Using Metacognitive Tools to Scaffold Medical Students Developing Clinical Reasoning Skills

摘要

BioWorld is a technology-rich learning environment that incorporates metacognitive tools to scaffold learners as they diagnose virtual patients. To argue for a diagnosis, users add patients' symptoms and test results to a virtual notepad known as the evidence palette, and then prioritize and summarize this evidence. This study investigated differences in medical students' and expert physicians' use of evidence while making diagnoses in BioWorld. Experts and students were compared on the quantity and content of evidence items selected for 3 cases. To evaluate the use of the evidence palette as a metacognitive tool, the proportion of prioritized evidence, confidence and accuracy of the two groups were compared. To evaluate the use of the evidence palette as a cognitive tool, the proportion of summarized evidence was compared. The problem-solving patterns of the experts in this study were consistent with principles of expertise that have been identified in the literature. The evidence palette was an effective cognitive tool for both students and experts, but less effective as a metacognitive tool for students. Further research is necessary to develop appropriate metacognitive scaffolds to address confirmation bias and accuracy awareness for difficult cases.