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BackgroundDuring self-study, students need to monitor and regulate mental effort to replete working memory resources and optimize learning results. Taking breaks during self-study could be an effective effort regulation strategy. However, little is known about how breaktaking relates to self-regulated learning. AimsWe investigated the effects of taking systematic or self-regulated breaks on mental effort, task experiences and task completion in real-life study sessions for 1 day. SampleEighty-seven bachelor's and master's students from a Dutch University. MethodsStudents participated in an online intervention during their self-study. In the self-regulated-break condition (n = 35), students self-decided when to take a break; in the systematic break conditions, students took either a 6-min break after every 24-min study block (systematic-long or 'Pomodoro technique', n = 25) or a 3-min break after every 12-min study block (systematic-short, n = 27). ResultsStudents had longer study sessions and breaks when self-regulating. This was associated with higher levels of fatigue and distractedness, and lower levels of concentration and motivation compared to those in the systematic conditions. We found no difference between groups in invested mental effort or task completion. ConclusionsTaking pre-determined, systematic breaks during a study session had mood benefits and appeared to have efficiency benefits (i.e., similar task completion in shorter time) over taking self-regulated breaks. Measuring how mental effort dynamically fluctuates over time and how effort spent on the learning task differs from effort spent on regulating break-taking requires further research.

The testing effect—the power of retrieval practice to enhance long-term knowledge retention more than restudying does—is a well-known phenomenon in learning. However, retrieval practice is hardly appreciated by students and underutilized when studying. One of the reasons is that learners usually do not experience immediate benefits of such practice which often present only after a delay. We therefore conducted 2 experiments to examine whether students choose retrieval practice more often as their learning strategy after having experienced its benefits. In Experiment 1, students received individual feedback about the extent to which their 7-day delayed test scores after retrieval practice differed from their test scores after restudy. Those students who had actually experienced the benefits of retrieval practice appreciated the strategy more and used it more often after receiving feedback. In Experiment 2, we compared the short-term and long-term effects on retrieval practice use of individual performance feedback and general instruction about the testing effect. Although both interventions enhanced its use in the short term, only the individual feedback led to enhanced use in the long term by those who had actually experienced its benefits, demonstrating the superiority of the individual feedback in terms of its ability to promote retrieval practice use.

When compared to high performers, low performers generally have more difficulty to accurately estimate their own performance. This has been explained by low performers being both unskilled and unaware about their performance. However, Miller and Geraci Journal of Experimental Psychology: Learning, Memory, and Cognition, 37(2), 502–506, (2011) found that low performing university students also assigned less confidence to their estimates (i.e., second-order judgments, SOJs), indicating some metacognitive awareness of their poor calibration. The current study examined whether the relationship between calibration accuracy and confidence in performance estimates is more general, and exists irrespective of performance level, not only for university students but also for secondary school students. We asked university students and secondary school students to estimate their exam grade after taking their exam, and to provide a second-order judgement). The results showed that for university students, poor calibration accuracy was indeed accompanied by low confidence scores, independent from performance level. For secondary school students however, calibration accuracy was unrelated to confidence scores, suggesting a less developed metacognitive awareness.

Applying effective learning strategies during self-study is important to build long-term knowledge. However, students rarely use such strategies, because they lack metacognitive knowledge and believe they are too effortful. To facilitate students use of these so-called desirable difficulties during self-study, we developed the Study Smart program, an intervention geared toward creating awareness of, reflection on, and practice with effective learning strategies. Based on a three-year design and implementation process, we share the problems we encountered and illustrate with student testimonials. Moreover, we reflect on future steps to be taken in research and practice. Among them is the need to debunk naive theories about learning strategies in students and teachers and to support the behavior change needed to develop effective study habits by implementing effective learning strategies in teaching and providing follow-up reflection sessions.

PurposeClinical educators often raise concerns that learners are not comfortable with uncertainty in clinical work, yet existing literature provides little insight into practicing clinicians' experiences of comfort when navigating the complex, ill-defined problems pervasive in practice. Exploring clinicians' comfort as they identify and manage uncertainty in practice could help us better support learners through their discomfort.MethodBetween December 2018 and April 2019, the authors employed a constructivist grounded theory approach to explore experiences of uncertainty in emergency medicine faculty. The authors used a critical incident technique to elicit narratives about decision making immediately following participants' clinical shifts, exploring how they experienced uncertainty and made real-time judgments regarding their comfort to manage a given problem. Two investigators analyzed the transcripts, coding data line-by-line using constant comparative analysis to organize narratives into focused codes. These codes informed the development of conceptual categories that formed a framework for understanding comfort with uncertainty.ResultsParticipants identified multiple forms of uncertainty, organized around their understanding of the problems they were facing and the potential actions they could take. When discussing their comfort in these situations, they described a fluid, actively negotiated state. This state was informed by their efforts to project forward and imagine how a problem might evolve, with boundary conditions signaling the borders of their expertise. It was also informed by ongoing monitoring activities pertaining to patients, their own metacognitions, and their environment.ConclusionsThe authors' findings offer nuances to current notions of comfort with uncertainty. Uncertainty involved clinical, environmental, and social aspects, and comfort dynamically evolved through iterative cycles of forward planning and monitoring.

