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

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Abstract

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.

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References

  • AAMC-HHMI. (2009). Report of Scientific Foundations for Future Physicians Committee (p. 43). Washington, DC. Retrieved from http://www.hhmi.org/news/aamc-hhmi-committee-defines-scientific-competencies-future-physicians.

  • Baghdady, M. T., Carnahan, H., Lam, E. W. N., & Woods, N. N. (2013). Integration of basic sciences and clinical sciences in oral radiology education for dental students. Journal of Dental Education, 77(6), 757–763.

    Google Scholar 

  • Baghdady, M. T., Carnahan, H., Lam, E. W. N., & Woods, N. N. (2014). Dental and dental hygiene students’ diagnostic accuracy in oral radiology: Effect of diagnostic strategy and instructional method. Journal of Dental Education, 78(9), 1279–1285.

    Google Scholar 

  • Berthold, K., Eysink, T. H. S., & Renkl, A. (2009). Assisting self-explanation prompts are more effective than open prompts when learning with multiple representations. Instructional Science, 37(4), 345–363.

    Article  Google Scholar 

  • Berthold, K., Röder, H., Knözer, D., Kessler, W., & Renkl, A. (2011). The double-edged effects of explanation prompts. Computers in Human Behavior, 27(1), 69–75.

    Article  Google Scholar 

  • Bielaczyc, K., Pirolli, P. L., & Brown, A. L. (1995). Training in self-explanation and self-regulation strategies: Investigating the effects of knowledge acquisition activities on problem solving. Cognition and Instruction, 13(2), 221–252.

    Article  Google Scholar 

  • Brauer, D. G., & Ferguson, K. J. (2015). The integrated curriculum in medical education: AMEE Guide No. 96. Medical Teacher, 37(4), 312–322.

    Article  Google Scholar 

  • Chamberland, M., Mamede, S., St-Onge, C., Rivard, M.-A., Setrakian, J., Lévesque, A., et al. (2013). Students’ self-explanations while solving unfamiliar cases: The role of biomedical knowledge. Medical Education, 47(11), 1109–1116.

    Article  Google Scholar 

  • Chamberland, M., Mamede, S., St-Onge, C., Setrakian, J., Bergeron, L., & Schmidt, H. (2015a). Self-explanation in learning clinical reasoning: The added value of examples and prompts. Medical Education, 49, 193–202.

    Article  Google Scholar 

  • Chamberland, M., Mamede, S., St-Onge, C., Setrakian, J., & Schmidt, H. G. (2015b). Does medical students’ diagnostic performance improve by observing examples of self-explanation provided by peers or experts. Advances in Health Science Education, 20(4), 981–993.

    Article  Google Scholar 

  • Chamberland, M., St-Onge, C., Setrakian, J., Lantheir, L., Bergeron, L., Bourget, A., et al. (2011). The influence of medical students’ self-explanations on diagnostic performance. Medical Education, 45, 688–695.

    Article  Google Scholar 

  • Chi, M. T. H. (2000). Self-explaining expository texts: The dual process of generating inferences and repairing mental models. In R. Glaser (Ed.), Advances in Instructional Psychology (pp. 161–238). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Chi, M. T. H., De Leeuw, N., Chiu, M.-H., & Lavancher, C. (1994). Eliciting self-explanations improves understanding. Cognitive Science, 18, 439–477.

    Google Scholar 

  • Crowley, K., & Siegler, R. S. (1999). Explanation and generalization in young children’s strategy learning. Child Development, 70(2), 304–316.

    Article  Google Scholar 

  • Drake, R. L., McBride, J. M., Lachman, N., & Pawlina, W. (2009). Medical education in the anatomical sciences: The winds of change continue to blow. Anatomical Sciences Education, 2(6), 253–259.

    Article  Google Scholar 

  • Finnerty, E. P., Chauvin, S., Bonaminio, G., Andrews, M., Carroll, R. G., & Pangaro, L. N. (2010). Flexner revisited: The role and value of the basic sciences in medical education. Academic Medicine, 85(2), 349–355.

    Article  Google Scholar 

  • Garner, W. R. (1974). The processing of information and structure. Potomac, MD: Erlbaum.

    Google Scholar 

  • Kuhn, D., & Katz, J. (2009). Are self-explanations always beneficial? Journal of Experimental Child Psychology, 103(3), 386–394.

    Article  Google Scholar 

  • Kulasegaram, K., Manzone, J. C., Ku, C., Skye, A., Wadey, V., & Woods, N. N. (2015). Cause and effect: Testing a mechanism and method for the cognitive integration of basic science. Academic Medicine, 90, S63–S69.

    Article  Google Scholar 

  • Kulasegaram, K. M., Martimianakis, M. A., Mylopoulos, M., Whitehead, C. R., & Woods, N. N. (2013). Cognition before curriculum: Rethinking the integration of basic science and clinical learning. Academic Medicine, 88(10), 1578–1585.

