACKGROUND: Self-explanation while individually diagnosing clinical cases has proved to be an effective instructional approach for teaching clinical reasoning. The present study compared the effects on diagnostic performance of self-explanation in small groups with the more commonly used hypothetico-deductive approach. METHODS: Second-year students from a six-year medical school in Saudi Arabia (39 males; 49 females) worked in small groups on seven clinical vignettes (four criterion cases representing cardiovascular diseases and three 'fillers', i.e. cases of other unrelated diagnoses). The students followed different approaches to work on each case depending on the experimental condition to which they had been randomly assigned. Under the self-explanation condition, students provided a diagnosis and a suitable pathophysiological explanation for the clinical findings whereas in the hypothetico-deduction condition students hypothesized about plausible diagnoses for signs and symptoms that were presented sequentially. One week later, all students diagnosed eight vignettes, four of which represented cardiovascular diseases. A mean diagnostic accuracy score (range: 0-1) was computed for the criterion cases. One-way ANOVA with experimental condition as between-subjects factor was performed on the mean diagnostic accuracy scores. RESULTS: Students in the hypothetico-deduction condition outperformed those in the self-explanation condition (mean = 0.22, standard deviation = 0.14, mean = 0.17; standard deviation = 0.12; F(1, 88) = 4.90, p = 0.03, partial η2 = 0.06, respectively). CONCLUSIONS: Students in the hypothetico-deduction condition performed slightly better on a follow-up test involving similar cases, possibly because they were allowed to formulate more than one hypothesis per case during the learning phase.

Concept Animation - a potential instructional scaffolding.

This article was migrated. The article was marked as recommended. Concept animation - the graphical array of pictures accompanied by text as speech balloons, can help to improve learner's comprehension from basic to advanced levels concepts. When the process of concept comprehension is not facilitated, the learner may come in a transitional state of misperception and understanding, that can restrain their learning to a surface approach. The basic science concepts learned at the inception of a Health Sciences program play a vital role towards the development of higher-order thinking and problem-solving aptitude in the subsequent years. Hence, it is important to facilitate meaningful learning of core concepts and principles in difficult basic science disciplines, like Pharmacology. This work reports our experiences of employing concept animations as a 'visual aid' instructional strategy to simplify pharmacology concepts to undergraduate Optometry students. The fundamental ideas of drug pharmacokinetics, pharmacodynamics and side effects were transformed into concept animations. The effects of these concept animations are explained by using Vygotsky's 'zone of proximal development, Mayer's cognitive theory of multimedia learning and cognitive load theory.

Eliciting explanations: Constraints on when self-explanation aids learning.

Generating explanations for oneself in an attempt to make sense of new information (i.e., self-explanation) is often a powerful learning technique. Despite its general effectiveness, in a growing number of studies, prompting for self-explanation improved some aspects of learning, but reduced learning of other aspects. Drawing on this recent research, as well as on research comparing self-explanation under different conditions, we propose four constraints on the effectiveness of self-explanation. First, self-explanation promotes attention to particular types of information, so it is better suited to promote particular learning outcomes in particular types of domains, such as transfer in domains guided by general principles or heuristics. Second, self-explaining a variety of types of information can improve learning, but explaining one's own solution methods or choices may reduce learning under certain conditions. Third, explanation prompts focus effort on particular aspects of the to-be-learned material, potentially drawing effort away from other important information. Explanation prompts must be carefully designed to align with target learning outcomes. Fourth, prompted self-explanation often promotes learning better than unguided studying, but alternative instructional techniques may be more effective under some conditions. Attention to these constraints should optimize the effectiveness of self-explanation as an instructional technique in future research and practice.

Why Sketching May Aid Learning From Science Texts: Contrasting Sketching With Written Explanations.

The goal of this study was to explore two accounts for why sketching during learning from text is helpful: (1) sketching acts like other constructive strategies such as self-explanation because it helps learners to identify relevant information and generate inferences; or (2) that in addition to these general effects, sketching has more specific benefits due to the pictorial representation that is constructed. Seventy-three seventh-graders (32 girls, M = 12.82 years) were first taught how to either create sketches or self-explain while studying science texts. During a subsequent learning phase, all students were asked to read an expository text about the greenhouse effect. Finally, they were asked to write down everything they remembered and then answer transfer questions. Strategy quality during learning was assessed as the number of key concepts that had either been sketched or mentioned in the self-explanations. The results showed that at an overall performance level there were only marginal group differences. However, a more in-depth analysis revealed that whereas no group differences emerged for students implementing either strategy poorly, the sketching group clearly outperformed the self-explanation group for students who applied the strategies with higher quality. Furthermore, higher sketching quality was strongly related to better learning outcomes. Thus, the study's results are more in line with the second account: Sketching can have a beneficial effect on learning above and beyond generating written explanations; at least, if well deployed.

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial.

OBJECTIVE: Appropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills. METHODS: First-year nursing students (N=36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example's correctness) and elaborated feedback (the true explanation). RESULTS: Participants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group. CONCLUSION: The worked example effect was successfully adapted for learning in the provider-patient communication domain. PRACTICE IMPLICATIONS: Implementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.