RATIONALE AND AIM: In virtual dissection, three-dimensional computed tomography scans are viewed on a near-life size virtual dissection table and through touchscreen technology, students work together to manipulate the data to perform their dissection. The purpose of this study was to develop a Virtual Dissection Curriculum for first year medical students and to assess its educational value as well as students' preferred pedagogy for learning with this new technology.METHODS: One hundred and five first-year medical students participated in a case-based virtual dissection curriculum and were invited to complete a theory-based post experience survey. Eight unique clinical cases were selected based on the first-year curricular objectives and divided into four 30-minute sessions. In groups of 6-8, students reviewed the cases with a radiologist. First, students' reactions to virtual dissection were measured by three constructs using a 5-point Likert scale: quality of curriculum design (11 questions), impact on learning (7 questions), and comfort with technology (3 questions). Second, students ranked the usefulness of six pedagogical approaches for this technology. Responses were tabulated and rank order item lists were generated statistically using the Schulze method where appropriate.RESULTS: The survey response rate was 83% (87/105). Overall, students' reactions to virtual dissection were positive across all three measured constructs. Most students indicated that the cases were of an appropriate level of difficulty (90%) and that virtual dissection improved their understanding of disease and pathology (89%), the clinical relevance of anatomy (77%), and visuospatial relationships (64%). Almost all students (94%) reported that the curriculum improved understanding of the role of the radiologist in patient care. Students felt that the "very useful" pedagogical approaches were small group demonstration (68%) and problem-based learning (51%).CONCLUSION: First-year medical students perceive the use of virtual dissection as a valuable tool for learning anatomy and radiology. This technology enables the integration of clinical cases and radiology content into preclinical learning.

The Coronavirus disease 2019 (COVID-19) pandemic has altered how medical education is delivered, worldwide. Didactic sessions have transitioned to electronic/online platforms and clinical teaching opportunities are limited. These changes will affect how radiology is taught to medical students at both the pre-clerkship (ie, year 1 and 2) and clinical (ie, year 3 and 4) levels. In the pre-clerkship learning environment, medical students are typically exposed to radiology through didactic lectures, integrated anatomy laboratories, case-based learning, and ultrasound clinical skills sessions. In the clinical learning environment, medical students primarily shadow radiologists and radiology residents and attend radiology resident teaching sessions. These formats of radiology education, which have been the tenets of the specialty, pose significant challenges during the pandemic. This article reviews how undergraduate radiology education is affected by COVID-19 and explores solutions for teaching and learning based on e-learning and blended learning theory.

PURPOSE Safe and effective supervised practice requires a negotiated partnership between trainees and their supervisors. Substantial work has explored how supervisors make judgments about trainees' readiness to safely engage in critical professional activities, yet less is known about how trainees leverage the support of supervisors when they perceive themselves to be at the limits of their abilities. The purpose of this study is to explore how trainees use supervisory support to navigate experiences of clinical uncertainty. METHOD Using a constructivist grounded theory approach, the authors explored how novice emergency medicine trainees conceptualized the role of their supervisors during experiences of clinical uncertainty. They employed a critical incident technique to elicit stories from participants immediately following clinical shifts between July and September 2020, and asked participants to describe their experiences of uncertainty within the context of supervised practice. Using constant comparison, 2 investigators coded line-by-line and organized these stories into focused codes. The relationships between these codes were discussed by the research team, and this enabled them to theorize about the relationships between the emergent themes. RESULTS Participants reported a strong desire for supported independence, where predictable and accessible supervisory structures enabled them to work semiautonomously through challenging clinical situations. They described a process of borrowing their supervisors' comfort during moments of uncertainty and mechanisms to strategically broadcast their evolving understanding of a situation to implicitly invoke (the right level of) support from their supervisors. They also highlighted challenges they faced when they felt insufficiently supported. CONCLUSIONS By borrowing comfort from-or deliberately projecting their thinking to-supervisors, trainees aimed to strike the appropriate balance between independence for the purposes of learning and support to ensure safety. Understanding these strategic efforts could help educators to better support trainees in their growth toward self-regulation.

Abstract. Media multitasking has been long considered as a distraction, as something that is inherently negative or irrational. Yet, casual observations and study findings indicate that in the current permanently online, permanently connected society, people still media multitask frequently, sometimes in spite of their knowledge of the costs. In this article, we introduce the exploitation–exploration model of media multitasking (EEMMM), which proposes that media multitasking occurs as a natural part of the waxing and waning of our task engagement: When primary task engagement (exploitation) begins to wane, alternative tasks become more attractive (exploration). In the first part of this paper, we delineate the limitations of the current perspective of media multitasking as a distraction. The second part provides an exposition for our model: What defines behavior exploitation and exploration, and why maintaining an optimal trade-off between the two is important; the everyday, media-related cues for exploiting and exploring; and the neurobiological evidence of a brain system that supports the transition from exploitation to exploration. Lastly, we show how our approach may explain why people media multitask spontaneously and in spite of their knowledge of the costs, and why not all media multitaskers are able to multitask optimally. We conclude the paper with an agenda for future media multitasking research based on the proposed framework.

Research has shown a bi-directional association between the (perceived) amount of invested effort to learn or retrieve information (e.g., time, mental effort) and metacognitive monitoring judgments. The direction of this association likely depends on how learners allocate their effort. In self-paced learning, effort allocation is usually data driven, where the ease of memorizing is used as a cue, resulting in a negative correlation between effort and monitoring judgments. Effort allocation is goal driven when it is strategically invested (e.g., based on the importance of items or time pressure) and likely results in a positive correlation. The current study used a meta-analytic approach to synthesize the results from several studies on the relationship between effort and monitoring judgments. The results showed that there was a negative association between effort and monitoring judgments (r = − .355). Furthermore, an exploration of possible moderators of this association between effort and monitoring was made. The negative association was no longer significant when goal-driven regulation was manipulated. Furthermore, it was found that the type of monitoring judgment (i.e., a weaker association for prospective judgments) and type of task (stronger association for problem-solving tasks relative to paired associates) moderated the relation between effort and monitoring. These results have important implications for future research on the use of effort as a cue for monitoring in self-regulated learning.

