PhenomenonAs a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one's thinking.... Show morePhenomenonAs a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one's thinking. Having a metacognitive habit of mind is essential for healthcare professionals. This study identified the metacognitive competencies of medical students as they completed a conceptual learning task, and provided insight into students' perceptions of self-regulated learning in their curriculum. Approach: Eleven third-year medical students from a Dutch University were purposively sampled to participate in this qualitative study. The study design included a think-aloud assignment followed by a semi-structured interview. During the assignment, participants were instructed to think aloud while solving questions about medical physiological concepts such as blood flow, pressure, and resistance. Think-aloud data were collected through audiotaping and used to identify participants' metacognitive competencies. The assignment also served as a prompt for an interview in which participants were questioned about metacognitive knowledge, monitoring, experiences, and perceptions of self-regulated learning in their curriculum. All data were transcribed verbatim and analyzed iteratively using a template analysis. Findings: Students differed in their use of metacognitive skills, with an overall focus on monitoring and, to a lesser extent, on planning and evaluation. Additionally, differences were found in students' metacognitive knowledge and metacognitive experiences. There was apparent use of inefficient, superficial predictive cues. Regarding perceptions of self-regulated learning skills, some students felt no need to develop such skills as they perceived medical education as an exercise in memorizing facts. Others emphasized the need for more insight into their actual level of knowledge and competence. Insights: Pre-clinical medical students require explicit teaching of metacognitive skills to facilitate self-regulated learning. Educators should aim to integrate metacognition in the everyday discourse of the classroom to foster an environment in which students discuss their own learning.Supplemental data for this article is available online at . Show less
The overall aim of this thesis was to improve health professions education by investigating spaced learning, concept learning and metacognitive learning using an educational neuroscience-inspired... Show moreThe overall aim of this thesis was to improve health professions education by investigating spaced learning, concept learning and metacognitive learning using an educational neuroscience-inspired approach. Our studies illustrate that cognitive psychology and neuroscience may guide the development of educational interventions. Examples from cognitive psychology are: the post-decision wagering method, overt learning theory, and metacognitive theory. Additionally, neuroscience informed us on the use of spacing formats. Vice versa, we used educational theories as input for neuroscientific hypotheses to uncover the mechanisms of concept learning. Our fMRI study is an example of how educational neuroscience may also be used to answer fundamental research questions about the science of learning. Overall, I argue that the value of educational neuroscience-inspired research lies in the interdisciplinary nature of the field and the open-minded view on collaborating with other disciplines. Furthermore, educational neuroscience has an urge to explain underlying mechanisms of behaviour and the field embraces the importance of flexibility in methods. I believe it is this combination of qualities that makes educational neuroscience a valuable addition to currently existing approaches in the health professions education research community. Show less
Versteeg, M.; Hafkemeijer, A.; Beaufort, A.J. de; Steendijk, P. 2020
Obtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in... Show moreObtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in the brain. Therefore, misconceptions must be cognitively inhibited in order to select the scientific knowledge. There is, however, lack of substantial neuroscientific evidence supporting this hypothesis. In this study, we sought for this evidence by investigating medical students who solved a cardiovascular conceptual problem in a magnetic resonance imaging scanner. Brain activation was compared between understanders who had the scientific knowledge, and misunderstanders who held a misconception. No significant activation was found in brain areas related to cognitive inhibition in understanders compared with misunderstanders. Therefore, we could not confirm the idea that cognitive inhibition is involved in overcoming a misconception. Instead, we found that the putamen was significantly activated in misunderstanders compared with understanders, suggesting a role for episodic memory in learners holding a misconception. Show less
Versteeg, M.; Hafkemeijer, A.; Beaufort, A.J. de; Steendijk, P. 2020
Obtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in... Show moreObtaining adequate understanding of scientific concepts is considered challenging due to learners' misconceptions about natural phenomena. Misconceptions may coexist with scientific knowledge in the brain. Therefore, misconceptions must be cognitively inhibited in order to select the scientific knowledge. There is, however, lack of substantial neuroscientific evidence supporting this hypothesis. In this study, we sought for this evidence by investigating medical students who solved a cardiovascular conceptual problem in a magnetic resonance imaging scanner. Brain activation was compared between understanders who had the scientific knowledge, and misunderstanders who held a misconception. No significant activation was found in brain areas related to cognitive inhibition in understanders compared with misunderstanders. Therefore, we could not confirm the idea that cognitive inhibition is involved in overcoming a misconception. Instead, we found that the putamen was significantly activated in misunderstanders compared with understanders, suggesting a role for episodic memory in learners holding a misconception. Show less
