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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.

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.

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.

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.

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.

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.

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.

Context Checklists are commonly proposed tools to reduce error. However, when applied by experts, checklists have the potential to increase cognitive load and result in ‘expertise reversal’. One potential solution is to use checklists in the verification stage, rather than in the initial interpretation stage of diagnostic decisions. This may avoid expertise reversal by preserving the experts’ initial approach. Whether checklist use during the verification stage of diagnostic decision making improves experts’ diagnostic decisions is unknown. Methods Fifteen experts interpreted 18 electrocardiograms (ECGs) in four different conditions: undirected interpretation; verification without a checklist; verification with a checklist, and interpretation combined with verification with a checklist. Outcomes included the number of errors, cognitive load, interpretation time and interpretation length. Outcomes were compared in two analyses: (i) a comparison of verification conditions with and without a checklist, and (ii) a comparison of all four conditions. Standardised scores for each outcome were used to calculate the efficiency of a checklist and to weigh its relative benefit against its relative cost in terms of cognitive load imposed, interpretation time and interpretation length. Results In both analyses, checklist use was found to reduce error (more errors were corrected in verification conditions with checklists [0.29 ± 0.77 versus 0.03 ± 0.61 errors per ECG], and fewer net errors occurred in all conditions with checklists [0.39 ± 1.14 versus 1.04 ± 1.49 errors per ECG]; p

The study investigated whether activation of inaccurate prior knowledge before study contributes to primary-school children’s commission errors and overconfidence in these errors when learning new concepts. Findings indicate that inaccurate prior knowledge affects children’s learning and calibration. The level of children’s judgments of learning for recall responses for which they would not receive credit was inappropriately high after activation of inaccurate prior knowledge. Moreover, results showed that activation of inaccurate prior knowledge was not only detrimental for monitoring judgments during learning, but also for calibration accuracy after test taking. When judging the quality of their recall responses on the posttest, children were more overconfident when they had activated inaccurate prior knowledge. Also, the children often discarded concepts from further study after activation of inaccurate prior knowledge. These results suggest that in order to improve self-regulated learning, it may be important to detect inaccuracies in children’s prior knowledge.

Students’ Judgments of Learning (JOLs) are often inaccurate: students often overestimate their future test performance. Because of the consequences that JOL inaccuracy can have for regulating study activities, an important question is how JOL accuracy can be improved. When learning texts, JOL accuracy has been shown to improve through ‘generation strategies’, such as generating keywords, summaries, or concept maps. This study investigated whether JOL accuracy can also be improved by means of a generation strategy (i.e., completing blank steps in the examples) when learning to solve problems through worked example study. Secondary education students of 14–15 years old (cf. USA 9th grade) either studied worked examples or completed partially worked examples and gave JOLs. It was found that completion of worked examples resulted in underestimation of future test performance. It seems that completing partially worked-out examples made students less confident about future performance than studying fully worked examples. However, this did not lead to better regulation of study.

Educators must select the best tools to teach anatomy to future physicians and traditionally, cadavers have always been considered the "gold standard" simulator for living anatomy. However, new advances in technology and radiology have created new teaching tools, such as virtual dissection, which provide students with new learning opportunities. Virtual dissection is a novel way of studying human anatomy through patient computed tomography (CT) scans. Through touchscreen technology, students can work together in groups to "virtually dissect" the CT scans to better understand complex anatomic relationships. This article presents the anatomic and pedagogic limitations of cadaveric dissection and explains what virtual dissection is and how this new technology may be used to overcome these limitations.

Summary Models of expertise differences in radiology often do not take into account visual differences between diseases. This study investigates the bottom-up effects of three types of images on viewing patterns of students, residents and radiologists: focal diseases (localized abnormality), diffuse diseases (distributed abnormality) and images showing no abnormalities (normal). Participants inspected conventional chest radiographs while their eye movements were recorded. Regardless of expertise, in focal diseases, participants fixated relatively long at specific locations, whereas in diffuse diseases, fixations were more dispersed and shorter. Moreover, for students, dispersion of fixations was higher on diffuse compared with normal images, whereas for residents and radiologists, dispersion was highest on normal images. Despite this difference, students showed relatively high performance on normal images but low performance on focal and diffuse images. Viewing patterns were strongly influenced by bottom-up stimulus effects. Although viewing behavior of students was similar to that of radiologists, they lack knowledge that helps them diagnose the disease correctly. Copyright © 2012 John Wiley & Sons, Ltd.