This article discusses the seven contributions to the special issue Facilitation of self-regulated learning. We first introduce the cue-utilization framework to study self-regulated learning; the basic idea of this framework is that learners use whatever cues are available to monitor and control their learning processes. This framework is then used to position, discuss, and critically compare the seven contributions, which represent a wide variety of approaches to self-regulated learning. Based on our analysis, five main conclusions are presented: (1) there is a tendency to focus investigations on learners' monitoring and reflection whereas it might be more fruitful to take the full learning cycle into account, (2) there are strong indications that learners' use cues to regulate their learning but which cues they are actually using depends on many different factors including the type and level of learning, (3) there is a clear need for the provision of metacognitive prompts to learners that stimulate them to use more diagnostic cues and make better control decisions, (4) on the instructional-sequence level, facilitation of self-regulated learning might include ‘second-order’ scaffolding where the number of prompts decreases as learners acquire more self-regulated learning skills, and (5) affective states may serve as cues but how they interact with cognitive cues is still unknown. We conclude that a design approach to self-regulated learning might help to acknowledge its enormous complexity.

Although self-regulated learning (SRL) is becoming increasingly important in modern educational contexts, disagreements exist regarding its measurement. One particularly important issue is whether self-reports represent valid ways to measure this process. Several researchers have advocated the use of behavioral indicators of SRL instead. An outstanding research debate concerns the extent to which it is possible to compare behavioral measures of SRL to traditional ways of measuring SRL using self-report questionnaire data, and which of these methods provides the most valid and reliable indicator of SRL. The current review investigates this question. It was found that granularity is an important concept in the comparison of SRL measurements, influencing the degree to which students can accurately report on their use of SRL strategies. The results show that self-report questionnaires may give a relatively accurate insight into students' global level of self-regulation, giving them their own value in educational research and remediation. In contrast, when students are asked to report on specific SRL strategies, behavioral measures give a more accurate account. First and foremost, researchers and practitioners must have a clear idea about their research question or problem statement, before choosing or combining either form of measurement.

Radiologists can visually detect abnormalities on radiographs within 2s, a process that resembles holistic visual processing of faces. Interestingly, there is empirical evidence using functional magnetic resonance imaging (fMRI) for the involvement of the right fusiform face area (FFA) in visual-expertise tasks such as radiological image interpretation. The speed by which stimuli (e.g., faces, abnormalities) are recognized is an important characteristic of holistic processing. However, evidence for the involvement of the right FFA in holistic processing in radiology comes mostly from short or artificial tasks in which the quick, ‘holistic’ mode of diagnostic processing is not contrasted with the slower ‘search-to-find’ mode. In our fMRI study, we hypothesized that the right FFA responds selectively to the ‘holistic’ mode of diagnostic processing and less so to the ‘search-to-find’ mode. Eleven laypeople and 17 radiologists in training diagnosed 66 radiographs in 2s each (holistic mode) and subsequently checked their diagnosis in an extended (10-s) period (search-to-find mode). During data analysis, we first identified individual regions of interest (ROIs) for the right FFA using a localizer task. Then we employed ROI-based ANOVAs and obtained tentative support for the hypothesis that the right FFA shows more activation for radiologists in training versus laypeople, in particular in the holistic mode (i.e., during 2s trials), and less so in the search-to-find mode (i.e., during 10-s trials). No significant correlation was found between diagnostic performance (diagnostic accuracy) and brain-activation level within the right FFA for both, short-presentation and long-presentation diagnostic trials. Our results provide tentative evidence from a diagnostic-reasoning task that the FFA supports the holistic processing of visual stimuli in participants’ expertise domain.

Objectives: Managing uncertainty is central to expert practice, yet how novice trainees navigate these moments is likely different than what has been described by experienced clinicians. Exploring trainees’ experiences with uncertainty could therefore help explicate the unique cues that they attend to, how they appraise their comfort in these moments and how they enact responses within the affordances of their training environment. Methods: Informed by constructivist grounded theory, we explored how novice emergency medicine trainees experienced and managed clinical uncertainty in practice. We used a critical incident technique to prompt participants to reflect on experiences with uncertainty immediately following a clinical shift, exploring the cues they attended to and the approaches they used to navigate these moments. Two investigators coded line-by-line using constant comparison, organising the data into focused codes. The research team discussed the relationships between these codes and developed a set of themes that supported our efforts to theorise about the phenomenon. Results: We enrolled 13 trainees in their first two years of postgraduate training across two institutions. They expressed uncertainty about the root causes of the patient problems they were facing and the potential management steps to take, but also expressed a pervasive sense of uncertainty about their own abilities and their appraisals of the situation. This, in turn, led to challenges with selecting, interpreting and using the cues in their environment effectively. Participants invoked several approaches to combat this sense of uncertainty about themselves, rehearsing steps before a clinical encounter, checking their interpretations with others and implicitly calibrating their appraisals to those of more experienced team members. Conclusions: Trainees’ struggles with the legitimacy of their interpretations impact their experiences with uncertainty. Recognising these ongoing struggles may enable supervisors and other team members to provide more effective scaffolding, validation and calibration of clinical judgments and patient management.

During the COVID-19 (coronavirus disease 2019) pandemic, universities had to shift from face-to-face to emergency remote education. Students were forced to study online, with limited access to facilities and less contact with peers and teachers, while at the same time being exposed to more autonomy. This study examined how students adapted to emergency remote learning, specifically focusing on students’ resource-management strategies using an individual differences approach. One thousand eight hundred university students completed a questionnaire on their resource-management strategies and indicators of (un)successful adaptation to emergency remote learning. On average, students reported being less able to regulate their attention, effort, and time and less motivated compared to the situation before the crisis started; they also reported investing more time and effort in their self-study. Using a k-means cluster analysis, we identified four adaptation profiles and labeled them according to the reported changes in their resource-management strategies: the overwhelmed, the surrenderers, the maintainers, and the adapters. Both the overwhelmed and surrenderers appeared to be less able to regulate their effort, attention, and time and reported to be less motivated to study than before the crisis. In contrast, the adapters appreciated the increased level of autonomy and were better able to self-regulate their learning. The resource-management strategies of the maintainers remained relatively stable. Students’ responses to open-answer questions on their educational experience, coded using a thematic analysis, were consistent with the quantitative profiles. Implications about how to support students in adapting to online learning are discussed.