Timmer, M.C.J.; Steendijk, P.; Arend, S.M.; Versteeg, M. 2020
IntroductionPoor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures.... Show moreIntroductionPoor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures. Guided by neuroscientific literature, we designed a spaced learning lecture in which the educator repeats the to-be-learned information using short temporal intervals. We investigated if this modified instructional design could enhance students' retention.Materials and MethodsSecond-year medical students (n = 148) were randomly allocated to either the spaced lecture or the traditional lecture. The spaced lecture consisted of three 15-min instructional periods, separated by 5-min intervals. A short summary of the preceding information was provided after each interval. The traditional lecture encompassed the same information including the summary in the massed format, thus without the intervals. All students performed a baseline knowledge test 2 weeks prior to the lectures and students' knowledge retention was assessed 8 days after the lectures.ResultsThe average score on the retention test (alpha = 0.74) was not significantly different between the spaced lecture group (33.8% 13.6%) and the traditional lecture group (31.8% +/- 12.9%) after controlling for students' baseline-test performance (F(1,104) = 0.566, p = 0.458). Students' narrative comments showed that the spaced lecture format was well-received and subjectively benefitted their attention-span and cognitive engagement.Discussion and Conclusion We were unable to show increased knowledge retention after the spaced lecture compared with the traditional lecture. Based on these findings, we provide recommendations for further research. Ultimately, we aim for optimized spaced learning designs to facilitate learning in the medical curriculum and to help educate health professionals with a solid knowledge base. Show less
Versteeg, M.; Loon, M.H. van; Wijnen-Meijer, M.; Steendijk, P. 2020
BackgroundIn medical physiology, educators and students face a serious challenge termed misconceptions. Misconceptions are incorrect ideas that do not match current scientific views. Accordingly,... Show moreBackgroundIn medical physiology, educators and students face a serious challenge termed misconceptions. Misconceptions are incorrect ideas that do not match current scientific views. Accordingly, they have shown to hamper teaching and learning of physiological concepts. Conceptual Change Theory forms the basis of new teaching and learning practices that may alleviate misconceptions and facilitate critical thinking skills that are essential in becoming knowledgeable, self-regulated health professionals. In this study, we examined if such an intervention named refutation texts, could enhance medical students' cognition and metacognition.MethodsFirst-year medical students (N=161) performed a pre-test and post-test on cardiovascular physiology concepts, including a self-perceived confidence rating. In between, students read either a standard text with an explanation of the correct answer, or a refutation text which additionally refuted related misconceptions.ResultsIn both groups, average performance scores (refutation: +22.5%, standard: +22.8%) and overall confidence ratings (refutation: Delta 0.42 out of 5, standard: Delta 0.35 out of 5) increased significantly (all p<.001), but a significant effect of the specific refutation element was not found. Initially incorrect answers were corrected less frequently in cases of high confidence (35.8%) than low confidence (61.4%).ConclusionsOur results showed that refutation texts significantly increased students' knowledge, however, the refutation element did not have a significant additional effect. Furthermore, high confidence in incorrect answers negatively affected the likelihood of correction. These findings provide implications for teaching practices on concept learning, by showing that educators should take into account the key role of metacognition, and the nature of misconceptions. Show less
Versteeg, M.; Hendriks, R.A.; Thomas, A.; Ommering, B.W.C.; Steendijk, P. 2020
Objectives To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education. Method The... Show moreObjectives To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education. Method The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods. Results Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching. Conclusions Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education. Show less
Versteeg, M.; Blankenstein, F.M. van; Putter, H.; Steendijk, P. 2019
Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual... Show moreMisconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding: however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students' awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students (N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation. i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation (R-2 = 0.13, P = 0.001) between students' confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students' conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education. Show less
