Article

Advances in Health Sciences Education

, Volume 15, Issue 1, pp 9-30

First online:

Factors affecting feeling-of-knowing in a medical intelligent tutoring system: the role of immediate feedback as a metacognitive scaffold

  • Gilan M. El SaadawiAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of MedicineDepartment of Health and Community Services, University of Pittsburgh School of Nursing
  • , Roger AzevedoAffiliated withDepartment of Psychology, University of Memphis
  • , Melissa CastineAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of Medicine
  • , Velma PayneAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of Medicine
  • , Olga MedvedevaAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of Medicine
  • , Eugene TseytlinAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of Medicine
  • , Elizabeth LegowskiAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of Medicine
  • , Drazen JukicAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of MedicineDepartment of Dermatology, University of Pittsburgh School of MedicineDepartment of Pathology, University of Pittsburgh School of Medicine
  • , Rebecca S. CrowleyAffiliated withDepartment of Biomedical Informatics, University of Pittsburgh School of MedicineDepartment of Pathology, University of Pittsburgh School of MedicineIntelligent Systems Program, University of Pittsburgh School of Arts and Sciences Email author 

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Abstract

Previous studies in our laboratory have shown the benefits of immediate feedback on cognitive performance for pathology residents using an intelligent tutoring system (ITS) in pathology. In this study, we examined the effect of immediate feedback on metacognitive performance, and investigated whether other metacognitive scaffolds will support metacognitive gains when immediate feedback is faded. Twenty-three participants were randomized into intervention and control groups. For both groups, periods working with the ITS under varying conditions were alternated with independent computer-based assessments. On day 1, a within-subjects design was used to evaluate the effect of immediate feedback on cognitive and metacognitive performance. On day 2, a between-subjects design was used to compare the use of other metacognitive scaffolds (intervention group) against no metacognitive scaffolds (control group) on cognitive and metacognitive performance, as immediate feedback was faded. Measurements included learning gains (a measure of cognitive performance), as well as several measures of metacognitive performance, including Goodman–Kruskal gamma correlation (G), bias, and discrimination. For the intervention group, we also computed metacognitive measures during tutoring sessions. Results showed that immediate feedback in an intelligent tutoring system had a statistically significant positive effect on learning gains, G and discrimination. Removal of immediate feedback was associated with decreasing metacognitive performance, and this decline was not prevented when students used a version of the tutoring system that provided other metacognitive scaffolds. Results obtained directly from the ITS suggest that other metacognitive scaffolds do have a positive effect on G and discrimination, as immediate feedback is faded. We conclude that immediate feedback had a positive effect on both metacognitive and cognitive gains in a medical tutoring system. Other metacognitive scaffolds were not sufficient to replace immediate feedback in this study. However, results obtained directly from the tutoring system are not consistent with results obtained from assessments. In order to facilitate transfer to real-world tasks, further research will be needed to determine the optimum methods for supporting metacognition as immediate feedback is faded.

Keywords

Intelligent tutoring systems Diagnostic reasoning Clinical competence Cognition Diagnostic errors Education, medical Educational technology Feeling-of-knowing Pathology Problem solving Metacognition