Objectives It remains unclear how medical educators can more effectively bridge the gap between trainees' intolerance of uncertainty and the tolerance that experienced physicians demonstrate in practice. Exploring how experienced clinicians experience, appraise and respond to discomfort arising from uncertainty could provide new insights regarding the kinds of behaviours we are trying to help trainees achieve. Methods We used a constructivist grounded theory approach to explore how emergency medicine faculty experienced, managed and responded to discomfort in settings of uncertainty. Using a critical incident technique, we asked participants to describe case-based experiences of uncertainty immediately following a clinical shift. We used probing questions to explore cognitive, emotional and somatic manifestations of discomfort, how participants had appraised and responded to these cues, and how they had used available resources to act in these moments of uncertainty. Two investigators coded the data line by line using constant comparative analysis and organised transcripts into focused codes. The entire research team discussed relationships between codes and categories, and developed a conceptual framework that reflected the possible relationships between themes. Results Participants identified varying levels of discomfort in their case descriptions. They described multiple cues alerting them to problems that were evolving in unexpected ways or problems with aspects of management that were beyond their abilities. Discomfort served as a trigger for participants to monitor a situation with greater attention and to proceed more intentionally. It also served as a prompt for participants to think deliberately about the types of human and material resources they might call upon strategically to manage these uncertain situations. Conclusions Discomfort served as a dynamic means to manage and respond to uncertainty. To be 'tolerant' of uncertainty thus requires clinicians to embrace discomfort as a powerful tool with which to grapple with the complex problems pervasive in clinical practice.

Practice testing and distributed practice are effective in enhancing learning outcomes and long-term retention. Yet, many students use ineffective learning strategies instead and are reluctant to change them because they hold erroneous beliefs about practice testing and distributed practice. This intervention study examined whether narratives, compared to traditional didactic communication, can change learning strategy-beliefs, stimulate intentions to change ineffective strategy use, and raise awareness of desirable difficulties (i.e., difficulties produced by strategies that slow down the acquisition process but enhance long-term retention and transfer). Narratives and didactic communication did not differ in their change of erroneous beliefs and stimulate intentions to change, but narratives led to a higher awareness of the importance of desirable difficulties for learning.

The Coronavirus disease 2019 (COVID-19) pandemic has altered how medical education is delivered, worldwide. Didactic sessions have transitioned to electronic/online platforms and clinical teaching opportunities are limited. These changes will affect how radiology is taught to medical students at both the pre-clerkship (ie, year 1 and 2) and clinical (ie, year 3 and 4) levels. In the pre-clerkship learning environment, medical students are typically exposed to radiology through didactic lectures, integrated anatomy laboratories, case-based learning, and ultrasound clinical skills sessions. In the clinical learning environment, medical students primarily shadow radiologists and radiology residents and attend radiology resident teaching sessions. These formats of radiology education, which have been the tenets of the specialty, pose significant challenges during the pandemic. This article reviews how undergraduate radiology education is affected by COVID-19 and explores solutions for teaching and learning based on e-learning and blended learning theory.

Extensive research has been conducted to understand how accurately students monitor their studying and performance via metacognitive judgments. Moreover, the bases of students’ metacognitive judgments are of interest. While previous results are quite consistent regarding the importance of performance for the accuracy of metacognitive judgments, results regarding motivational and personality variables are rather heterogeneous. This paper reports on two studies that simultaneously examined the predictive power of several performance, motivational, and personality variables on metacognitive judgments. The studies investigated a set of judgments (local and global postdictions in Study 1 and global pre- and postdictions in Study 2) and accuracy scores (bias, sensitivity, and specificity) in two different settings. Individual differences in judgments and judgment accuracy were studied via hierarchical regression analyses. Study 1 with N = 245 undergraduate students identified performance and domain-specific self-concept as relevant predictors for judgments after test taking. This was consistently found for local and global judgments. Study 2 with N = 138 undergraduate students hence focused on domain-specific self-concept and extended results to predictions. Study 2 replicated results for global postdictions but not predictions. Specifically, before task processing, students’ judgments relied mostly on domain-specific self-concept but not on test performance itself. The studies indicate that different judgments and measures of judgment accuracy are needed to obtain comprehensive insights into individual differences in metacognitive monitoring.

Objective: Evidence-based medicine practices of medical students in clinical scenarios are not well understood. Optimal foraging theory (OFT) is one framework that could be useful in breaking apart information-seeking patterns to determine effectiveness and efficiency of different methods of information seeking. The aims of this study were to use OFT to determine the number and type of resources used in information seeking when medical students answer a clinical question, to describe common information-seeking patterns, and identify patterns associated with higher quality answers to a clinical question.Methods: Medical students were observed via screen recordings while they sought evidence related to a clinical question and provided a written response for what they would do for that patient based on the evidence that they found.Results: Half (51%) of study participants used only 1 source before answering the clinical question. While the participants were able to successfully and efficiently navigate point-of-care tools and search engines, searching PubMed was not favored, with only half (48%) of PubMed searches being successful. There were no associations between information-seeking patterns and the quality of answers to the clinical question.Conclusion: Clinically experienced medical students most frequently relied on point-of-care tools alone or in combination with PubMed to answer a clinical question. OFT can be used as a framework to understand the information-seeking practices of medical students in clinical scenarios. This has implications for both teaching and assessment of evidence-based medicine in medical students.