Students learn more effectively when they know what they do not know. Gaining insight into students' metacognitive awareness is needed as misalignment between actual and self-perceived knowledge... Show moreStudents learn more effectively when they know what they do not know. Gaining insight into students' metacognitive awareness is needed as misalignment between actual and self-perceived knowledge impedes their learning process. The optimal method of measuring self-perceived knowledge is still under debate. In this study, we evaluate the use of psychology-derived post-decision wagering for mapping students self-perceived knowledge.Students (n = 71) performed a pre-test on medical physiology, followed by a teacher-moderated discussion and a post-test with isomorph questions. Half of the students rated their self-perceived knowledge on each question using post-decision wagering, i.aEuroe. betting 1-5 points on the correctness of their answer, whereas the other half used a 5-point Likert scale to rate their confidence.Self-perceived knowledge scores were higher for post-decision wagering (pre: 3.75 +/- 0.14, post: 4.60 +/- 0.07) compared with Likert scales (pre: 3.13 +/- 0.08, post: 3.92 +/- 0.08) despite similar actual knowledge scores. Furthermore, Likert ratings showed a near-normal distribution, whereas wagers were placed preferentially using the outer ends of the scale. Correlations between mean actual and self-perceived knowledge scores were low in both groups. On average, 8.5% of responses were classified as misconceptions, defined as highly confident incorrect answers.Despite the presumed reliability of post-decision wagering, our findings suggest that we should adhere to the use of Likert scales as a balanced measure for self-perceived knowledge in medical education. Moreover, the prevalence of misconceptions did not alter after instruction, indicating a need for instructional designs that enhance students' conceptual understanding in basic sciences. Show less
Introduction. Students learn more effectively when they know what they do not know. Gaining insight into students’ metacognitive awareness is needed as misalignment between actual and self... Show moreIntroduction. Students learn more effectively when they know what they do not know. Gaining insight into students’ metacognitive awareness is needed as misalignment between actual and self-perceived knowledge impedes their learning process. The optimal method of measuring self-perceived knowledge is still under debate. In this study, we evaluate the use of psychology-derived post-decision wagering for mapping students self-perceived knowledge. Methods Students (n= 71) performed a pre-test on medical physiology, followed by a teacher-moderated discussion and a post-test with isomorph questions. Half of the students rated their self-perceived knowledge on each question using post-decision wagering, i. e. betting 1–5 points on the correctness of their answer, whereas the other half used a 5-point Likert scale to rate their confidence. Results. Self-perceived knowledge scores were higher for post-decision wagering (pre: 3.75± 0.14, post: 4.60± 0.07) compared with Likert scales (pre: 3.13± 0.08, post: 3.92± 0.08) despite similar actual knowledge scores. Furthermore, Likert ratings showed a near-normal distribution, whereas wagers were placed preferentially using the outer ends of the scale. Correlations between mean actual and self-perceived knowledge scores were low in both groups. On average, 8.5% of responses were classified as misconceptions, defined as highly confident incorrect answers. Discussion. Despite the presumed reliability of post-decision wagering, our findings suggest that we should adhere to the use of Likert scales as a balanced measure for self-perceived knowledge in medical education. Moreover, the prevalence of misconceptions did not alter after instruction, indicating a need for instructional designs that enhance students’ conceptual understanding in basic sciences. Show less
Versteeg, M.; Wijnen-Meijer, M.; Steendijk, P. 2018
Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual... Show moreMisconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding; however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students’ awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students (N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation, i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation (R2 = 0.13, P = 0.001) between students’ confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students’ conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education. Show less
Versteeg, M.; Blankenstein, F.M. van; Putter, H.; Steendijk, P. 2018
Comprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer... Show moreComprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer instruction (PI) is known to stimulate students' comprehension, but its relative efficacy and working mechanisms remain to be elucidated. In this study, we investigated if and how PI could optimize comprehension of physiological concepts and transfer relative to Self-explanation (SE) which is considered a lower-order type of overt learning. First-year medical students (n = 317) were randomly assigned to either PI or SE in a pre-post test design, followed by a set of near and far transfer questions. In both PI and SE groups post-test scores were significantly improved (p < 0.0001) with PI outperforming SE (+ 35% vs. + 23%, p = 0.006). Interestingly, a substantial number of students with initial incorrect answers even had enhanced scores after discussion with an incorrect peer. Both methods showed higher transfer scores than control (p = 0.006), with a tendency for higher near transfer scores for PI. These findings support PI as a valuable method to enhance comprehension of physiological concepts. Moreover, by comparing the effects of interactive PI with constructive SE we have established new insights that complement educational theories on overt learning activities. Show less
Halff, E.F.; Diebolder, C.A.; Versteeg, M.; Schouten, A.; Brondijk, T.H.C.; Huizinga, E.G. 2012
