Advances in Health Sciences Education

, Volume 15, Issue 1, pp 9–30

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

  • Gilan M. El Saadawi
  • Roger Azevedo
  • Melissa Castine
  • Velma Payne
  • Olga Medvedeva
  • Eugene Tseytlin
  • Elizabeth Legowski
  • Drazen Jukic
  • Rebecca S. Crowley
Article

DOI: 10.1007/s10459-009-9162-6

Cite this article as:
El Saadawi, G.M., Azevedo, R., Castine, M. et al. Adv in Health Sci Educ (2010) 15: 9. doi:10.1007/s10459-009-9162-6

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 systemsDiagnostic reasoningClinical competenceCognitionDiagnostic errorsEducation, medicalEducational technologyFeeling-of-knowingPathologyProblem solvingMetacognition

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Gilan M. El Saadawi
    • 1
    • 2
  • Roger Azevedo
    • 3
  • Melissa Castine
    • 1
  • Velma Payne
    • 1
  • Olga Medvedeva
    • 1
  • Eugene Tseytlin
    • 1
  • Elizabeth Legowski
    • 1
  • Drazen Jukic
    • 1
    • 4
    • 5
  • Rebecca S. Crowley
    • 1
    • 5
    • 6
  1. 1.Department of Biomedical InformaticsUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of Health and Community ServicesUniversity of Pittsburgh School of NursingPittsburghUSA
  3. 3.Department of PsychologyUniversity of MemphisMemphisUSA
  4. 4.Department of DermatologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  5. 5.Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  6. 6.Intelligent Systems ProgramUniversity of Pittsburgh School of Arts and SciencesPittsburghUSA