Rationale and Aim As medical schools reduce the hours of anatomy teaching, residents in anatomy-intensive residency programs like radiology must independently acquire the anatomy knowledge needed to achieve competency. The purpose of this study was to develop and evaluate a 4-week competency-based self-directed anatomy rotation for junior residents. Methods Seven post-graduate year 1 (PGY-1) radiology residents completed a 4-week rotation of radiologic anatomy. The objectives were developed from standards, senior residents, and expert opinion, and the competency-based curriculum included self-directed modules. Pre-course and post-course tests were administered and test scores were compared using an unpaired t test. In addition, PGY-1 residents completed a course evaluation and survey regarding their anatomy knowledge and anatomy exposure prior to completing the course. Results Out of the 25 points available, the average pre-test score was 10.79 ± 2.78 (range 8–16.5), and the average post-test score was 21.64 ± 2.23 (range 18.5–25). This difference was statistically significant ( P < .0001). The PGY-1 residents reported receiving < 10% of dedicated radiologic anatomy teaching prior to residency and felt unprepared for the anatomy required in residency. Overall, residents felt more confident in looking at images after completing the self-directed radiologic anatomy course. Conclusion This study demonstrates the feasibility of creating a self-directed course for radiology residents that significant improves their anatomy knowledge. Given the trend in medical undergraduate education away from dedicated anatomy teaching, residency programs should consider addressing anatomy education more formally for junior residents to ensure that trainees receive the foundational knowledge required for residency.

The current study investigated kindergarteners and second graders' ability to monitor and evaluate their own and a virtual peer's performance in a paired-associate learning task. Participants provided confidence judgments (CJs) for their own responses and performance-based judgments (judgments provided after receiving feedback on their performance) for both their own and a virtual peer's responses. For the performance-based judgments, children were confronted with their own or the peer's answer as well as the correct answer. Additionally, participants were asked to credit their own and the peer's correct and incorrect answers while facing feedback. Results indicate an age-related progression in metacognitive monitoring skills, with second graders differentiating more strongly in their confidence judgments between correct and incorrect responses compared to kindergarteners. Regarding performance-based judgments, children of both age groups provided higher judgments for correctly compared to incorrectly recognized items as well as for their own responses in comparison to the responses of the unknown child. Similarly, when crediting, participants of both age groups gave more credits for correct recognition than for incorrect recognition and for their own responses than for the peer's responses. The significant interaction between age group and recognition accuracy for the crediting shows that second graders gave more credits for correctly recognized items while kindergarteners gave more credits for incorrect answers than the older children - primarily for their own incorrect answers. In conclusion, the study provides new insights into 6- and 8-year-olds' evaluations of their own and an unknown child's performance in a paired-associate learning task by showing that children of both age groups generally judged and credited responses in their own favor. These results add to our understanding of biases in children's performance evaluations, including metacognitive judgments and judgments provided after receiving feedback.

The aim of this Introduction to the Special Issue 'Bridging Cognitive Load and Self-Regulated Learning Research' is to explore how cognitive load theory, which is particularly relevant for how learners deal with complex information, and self-regulated learning theory, which is particularly relevant for how learners use information to monitor and control their learning, can be combined into one joint research paradigm that is relevant for contemporary and future developments in education. The first two sections introduce cognitive load theory and self-regulated learning theory. The third section discusses the main similarities and differences between the theories, and describes how the cue-utilization framework can be used as the basis for a joint research paradigm. The main idea postulated is that new instructional methods should help learners identify diagnostic cues in available information that provide an accurate indication of where learners stand in relation to criterion task performance. Use of these diagnostic cues when monitoring learning will lead to better regulation of learning activities and of mental resources allocated, and thus to more efficient learning and higher learning outcomes.In the fourth section, the six studies and two commentaries presented in this special issue are positioned within this paradigm. In the fifth and final section, a common research agenda based on the joint CLT-SRL paradigm is sketched and its relevance for future developments is explained. The studies presented in this special issue and the two commentaries, which complete the Special Issue, should be seen as a very first step in executing this research agenda. (C) 2017 Elsevier Ltd. All rights reserved.

Children are often overconfident when monitoring their learning, which is harmful for effective control and learning. The current study investigated children's (N = 167, age range 7-12 years) judgments of learning (JOLs) when studying difficult concepts. The main aims were (a) to investigate how JOL accuracy is affected by accessibility cues and (b) to investigate developmental changes in implementing accessibility cues in JOLs. After studying different concepts, children were asked to generate novel sentences and then to make JOLs, select concepts for restudy, and take a final test. Overconfidence for incorrect and incomplete test responses was reduced for older children in comparison with younger children. For older age groups, generating a sentence led to greater overconfidence compared with not being able to generate a sentence, which indicates that older children relied more on accessibility cues when making JOLs. This pattern differed in the youngest age group; younger children were generally overconfident regardless of whether they had generated sentences or not. Overconfidence was disadvantageous for effective control of learning for all age groups. These findings imply that instructions to encourage children to avoid metacognitive illusions need to be adapted to children's developmental stage. (C) 2017 Elsevier Inc. All rights reserved.

In order to ensure long-term retention of information students must move from relying on surface-level approaches that are seemingly effective in the short-term to "building in" so called "desirable difficulties," with the aim of achieving understanding and long-term retention of the subject matter. But how can this level of self-regulation be achieved by students when learning? Traditionally, research on learning strategy use is performed using self-report questionnaires. As this method is accompanied by several drawbacks, we chose a qualitative, in-depth approach to inquire about students' strategies and to investigate how students successfully self-regulate their learning. In order to paint a picture of effective learning strategy use, focus groups were organized in which previously identified, effectively self-regulating students (N = 26) were asked to explain how they approach their learning. Using a constructivist grounded theory methodology, a model was constructed describing how effective strategy users manage their learning. In this model, students are driven by a personal learning goal, adopting a predominantly qualitative, or quantitative approach to learning. While learning, students are continually engaged in active processing and self-monitoring. This process is guided by a constant balancing between adhering to established study habits, while maintaining a sufficient degree of flexibility to adapt to changes in the learning environment, assessment demands, and time limitations. Indeed, students reported using several strategies, some of which are traditionally regarded as "ineffective" (highlighting, rereading etc.). However, they used them in a way that fit their learning situation. Implications are discussed for the incorporation of desirable difficulties in higher education.

