Intelligent Tutoring Systems for Ill-Defined Domains - Philippe ...

69 Gauthier, Naismith, Lajoie, & Wiseman
Medicine is an ill-defined domain [9] that has a long-standing tradition of teaching
using tutorials that are based on real patient cases [10]. By ill-defined we mean that
that medical problem solving does not involve a set of strict problem solving
sequences for obtaining the correct answer. There are many routes to solving a
problem and one medical problem may lead to a new set of medical issues that need
to be resolved. Well-defined problem domains, on the other hand, often have clear
procedures and outcomes. Case presentation is both a formal and informal practice in
medicine [11]. In practice, a case presentation generally consists of an instructor
offering a verbal, detailed analysis of a patient case to his students. However, the
explanation and solution for these cases may vary substantially depending on the
instructor’s prior experience and teaching abilities. Indeed, medical instructors learn
to teach mainly by doing it, and little guidance or content is provided to help them
improve their teaching practice. Many issues related to case-based medical teaching
need to be investigated: what exactly constitutes a case, how and what knowledge and
strategies are taught using cases and how this knowledge is validated in the context of
multiple possible answers. This research aims at improving medical case-based
teaching practices by proposing an innovative methodology for building and teaching
medical cases using visual representations.
In this paper we review the definition of “case” to inform our conceptual
understanding of cases as instances of ill-defined problem solving. We suggest that
the multilayered visual representation of the solution process reveals the series of
decisions leading to and explaining the answer. We hypothesize that understanding
the process is crucial in promoting a better understanding of the solution as well as the
problem. We briefly review the way we construct visual representations of solution
processes [12] before describing the pilot study conducted to explore the impact of
these representations on medical students. More precisely we look at whether
participants can understand the representation with minimal instruction and if this
kind of feedback improves their ability to self-assess and reflect on their own
performance.
1.1 Definition and Use of Cases
The first challenge in trying to design cases is to agree upon what constitutes a case.
In trying to explore the concept of “case” we looked at different contexts in which it
is used and how the term is defined. At a general level a case is described as “a set of
circumstances or conditions” [13]. The list of synonyms accompanying the definition
is more revealing of the assembly of concepts it contains, i.e.: instance, illustration,
example, sample and specimen. This list of concepts provides a good overview of the
diversity of meanings and concepts related to the use of this word. Considering the
instructional context and technology mediated activities and tools for structuring and
presenting cases, we have selected to look at education and case-based reasoning
literatures to inform the definition of cases.