The evaluation of a web-based metacognitive tool: the effect of problem-centered reflection on the development of learning strategies associated with the diagnostic reasoning process

Medical students in a conventional medical curriculum are unable to integrate knowledge learned in the basic sciences and apply that knowledge to clinical situations (Gruppen, 1997; Bamett, 1995). This study examined the effect of a web-based metacognitive tool on medical student development of learning strategies and the changes in motivation that are associated with the diagnostic reasoning process.

The data presented in this study provide information on the development of learning strategies in a hybrid instructional environment consisting of lecture-based instruction and problem-centered reflection. The questions addressed by this study were: 1. What are the effects of problem-centered reflection on achievement? 2. What are the effects of problem-centered reflection on depth of learning? 3. What are the effects of problem-centered reflection on the use of reflection time during examinations? 4. What are the effects of problem-centered reflection on the structure and complexity of learned knowledge? 5. What effect does problem-centered reflection have on the development of learning strategies and the changes in motivation?

The study of medical diagnostic decision-making has mainly been based on the reasoning process in simulated case studies. The theoretical approaches to these studies include information processing theory and schema theory (Greenwood, 1998, 2000). In problem-centered reflection, a clinical problem is the focal point about which data are organized, interpreted, and integrated. Problem-centered reflection combines aspects of both Information Processing and Schema Theories.

The participants in this study were medical students who were enrolled in the first year of medical school and were randomly assigned to the direct instruction and problemcentered reflection groups. The direct instruction group accessed the web-based direct instruction tutorial while the problem-centered reflection group accessed the web-based metacognitive tool. The participants accessed the appropriate web-based learning activities for approximately one hour each day for two weeks which corresponded with the Upper Extremity Unit in Gross Anatomy. This quasi-experimental study examined the effects of problem-centered reflection on achievement, depth of learning, reflection time during examinations, and structure and complexity of learned knowledge.