Background Medical students need feedback to improve their patient-interviewing skills because self-monitoring is often inaccurate. Effective feedback should reveal any discrepancies between desired and observed performance (cognitive feedback) and indicate metacognitive cues which are diagnostic of performance (metacognitive feedback). We adapted a cue-utilization model to studying supervisors’ cue-usage when preparing feedback and compared doctors’ and non-doctors’ cue usage. Method Twenty-one supervisors watched a video of a patient interview, choose scenes for feedback, and explained their selection. We applied content analysis to categorize and count cue-use frequency per communication pattern (structuring/facilitating) and scene performance rating (positive/negative) for both doctors and non-doctors. Results Both groups used cognitive cues more often than metacognitive cues to explain their scene selection. Both groups also used metacognitive cues such as subjective feelings and mentalizing cues, but mainly the doctors mentioned ‘missing information’ as a cue. Compared to non-doctors, the doctors described more scenes showing negative performance and fewer scenes showing positive narrative-facilitating performance. Conclusions Both groups are well able to communicate their observations and provide cognitive feedback on undergraduates’ interviewing skills. To improve their feedback, supervisors should be trained to also recognize metacognitive cues, such as subjective feelings and mentalizing cues, and learn how to convert both into metacognitive feedback.

In order to support learners with their learning processes, using effective strategies is important. Students are expected to monitor and regulate their own learning to a great extent, especially when learning takes place in digital learning environments. However, students tend to overestimate their own performance, which is problematic for decisions on their future learning, especially with complex problem-solving tasks that impose a high cognitive load. Using collaborative learning as a strategy to divide the demands of learning, learners can create a collective cognitive capacity. Supporting the use of shared regulation of learning, collective working memory, and team cognition as strategies for learning, could theoretically improve self-regulated learning skills such as monitoring and regulation both at the individual and the group level. From this discussion, possible future research questions on how collaborative learning could be a strategy to support SRL will be suggested.

Cognitive psychological research from the last decades has shown that learning strategies that create desirable difficulties during learning, e.g., practice testing, are most effective for long-term learning outcomes. However, there is a paucity of research on how to effectively translate these insights into training students in higher education. Therefore, we designed an intervention program aiming to create awareness about, foster reflection on, and stimulate practice of effective learning strategies. In a first examination of the pilot intervention (N = 47), we tested the effects of the intervention on metacognitive knowledge and self-reported use of effective learning strategies during self-study, using a control-group mixed-methods design. The intervention program had positive effects on knowledge about effective learning strategies and increased the use of practice testing. Qualitative interview results suggested that to sustainably change students’ learning strategies, we may consider tackling their uncertainty about effort and time, and increase availability of practice questions.

For ∼40 years, thinking about reasoning has been dominated by dual-process theories. This model, consisting of two distinct types of human reasoning, one fast and effortless and the other slow and deliberate, has also been applied to medical diagnosis. Medical experts are trained to diagnose patients based on their symptoms. When symptoms are prototypical for a certain diagnosis, practitioners may rely on fast, recognition-based reasoning. However, if they are confronted with ambiguous clinical information slower, analytical reasoning is required. To examine the neural underpinnings of these two hypothesized forms of reasoning, 16 highly experienced clinical neurologists were asked to diagnose two types of medical cases, straightforward and ambiguous cases, while functional magnetic resonance imaging was being recorded. Compared with reading control sentences, diagnosing cases resulted in increased activation in brain areas typically found to be active during reasoning such as the caudate nucleus and frontal and parietal cortical regions. In addition, we found vast increased activity in the cerebellum. Regarding the activation differences between the two types of reasoning, no pronounced differences were observed in terms of regional activation. Notable differences were observed, though, in functional connectivity: cases containing ambiguous information showed stronger connectivity between specific regions in the frontal, parietal and temporal cortex in addition to the cerebellum. Based on these results, we propose that the higher demands in terms of controlled cognitive processing during analytical medical reasoning may be subserved by stronger communication between key regions for detecting and resolving uncertainty., Here, experienced neurologists diagnosed straightforward and ambiguous cases while brain activity was measured using functional magnetic resonance imaging. Results show involvement, and differential connectivity of brain regions associated with the detection of ambiguity, attention and information content processing. The findings are consistent with a dynamic schematic anticipation model of medical reasoning., Graphical Abstract Graphical Abstract

de Bruin argues that efforts to eradicate erroneous assumptions students and teachers hold about learning requires refutation, a process that combines both correct scientific knowledge and rejection of misconceptions.

Since emergence of the field ‘Educational Neuroscience’ (EN) in the late nineties of the previous century, a debate has emerged about the potential this field holds to influence teaching and learning in the classroom. By now, most agree that the original claims promising direct translations to teaching and learning were too strong. I argue here that research questions in (health professions) education require multi-methodological approaches, including neuroscience, while carefully weighing what (combination of) approaches are most suitable given a research question. Only through a multi-methodological approach will convergence of evidence emerge, which is so desperately needed for improving teaching and learning in the classroom. However, both researchers and teachers should become aware of the so-called ‘seductive allure’ of EN; that is, the demonstrable physical location and apparent objectivity of the measurements can be interpreted as yielding more powerful evidence and warranting stronger conclusions than, e.g., behavioral experiments, where in fact oftentimes the reverse is the case. I conclude that our tendency as researchers to commit ourselves to one methodological approach and to addressing educational research questions from a single methodological perspective is limiting progress in educational science and in translation to education.

Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.

