Elsevier

Computers in Human Behavior

Volume 18, Issue 6, November 2002, Pages 761-772
Computers in Human Behavior

Web-based problem solving learning: third-year medical students' participation in end-of-life care Virtual Clinic

https://doi.org/10.1016/S0747-5632(02)00029-8Get rights and content

Abstract

This exploratory study examined problem-solving in an on-line problem-based learning environment. Participants included two moderators and 30 medical students in the end-of-life care Virtual Clinic. Using content analysis of transcripts, we analyzed interaction patterns in two groups of students and moderators and students' problem-solving skills as measured by the critical thinking ratio. Moderator in Group 1 posted more connected comments, feedback, and questions than the moderator in Group 2. Students in Group 1 posted more connected comments compared to students in Group 2. However, the disparate interaction patterns yielded little differences in students' critical thinking skills in both groups. We propose the use of critical thinking ratio as an effective outcome measure in assessing problem-solving skills.

Introduction

Problem-solving or critical thinking that leads to an effective and accurate medical diagnosis is an essential skill in physicians' patient care. Although interchanged in the literature, problem-solving skills involve logical reasoning and inference that lead to solutions while critical thinking skills involve reasoning about ill-structured problems that lead to a general understanding about a problem and a tolerance for ambiguity (Kamin, O'Sullivan, Younger, & Deterding, 2001).

Since the 1960s, problem-solving skills have been taught in medical schools primarily through the problem-based learning (PBL) format. Typically, a small group of medical students examine realistic clinical problems under the guidance of a tutor and engage in a series of activities organized into problem-solving stages (Garrison, 1991): (1) problem identification; (2) problem description; (3) problem exploration; (4) applicability; and (5) integration. Problem identification involves seeking information necessary for problem solving, such as lab test results or literature; problem definition involves clarifying concepts related to the presented problems based on students' knowledge in basic sciences and clinical experiences; problem exploration involves linking ideas by posing questions or justifying one's problem-solving approaches; applicability involves connecting knowledge gained during learning to on-going practical experiences; and integration involves making use of comments of moderators and peer students during problem solving.

The assessment of students' problem-solving skills in medical education often compares the performance of clinical skills in students in the PBL format with students trained in a conventional curricular format (Albanses and Mitchell, 1993, Woodward, 1990). Outcome measures in comparative studies mainly included ratings by faculty of students' skills in history taking, physical exam, problem recognition, and case management during their interactions with standardized patients, who are trained actors simulating conditions of particular illnesses. Few studies have assessed students' problem-solving skills as learning takes place during PBL sessions.

The goal of PBL is to help students construct their knowledge through peer interactions in a small group as students evaluate and clarify their misconceptions with peer input (Dolmans et al., 2001, Frederiksen, 1999). Problem-based learning facilitated in collaborative computer conferencing raises challenges as these interactions are formed and sustained in a virtual environment. Studies have shown that deliberate strategies by moderators produced a higher level of cross referencing to individuals' contributions among students and a higher proportion of students' messages containing feedback, such as agreement, disagreement, and contact statement (e.g. are you there?) (Howell-Richardson and Mellar, 1996, Marttunen, 1998). These findings are important as the quality of collaborative learning is often measured by the number of suggestions, argumentation, and explanations students provide (Marttunen, 1998, Susman, 1998). Some of the specific moderating strategies are summarized: (1) scaffolding students' thinking by providing introduction of new topics and specific discussion topics; (2) using questions to trigger multiple perspectives and to encourage students to justify connections between claim and evidence; (3) modeling how to select, evaluate, and synthesize information from multiple sources; (4) highlighting misconceptions by comparing and contrasting statements; (5) linking individual ideas into generalizable principles; and (6) providing feedback in the form of praise or a direct reference to a student's remark for modeling social interactions and recognizing other students' contributions (Hara et al., 2000, Marttunen, 1998, Mowrer, 1996, Veerman et al., 2000). Compared to traditional PBL format, moderators need to assume an active role for creating an interactive learning environment that promotes conceptual refinement and deeper understanding for overcoming limitations associated with computer conferencing. These limitations encompass lack of social presence, unfamiliarity with peer collaborators, absence of non-verbal cues, and time lags in posting messages (Hron, Hesse, Cress, & Giovis, 2000).

This exploratory study examines medical students' problem-solving skills in an on-line problem-based learning environment where learning is mediated through interactions with faculty moderators and peer students in asynchronous discussion sessions. More specifically, the study focuses on the effects of moderators' facilitation styles on the quality of student learning. We examined the moderators' facilitation style according to their comments that are connected to students' comments as well as frequency of praise, responses, questions provided to students. We also examined student discourse style in terms of students' connected comments and statements including praise, response, and questions. Our research questions include: (1) is there a relationship between moderator facilitation style and student discourse style? and (2) is there a relationship between student discourse style and the quality of their learning as measured by critical thinking ratios? The critical thinking ratios are calculated by categorizing each comment as deep or surface learning and dividing the difference in frequencies between deep and surface learning by their sum, yielding an index between −1 and +1.

Section snippets

Setting

The instructional material used in this study is an on-line case learning tool in end-of-life care called, the Virtual Clinic. The Virtual Clinic is designed for third-year medical students who participate in the required family medicine clinical rotations at 24 training sites in five states (Washington, Wyoming, Alaska, Idaho, Montana). Students access via the Web weekly case materials, tasks, and discussion forum where they are required to post three messages per week over a 4-week period.

Results

We examined the following two questions: (1) is there a relationship between moderator facilitation style and student discourse style? and (2) is there a relationship between student discourse style and the quality of their learning as measured by the critical thinking ratio?

Discussion

This exploratory study examined medical students' problem-solving skills in an on-line problem-based learning format where learning was largely mediated by interactions with faculty moderators and peer students. The content analysis was guided by the assumption that the discourse during problem-based learning reflects students' problem-solving or critical thinking skills; and in-depth processing or deep learning is important for effective problem solving (Miller, 1992). Although there were

Acknowledgements

This project was funded by the University of Washington Tools for Transformation grant under the title, A Required, Regional Community-based Clerkship School of Medicine, Family Medicine: An Experiment in Problem-Based Distance Learning for a Required, Regional Community-based Clerkship. The authors wish to thank Dr. Ok Choon Park, Office of Educational Research and Improvement (OERI), Department of Education, for his critical review of the manuscript.

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