The ability to monitor understanding of texts, usually referred to as metacomprehension accuracy, is typically quite poor in adult learners: however, recently interventions have been developed to improve accuracy. In two experiments, we evaluated whether generating delayed keywords prior to judging comprehension improved metacomprehension accuracy for children. For sixth and seventh graders, metacomprehension accuracy was greater when generating keywords. By contrast, for fourth graders, metacomprehension accuracy did not differ across conditions. Improved metacomprehension accuracy led to improved regulation of study. The delayed keyword effect in children reported here is discussed in terms of situation model activation.

The positive learning effect of metacognitive strategy instructions based on the cue-utilisation framework (Koriat, 1997) has been shown in memorising word pairs and studying expository text. The present study explored the relevance of this framework in cognitive skill acquisition for learners with and without prior domain knowledge. That is, the quality of metacomprehension and self-regulation of novices and more experienced chess players were compared, when learning an endgame of chess. The experienced chess players not only became more skilled at the endgame, but also exemplified higher metacomprehension accuracy and self-regulation than the novices. The absolute level of metacomprehension accuracy and self-regulation of the novices was close to zero. This is the first study that shows an effect of expertise on metacomprehension accuracy in cognitive skill acquisition. Differences between cognitive skill acquisition and text comprehension that might explain differences in quality of metacognitive proce...

This special issue on Innovations in Problem-Based Learning is based on a symposium that was organized during the 11th biennial meeting of the European Association for Research on Learning and Instruction (EARLI) in Nicosia (Cyprus). Most papers in this special issue were presented at this symposium. The aim of this special issue in Advances in Health Sciences Education is to provide an overview of the state of the art in PBL research, and to discuss implications of these recent developments for educational practice. This introductory paper presents a short overview of all contributions to the special issue.

In order to examine the effect of monitoring and self-regulation on skill acquisition, the present study asked novice chess players to provide judgments of learning (JOLs) and to select moves for restudy after studying an endgame of chess. In four groups, we varied the JOL instruction (present versus absent) and the selection instruction (free number of move selections versus selection of at least two moves per chess exercise). After four learning trials, participants were required to play against a chess computer. In the learning phase, participants who were forced to select moves for restudy outperformed those who were free to select moves for restudy when predicting the next computer move, even after controlling for the actual number of restudied moves. Although the groups that did provide JOLs showed better self-regulatory behaviour, there were no or even negative performance differences between the groups that did provide JOLs and the groups that did not provide JOLs. This same pattern emerged in the test phase: Although no differences were found between the groups with and without JOLs, the groups that were forced to select moves for restudy outperformed the groups that were free in the number of move selections. These data show that, for novice chess players, the instruction to provide JOLs possibly places a high and ineffective load on working memory and therefore has no effect on learning a chess endgame. To examine the relation between prior knowledge and quality of self-regulation, further research is needed that examines the effect of the JOL and selection instruction in groups that differ in chess experience. Copyright © 2005 John Wiley & Sons, Ltd.

Checklists are commonly proposed tools to reduce error. However, when applied by experts, checklists have the potential to increase cognitive load and result in 'expertise reversal'. One potential solution is to use checklists in the verification stage, rather than in the initial interpretation stage of diagnostic decisions. This may avoid expertise reversal by preserving the experts' initial approach. Whether checklist use during the verification stage of diagnostic decision making improves experts' diagnostic decisions is unknown.Fifteen experts interpreted 18 electrocardiograms (ECGs) in four different conditions: undirected interpretation; verification without a checklist; verification with a checklist, and interpretation combined with verification with a checklist. Outcomes included the number of errors, cognitive load, interpretation time and interpretation length. Outcomes were compared in two analyses: (i) a comparison of verification conditions with and without a checklist, and (ii) a comparison of all four conditions. Standardised scores for each outcome were used to calculate the efficiency of a checklist and to weigh its relative benefit against its relative cost in terms of cognitive load imposed, interpretation time and interpretation length.In both analyses, checklist use was found to reduce error (more errors were corrected in verification conditions with checklists [0.29 ± 0.77 versus 0.03 ± 0.61 errors per ECG], and fewer net errors occurred in all conditions with checklists [0.39 ± 1.14 versus 1.04 ± 1.49 errors per ECG]; p0.01 for both). Checklists were not associated with increased cognitive load (verifications with and without checklists: 3.7 ± 1.9 and 3.3 ± 2.0, respectively; conditions with and without checklists: 4.0 ± 1.8 versus 3.9 ± 2.0, respectively [p = not significant for both]). Checklists resulted in greater interpretation times and lengths (p0.01 for all). However, checklists were efficient in terms of the cognitive load invested, interpretation time and interpretation length (p0.01 for all).Among ECG interpretation experts, checklist use during the verification stage of diagnostic decisions did not increase cognitive load or cause expertise reversal, but did reduce diagnostic error.