Background Grandiosity is designated as a hallmark trait of narcissism. The current study tested whether narcissistic traits are related to overestimation of a range of agentic performances. Method Eighty-five non-patients executed six objective tasks to assess their level of (emotional) intelligence, first impression, attractiveness, social skills and learning performance. They were also asked to estimate their level of functioning in these six areas. This estimation was given on two moments: before and after performing the objective tasks. Our main variable of interest was the degree to which subjective estimation exceeds objective scores. Results Narcissistic traits were related to overestimation of (emotional) intelligence, attractiveness and social skills, particularly at a global level before performing the tasks. Limitations The use of a homogenous student sample; Mainly agentic performances, were studied. Conclusion Overall, the findings provide a theoretical validation of unwarranted feelings of grandiosity as a core narcissistic criterion. Copyright © 2016 John Wiley & Sons, Ltd.

In order to ensure long-term retention of information students must move from relying on surface-level approaches that are seemingly effective in the short-term to "building in" so called "desirable difficulties," with the aim of achieving understanding and long-term retention of the subject matter. But how can this level of self-regulation be achieved by students when learning? Traditionally, research on learning strategy use is performed using self-report questionnaires. As this method is accompanied by several drawbacks, we chose a qualitative, in-depth approach to inquire about students' strategies and to investigate how students successfully self-regulate their learning. In order to paint a picture of effective learning strategy use, focus groups were organized in which previously identified, effectively self-regulating students (N = 26) were asked to explain how they approach their learning. Using a constructivist grounded theory methodology, a model was constructed describing how effective strategy users manage their learning. In this model, students are driven by a personal learning goal, adopting a predominantly qualitative, or quantitative approach to learning. While learning, students are continually engaged in active processing and self-monitoring. This process is guided by a constant balancing between adhering to established study habits, while maintaining a sufficient degree of flexibility to adapt to changes in the learning environment, assessment demands, and time limitations. Indeed, students reported using several strategies, some of which are traditionally regarded as "ineffective" (highlighting, rereading etc.). However, they used them in a way that fit their learning situation. Implications are discussed for the incorporation of desirable difficulties in higher education.

Adolescence is associated with widespread maturation of brain structures and functional connectivity profiles that shift from local to more distributed and better integrated networks, which are active during a variety of cognitive tasks. Nevertheless, the approach to examine task-induced developmental brain changes is function-specific, leaving the question open whether functional maturation is specific to the particular cognitive demands of the task used, or generalizes across different tasks. In the present study we examine the hypothesis that functional brain maturation is driven by global changes in how the brain handles cognitive demands. Multivariate pattern classification analysis (MVPA) was used to examine whether age discriminative task-induced activation patterns generalize across a wide range of information processing levels. 25 young (13-years old) and 22 old (17-years old) adolescents performed three conceptually different tasks of metacognition, cognition and visual processing. MVPA applied within each task indicated that task-induced brain activation is consistent and reliably different between ages 13 and 17. These age-discriminative activation patterns proved to be common across the different tasks used, despite the differences in cognitive demands and brain structures engaged by each of the three tasks. MVP classifiers trained to detect age-discriminative patterns in brain activation during one task were significantly able to decode age from brain activation maps during execution of other tasks with accuracies between 63 and 75%. The results emphasize that age-specific characteristics of task-induced brain activation have to be understood at the level of brain-wide networks that show maturational changes in their organization and processing efficacy during adolescence.

Rationale and Objectives Radiologists commonly use comparison films to improve their differential diagnosis. Educational literature suggests that this technique might also be used to bolster the process of learning to interpret radiographs. We investigated the effectiveness of three comparison techniques in medical students, whom we invited to compare cases of the same disease (same-disease comparison), cases of different diseases (different-disease comparison), disease images with normal images (disease/normal comparison), and identical images (no comparison/control condition). Furthermore, we used eye-tracking technology to investigate which elements of the two cases were compared by the students. Materials and Methods We randomly assigned 84 medical students to one of four conditions and had them study different diseases on chest radiographs, while their eye movements were being measured. Thereafter, participants took two tests that measured diagnostic performance and their ability to locate diseases, respectively. Results Students studied most efficiently in the same-disease and different-disease comparison conditions: test 1, F (3, 68) = 3.31, P = .025, η p 2 = 0.128; test 2, F (3, 65) = 2.88, P = .043, η p 2 = 0.117. We found that comparisons were effected in 91% of all trials (except for the control condition). Comparisons between normal anatomy were particularly common (45.8%) in all conditions. Conclusions Comparing cases can be an efficient way of learning to interpret radiographs, especially when the comparison technique used is specifically tailored to the learning goal. Eye tracking provided insight into the comparison process, by showing that few comparisons were made between abnormalities, for example.

Prescribing tasks, which involve pharmacological knowledge, clinical decision-making and practical skill, take place within unpredictable social environments and involve interactions within and between endlessly changing health care teams. Despite this, curriculum designers commonly assume them to be simple to learn and perform. This research used mixed methods to explore how undergraduate medical students learn to prescribe in the 'real world'. It was informed by cognitive psychology, sociocultural theory, and systems thinking. We found that learning to prescribe occurs as a dynamic series of socially negotiated interactions within and between individuals, communities and environments. As well as a thematic analysis, we developed a framework of three conceptual spaces in which learning opportunities for prescribing occur. This illustrates a complex systems view of prescribing education and defines three major system components: the "social space", where the environmental conditions influence or bring about a learning experience; the "process space", describing what happens during the learning experience; and the intra-personal "cognitive space", where the learner may develop aspects of prescribing expertise. This conceptualisation broadens the scope of inquiry of prescribing education research by highlighting the complex interplay between individual and social dimensions of learning. This perspective is also likely to be relevant to students' learning of other clinical competencies.