    Article  Google Scholar 

  • Larsen, D. P., Butler, A. C., & Roediger, H. L., III. (2013). Comparative effects of test-enhanced learning and self-explanation on long-term retention. Medical Education, 47, 674–682. doi:10.1111/medu.12141.

    Article  Google Scholar 

  • Leppink, J., Broers, N. J., Imbos, T., van der Vleuten, C. P. M., & Berger, M. P. F. (2012). Prior knowledge moderates instructional effects on conceptual understanding of statistics. Educational Research and Evaluation, 18(1), 37–51.

    Article  Google Scholar 

  • Lisk, K., Agur, A. M. R., & Woods, N. N. (2016). Exploring cognitive integration of basic science and its effect on diagnostic reasoning in novices. Perspectives on Medical Education, 5(3), 147–153.

    Article  Google Scholar 

  • Lombrozo, T. (2006). The structure and function of explanations. Trends in Cognitive Sciences, 10(10), 464–470.

    Article  Google Scholar 

  • Medin, D. L., & Schaffer, M. M. (1978). Context theory of classification learning. Psychological Review, 85, 207–238.

    Article  Google Scholar 

  • Patel, V. L., Groen, G. J., & Scott, H. M. (1988). Biomedical knowledge in explanations of clinical problems by medical students. Medical Education, 22(5), 398–406.

    Article  Google Scholar 

  • Renkl, A. (1997). Learning from worked-out examples: A study on individual differences. Cognitive Science, 21(1), 1–29.

    Article  Google Scholar 

  • Rittle-Johnson, B. (2006). Promoting transfer: Effects of self-explanation and direct instruction. Child Development, 77, 1–15.

    Article  Google Scholar 

  • Rittle-Johnson, B., & Loehr, A. M. (2016). Eliciting explanations: Constraints on when self-explanation aids learning. Psychonomic Bulletin and Review. doi:10.3758/s13423-016-1079-5.

    Google Scholar 

  • Tracy, J. I., Pinsk, M., Helverson, J., Urban, G., Dietz, T., & Smith, D. J. (2001). Test of a potential link between analytic and nonanalytic category learning and automatic. Effortful processing. Brain and Cognition, 46(3), 326–341.

    Article  Google Scholar 

  • Urbaniak, G. C., & Plous, S. (2015). Research randomizer. Retrieved September 9, 2015, from http://www.randomizer.org/.

  • van der Meij, J., & de Jong, T. (2011). The effects of directive self-explanation prompts to support active processing of multiple representations in a simulation-based learning environment. Journal of Computer Assisted Learning, 27(5), 411–423.

    Article  Google Scholar 

  • Williams, J. J., & Lombrozo, T. (2010). The role of explanation in discovery and generalization: Evidence from category learning. Cognitive Science, 34(5), 776–806.

    Article  Google Scholar 

  • Williams, J., Lombrozo, T., & Rehder, B. (2013). The hazards of explanation: Overgeneralization in the face of exceptions. Journal of Experimental Psychology: General, 142(4), 1006–1014.

    Article  Google Scholar 

  • Woods, N. N., Brooks, L. R., & Norman, G. R. (2007a). It all makes sense: Biomedical knowledge, causal connections and memory in the novice diagnostician. Advances in Health Sciences Education, 12(4), 405–415.

    Article  Google Scholar 

  • Woods, N. N., Brooks, L. R., & Norman, G. R. (2007b). The role of biomedical knowledge in diagnosis of difficult clinical cases. Advances in Health Sciences Education, 12(4), 417–426.

    Article  Google Scholar 

  • Wylie, R., & Chi, M. T. H. (2014). The self-explanation principle in multimedia learning. In R. Mayer (Ed.), The Cambridge handbook of multimedia learning (2nd ed., pp. 413–432). New York, NY: Cambridge University Press.

    Chapter  Google Scholar 

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Authors and Affiliations

  1. Rehabilitation Sciences Institute, Division of Anatomy, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 1158, Toronto, ON, M5S 1A8, Canada

    Kristina Lisk, Anne M. R. Agur & Nicole N. Woods

  2. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Anne M. R. Agur

  3. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Nicole N. Woods

  4. The Wilson Centre, University Health Network, Toronto, ON, Canada

    Kristina Lisk & Nicole N. Woods

Authors
  1. Kristina Lisk
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  2. Anne M. R. Agur
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  3. Nicole N. Woods
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Correspondence to Kristina Lisk.

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Lisk, K., Agur, A.M.R. & Woods, N.N. Examining the effect of self-explanation on cognitive integration of basic and clinical sciences in novices. Adv in Health Sci Educ 22, 1071–1083 (2017). https://doi.org/10.1007/s10459-016-9743-0

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  • DOI: https://doi.org/10.1007/s10459-016-9743-0

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