Both retrospective and prospective monitoring are considered important for self-regulated learning of problem-solving skills. Retrospective monitoring (or self-assessment; SA) refers to students' assessments of how well they performed on a problem just completed. Prospective monitoring (or Judgments of Learning; JOLs) refers to students' judgments about how well they will perform on a (similar) problem on a future test. We investigated whether secondary education students' SA accuracy could be improved by training (Experiment 1 and 2), or by providing assessment standards (Experiment 2), and whether this would also affect the accuracy of JOLs. Accurate assessment of past performance might provide a good cue for judging future performance. Both Experiment 1 and 2 showed no effect of training on SA or JOL accuracy, but SA and JOLs were positively correlated with each other and negatively with effort. Providing standards did improve SA and JOL accuracy on identical problems, and performance on all problems.

Comparison learning is a promising approach for learning complex real-life visual tasks. When medical students study radiological appearances of diseases, comparison of images showing diseases with images showing no abnormalities could help them learn to discriminate relevant, disease-related information. Medical students studied 12 diseases on chest x-ray images. They were randomly assigned to a group (n = 31) that compared radiographs of diseases with normal images and a group (n = 30) that only studied radiographs of diseases. On a visual diagnosis test, students who compared with normal images during study were better able to diagnose focal diseases (i.e., lesions at one location) than students who could not compare, but for the diagnosis of diffuse diseases (i.e., involving both lungs) there was no significant difference between groups. Results show that comparison with normal images made it easier to discriminate relevant information for focal diseases.

Being overconfident when estimating scores for an upcoming exam is a widespread phenomenon in higher education and presents threats to self-regulated learning and academic performance. The present study sought to investigate how overconfidence and poor monitoring accuracy vary over the length of a college course, and how an intervention consisting of (1) a monitoring exercise and (2) a monitoring and regulation strategy, improves students’ monitoring accuracy and academic performance. Moreover, we investigated how personality factors (i.e., grandiose and vulnerable narcissism, optimism) influence monitoring accuracy. We found that the monitoring and regulation strategy positively influenced monitoring accuracy and exam scores, whereas the monitoring exercise that confronted students with their overconfidence protected students against overconfidence in the second exam score prediction but did not affect exam score. The results further revealed that exam score predictions lowered from the start to the end of the course for both poor and high performing students, but still leaving poor performers overconfident and high performers underconfident. Topic knowledge gained in the course did not wash out the dunning kruger effect, and results indicate that poor and high performers use different cues when predicting exam scores. Both grandiose and vulnerable narcissism contributed to overconfidence on exam score predictions but not on the monitoring exercise. These findings underline the potential of the monitoring and regulation strategy intervention and ask for upscaling it to include measurements of self-regulated learning activities.

Background: To get insight in how theoretical knowledge is transformed into clinical skills, important information may arise from mapping the development of anatomical knowledge during the undergraduate medical curriculum. If we want to gain a better understanding of teaching and learning in anatomy, it may be pertinent to move beyond the question of how and consider also the what, why and when of anatomy education. Methods: A purposive sample of 78 medical students from the 2nd, 3rd, 4th and 6th year of a PBL curriculum participated in 4 focus groups. Each group came together twice, and all meetings were recorded and transcribed verbatim. Data were analysed with template analysis using a phenomenographical approach. Results: Five major topics emerged and are described covering the students' perceptions on their anatomy education and anatomical knowledge: 1) motivation to study anatomy, 2) the relevance of anatomical knowledge, 3) assessment of anatomical knowledge, 4) students' (in) security about their anatomical knowledge and 5) the use of anatomical knowledge in clinical practice. Conclusions: Results indicated that a PBL approach in itself was not enough to ensure adequate learning of anatomy, and support the hypothesis that educational principles like time-on-task and repetition, have a stronger impact on students' perceived and actual anatomical knowledge than the educational approach underpinning a curriculum. For example, students state that repetitive studying of the subject increases retention of knowledge to a greater extent than stricter assessment, and teaching in context enhances motivation and transfer. Innovations in teaching and assessment, like spiral curriculum, teaching in context, teaching for transfer and assessment for learning (rewarding understanding and higher order cognitive skills), are required to improve anatomy education.