title: Improving the learning of clinical reasoning through computer-based cognitive representation.
abstract: OBJECTIVE
  Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems.
  
  
  METHODS
  Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process.
  
  
  RESULTS
  A significant improvement was found in students' learning products from the beginning to the end of the study, consistent with students' report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment.
  
  
  CONCLUSIONS
  The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction.
authors.affiliation: Department of Educational Information Technology, East China Normal University, Shanghai, China; KM&EL Lab, The University of Hong Kong, Hong Kong, China.
authors.forename: Bian
authors.initials: B
authors.lastname: Wu
authors.affiliation: KM&EL Lab, The University of Hong Kong, Hong Kong, China; Faculty of Education, The University of Hong Kong, Hong Kong, China; magwang@hku.hk.
authors.forename: Minhong
authors.initials: M
authors.lastname: Wang
authors.affiliation: Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Johnson
authors.affiliation: Harvard Graduate School of Education, Harvard University, MA, USA.
authors.forename: Tina A
authors.initials: TA
authors.lastname: Grotzer
mesh_terms: D002681:China; D003071:Cognition; D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D018794:Problem-Based Learning; D058996:Quality Improvement; D014584:User-Computer Interface
keywords: clinical reasoning; cognitive representation; computers/technology; knowledge construction; problem solving