To effectively self-regulate learning, children need to self-evaluate whether they meet learning goals. Unfortunately, self-evaluations are often inaccurate, typically, children are overconfident. We investigated two explanations for developmental progression in self-evaluations related to children's (48 5/6 year-olds and 53 7/8-year-olds) interpretations of performance: Improved reliance on item difficulty, and reduced sensitivity to self-protection biases. Self-evaluations were more accurate for 7/8-year-olds than for 5/6-year-olds. There was no developmental increase in reliance on item difficulty; even 5/6-year-olds made adaptive use of this cue. Both age groups were overconfident for incorrect responses, but were able to use performance feedback to improve confidence judgments. However, when self-rewarding, 5/6 year-olds were less likely to take negative performance feedback into account than 7/8-year-olds. The 5/6-year-olds were able to base confidence judgments on performance feedback, but did not use feedback to the same extent when self-rewarding. This may indicate that self-protective biases are an important cause of overconfidence in children. (C) 2016 Elsevier Ltd. All rights reserved.

Context Being able to accurately monitor learning activities is a key element in self-regulated learning in all settings, including medical schools. Yet students' ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students' monitoring can optimise self-regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research.Cognitive Psychology Effective monitoring depends on students' ability to generate information (cues') that accurately reflects their knowledge and skills. The ability of these cues' to predict achievement is referred to as cue diagnosticity'. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self-generation of cues and (ii) generation of cues that is delayed after self-study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used.Application to Medical Education Limited evidence exists about interventions to improve the accuracy of self-monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self-monitoring, thereby improving self-study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning.Conclusions Improving self-regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self-regulated learning and achievement. This framework is applicable to learning in several areas, including the development of clinical reasoning.

Research on expository text has shown that the accuracy of students' judgments of learning (JOLs) can be improved by instructional interventions that allow students to test their knowledge of the text. The present study extends this research, investigating whether allowing students to test the knowledge they acquired from studying a worked example by means of solving an identical problem, either immediately or delayed, would enhance JOL accuracy. Fifth grade children (i) gave an immediate JOL, (ii) a delayed JOL, (iii) solved a problem immediately and then gave a JOL, (iv) solved a problem immediately and gave a delayed JOL, or (v) solved a problem at a delay and then gave a JOL. Results show that problem solving after example study improved children's JOL accuracy (i.e., overestimation decreased). However, no differences in the accuracy of restudy indications were found. Results are discussed in relation to cue utilization when making JOLs.

Background: Checking diagnostic and management decisions can help reduce medical error, however, little literature explores how this is best taught. Aims: To provide practical advice to direct teaching practices. Methods: The authors conducted a literature review using Medline and PsychInfo using search terms: check or checklist and medical error or diagnostic error, supplemented by a manual search through cited literature. Conclusion: Twelve tips for teaching how to check diagnostic and management decisions are presented.

Eight factors are claimed to have a negative influence on anatomical knowledge of medical students: (1) teaching by nonmedically qualified teachers, (2) the absence of a core anatomy curriculum, (3) decreased use of dissection as a teaching tool, (4) lack of teaching anatomy in context, (5) integrated curricula (problem-based learning or systems-based curricula), (6) inadequate assessment of anatomical knowledge, (7) decreased anatomy teaching time, and (8) neglect of vertical integration of anatomy teaching. A recent review revealed a lack of evidence underpinning any of the claims owing to the poor quality of papers, and recommendations were made for education and research on teaching in context and the implementation of vertical integration and of assessment strategies. In this article, we will describe the alleged factors fully, revealing additional recommendations for improving anatomy education by promoting recognition for teaching in institutions, by enhancing the professional recognition of anatomists through the implementation of a national postgraduate training program, and by encouraging anatomists to participate in educational research.

Children differ in their ability to build referentially coherent discourse representations. Using a visual world paradigm, we investigated how these differences might emerge during the online processing of spoken discourse. We recorded eye movements of 69 children (6–11 years of age) as they listened to a 7-min story and concurrently viewed a display containing line drawings of the protagonists. Throughout the story, the protagonists were referenced by either a name (e.g., rabbit ) or an anaphoric pronoun (e.g., he ). Results showed that the probability of on-target fixations increased after children heard a proper name, but not after they heard an anaphoric pronoun. However, differences in the probability of on-target fixation at word onset indicate that the referents of anaphoric pronouns were anticipated by good comprehenders, but less so by poor comprehenders. These findings suggest that comprehension outcomes are related to the online processing of discourse-level cues that regulate the accessibility of entities.

Previous studies have generally found no relation between IQ and chess skill in chess experts. This lack of a relation could be due to the influence of practice being more important than IQ in chess expertise. An alternative explanation is that IQ is relatively high and might therefore be restricted in range in chess experts. The current study investigated the contribution of practice, IQ and motivation to chess performance prospectively in a group of young, novice chess players in which IQ restriction of range did not play a role. Children who entered their first chess course were asked to complete weekly diaries indicating the amount of practice and their enjoyment of the course. IQ and motivation were measured using standardized tests. Using pith analysis, we found that IQ and practice independently predicted chess performance on a chess test at the end of the course: Motivation influenced performance indirectly, by moderating the amount of practice that was undertaken. The results indicate that, at the early stages of expertise development, IQ and motivation influence chess performance.

When studying verbal materials, both adults and children are often poor at accurately monitoring their level of learning and regulating their subsequent restudy of materials, which leads to suboptimal test performance. The present experiment investigated how monitoring accuracy and regulation of study could be improved when learning idiomatic phrases. Elementary school children (fourth and sixth-graders) were instructed to predict their test performance by providing judgments of learning (JOLs). They provided JOLs immediately after studying each idiom, after studying all idioms, or after studying all idioms followed by generating sentences in which the idioms were used. Correlations between JOLs and test performance showed that delayed-JOLs and delayed-JOLs with sentence generation were more accurate than immediate JOLs. JOLs after sentence generation also improved regulation of study compared to delayed-JOLs only. Analyses of JOL reaction times suggest that delayed-JOLs led children to retrieve the literal meaning of the idiom, whereas JOLs after sentence generation led children to focus on connections between studied information, contextual information, and prior knowledge. Sentence generation presents a promising method to improve regulation of study, and thus idiom learning.