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

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Experts have been found to have strong metacognitive skills [33] whereas novice learners demonstrate less planning and self monitoring [34]. Research has shown that experts use deliberate practice to improve their ability to observe, monitor and fine tune their performance [35]. Visualization of performance in sports and other performance-based disciplines is used to help athletes and performers to look back and reflect on their performance as well as the performance of others. Delayed observations provide athletes and chess players with a different perspective on their performance and help them adapt their specific moves according to the overview of the performance [35]. We anticipate that doing similar visualizations might promote discussions about problem solving processes that will enhance metacognitive processes and decrease the possibility of fragmentation of the problem solving processes. 2 Context of Studies In the preliminary phase of our research, we designed an activity in which medical students had to create fictitious patient case scenarios. This activity highlighted important validity and reliability issues of case creation and resolution. When asked to solve the case they had written, participants did not arrive at the solution they had proposed initially. When testing this problem with expert clinicians, we found that their solution differed each time they solved the same case [1]. Additionally experts did not agree with each other concerning the ideal solution for a relatively simple case. To address these issues of the validity and reliability of solutions in a more systematic manner, we designed a methodology that uses visual representations to create and evaluate medical case presentation scenarios [1]. This methodology supports case-based teaching by offering a systematic procedure to: a) track and represent expert medical instructors’ solution processes and explanations, b) capture pedagogical expertise from these experienced teachers and, c) compare and combine solution paths for the representation and explanation of specific cases. In the current pilot study we needed to test the usability of these case-specific models on medical students. The purpose was to verify if the methodology and visual representation of cases was adequate for instructional use with medical students. We wanted to see if these visual representations could be understood by medical students and if they had an impact on their learning and improve their self-assessment by helping them "look back" at their own thinking. 3 Study Design Using Expert Decision Maps 72 In order to evaluate whether or not medical students could understand and utilize visual representations to improve their learning, we designed an experiment in which an experimental group interacted with visual representations while a control group did not. We anticipate that using visual representations of solution paths can provide a meaningful framework to synthesize, structure and communicate different levels of
73 Gauthier, Naismith, Lajoie, & Wiseman knowledge and reasoning strategies by promoting metacognition. We thus hypothesized that the experimental group would outperform the control group on various measures including accuracy of the final diagnosis, average time spent per case, self-reported confidence levels and evidence of self-reflection. 3.1 Participants Eighteen second-year medical students from a North American University participated in this pilot study. Participation was required as part of a teaching module on clinical reasoning, but the students were given the opportunity at the beginning of the study to opt-out of data collection for research purposes. Data was recorded anonymously. 3.2 Materials Cases. Four BioWorld [36] cases were used in this study. In each case, the symptoms presented by the patients were similar and nonspecific, including weight loss, fatigue and anxiety. The expert diagnosis for the tutorial case was the digestive disorder of celiac disease, which was expected to be familiar to the majority of the students. The three test cases were the same cases that were used in [12] with expert medical instructors. The expert diagnosis for the first test case was pheochromocytoma, an extremely rare endocrine disorder that was not expected to be familiar to majority of the students. The expert diagnoses for the other two test cases were more common endocrine disorders: type 1 diabetes and hyperthyroidism, both of which the students would have already encountered in their studies. After the students submitted their final diagnoses, they were able to view and compare their performance to a text-based expert summary. The experimental condition was also given an expert decision map [12] as an additional feedback mechanism. The maps contained a visual representation of the overall problem solving process, as well as links to the verbatim transcript of the expert’s think-aloud protocol. Figure 1 illustrates a portion of a sample expert decision map.
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