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Abstract 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.

Studying texts constitutes a significant part of student learning in health professions education. Key to learning from text is the ability to effectively monitor one's own cognitive performance and take appropriate regulatory steps for improvement. Inferential cues generated during a learning experience typically guide this monitoring process. It has been shown that interventions to assist learners in using comprehension cues improve their monitoring accuracy. One such intervention is having learners to complete a diagram. Little is known, however, about how learners use cues to shape their monitoring judgments. In addition, previous research has not examined the difference in cue use between categories of learners, such as good and poor monitors. This study explored the types and patterns of cues used by participants after being subjected to a diagram completion task prior to their prediction of performance (PoP). Participants' thought processes were studied by means of a think-aloud method during diagram completion and the subsequent PoP. Results suggest that relying on comprehension-specific cues may lead to a better PoP. Poor monitors relied on multiple cue types and failed to use available cues appropriately. They gave more incorrect responses and made commission errors in the diagram, which likely led to their overconfidence. Good monitors, on the other hand, utilized cues that are predictive of learning from the diagram completion task and seemed to have relied on comprehension cues for their PoP. However, they tended to be cautious in their judgement, which probably made them underestimate themselves. These observations contribute to the current understanding of the use and effectiveness of diagram completion as a cue-prompt intervention and provide direction for future research in enhancing monitoring accuracy.

Recent research has suggested that students prefer restudying over retrieval practice when learning difficult materials, despite the latter being a more effective learning strategy. The current study investigated whether an instructional intervention can improve the use of retrieval practice for both easy and difficult materials. In Experiment 1, after initial learning of each item, participants rated their perceived mental effort (PME) and judgment of learning (JOL) for each item. Then, participants chose whether to restudy or take retrieval practice for that item. The results showed that participants chose to take retrieval practice less frequently for difficult items compared to easy ones. Furthermore, participants' ratings of PME and JOL sequentially mediated the relationship between item difficulty and their learning strategy choices. Specifically, difficult items resulted in higher levels of PME, which in turn led to lower JOL, ultimately reducing the likelihood of choosing retrieval practice. In Experiment 2, half of the participants received an instructional intervention, which revealed that while students prefer restudying for difficult items, retrieval practice benefits both easy and difficult items in long-term retention. The remaining half did not receive such intervention and were designated as the control group. The results indicated that, compared to the control group, students who received the intervention increased the odds of choosing retrieval practice for both types of materials after the intervention. The findings of this study suggest that students can be supported to use retrieval practice regardless of item difficulty.

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.

Functional neuroimaging is a useful approach to study the neural correlates of visual perceptual expertise. The purpose of this paper is to review the functional-neuroimaging methods that have been implemented in previous research in this context. First, we will discuss research questions typically addressed in visual expertise research. Second, we will describe which kinds of stimuli are employed and which functional-neuroimaging techniques are implemented in this kind of research, with a special focus on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Third, we will summarize the outcomes of recent studies that addressed the neural correlates of visual expertise and will particularly focus on studies that examined the neural correlates of visual expertise in medical image diagnosis. Finally, the review closes with a discussion of the benefits, caveats, and future directions of cognitive-neuroscience research for studying visual expertise.

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.