Improving the learning of clinical reasoning through computer-based cognitive representation

Objective: Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems. Methods: Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process. Results: A significant improvement was found in students’ learning products from the beginning to the end of the study, consistent with students’ report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment. Conclusions: The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction

Exploring Ecosystems from the Inside: How Immersive Multi-user Virtual Environments Can Support Development of Epistemologically Grounded Modeling Practices in Ecosystem Science Instruction

Recent reform efforts and the next generation science standards emphasize the importance of incorporating authentic scientific practices into science instruction. Modeling can be a particularly challenging practice to address because modeling occurs within a socially structured system of representation that is specific to a domain. Further, in the process of modeling, experts interact deeply with domain-specific content knowledge and integrate modeling with other scientific practices in service of a larger investigation. It can be difficult to create learning experiences enabling students to engage in modeling practices that both honor the position of the novice along a spectrum toward more expert understanding and align well with the practices and reasoning used by experts in the domain. In this paper, we outline the challenges in teaching modeling practices specific to the domain of ecosystem science, and we present a description of a curriculum built around an immersive virtual environment that offers unique affordances for supporting student engagement in modeling practices. Illustrative examples derived from pilot studies suggest that the tools and context provided within the immersive virtual environment helped support student engagement in modeling practices that are epistemologically grounded in the field of ecosystem science

EcoMOBILE – Designing for contextualized STEM learning using mobile technologies and augmented reality

The ubiquity of mobile technologies can unlock new opportunities for “anytime, anywhere” learning, and some argue that portable mobile platforms will inherently lead to more contextualized learning experiences. However, the meaning of contextualization and how to achieve it in mobile designs bears further examination, as the greater the level of contextualization, the more difficult it may be to scale mobile designs. Context is a product of the interaction among learners, the personal, social and physical resources at hand, and mobile technologies. We examine how, through the affordances of mobile technologies, designers might emphasize different aspects of social and physical context in order to support learning. In particular, augmented reality enables students to interact—via mobile wireless devices—with virtual information, visualizations, and simulations superimposed on real-world physical landscapes. The EcoMOBILE activity considered here involved student participation in an outdoor field trip near their school using mobile broadband devices running augmented reality software. We present a case study highlighting two designs focused on a similar middle- grades science learning goal of exploring the local watershed – a place-dependent, collaborative design (“Take a Tour”) and a place-independent, individual design (“Follow the Flow”). We implemented these designs with two different teachers each with four classes of students. We present detailed comparison of the design logic and features of each experience, and a summary of feedback from interviews and student focus groups with attention to feelings of contextualization, engagement and support for learning. Our results showed little difference in student comments related to the contextualization of the experience, which suggests that carefully constructed, yet minimalist designs may support a perception of contextualization that comes from the perspective of the user rather than from the device. A place-independent mobile learning experience may, with minimal modification, be used in a location other than the one in which it was designed, and may still have positive effects on feelings of contextualization, engagement and support for learning among participants

Teacher Perceptions of the Practicality and Effectiveness of Immersive Ecological Simulations as Classroom Curricula

Recent research with Multi-User Virtual Environments (MUVEs) in education has shown that these platforms can be effective and engaging for students; however, educators and administrators have practical concerns about the adoption of MUVE-based curricula. This study looks at implementations of EcoMUVE, a MUVE-based curriculum designed to support middle school learning of ecosystem concepts and processes. Research questions looked at teacher perceptions of the curriculum’s implementation feasibility, alignment with curricular objectives and standards, and perceived value. Results showed that EcoMUVE was very well-received, and technical issues were manageable. Teachers felt the curriculum was effective, aligned well with standards, and compared favorably with a non-MUVE alternative. Particular technological and curriculum features that contributed to EcoMUVE’s perceived value included student-directed learning, an inquiry, role-based pedagogy, immersion in the virtual environment, and the ease of collecting and comparing data with graphs

Atom tracker: Designing a mobile augmented reality experience to support instruction about cycles and conservation of matter in outdoor learning environments

We describe a mobile augmented reality (AR) experience called Atom Tracker designed to help middle school students better understand the cycling of matter in ecosystems with a focus on the concept of conservation of matter and the processes of photosynthesis and respiration. Location-based AR allows students to locate virtual "hotspots," where they interact with multiple representations including vision-based AR animations of virtual atoms during ecological processes such as photosynthesis and physical LEGO® -based representations of molecules. This design case describes the design rationale, the iterative design process, the context for implementation, and reflections on the success and limitations of the Atom Tracker AR experience. An augmented reality interface was chosen due to theoretical support for its utility in supporting interaction with multiple representations (both physical and virtual) of atoms and molecules, the ability to condense and expand temporal and spatial scales associated with ecological processes, and its ability to explicitly situate these representations in real-world contexts that could support learning. Two significant design challenges that we recognized were (a) appropriately leveraging narrative, student engagement and agency when designing around the topic of atoms and molecules, which are inanimate and invisible; and (b) designing for engagement with both virtual and physical resources available during the experience

EcoMOBILE: Integrating augmented reality and probeware with environmental education field trips

Positioned in the context of situated learning theory, the EcoMOBILE project combines an augmented reality (AR) experience with use of environmental probeware during a field trip to a local pond environment. Activities combining these two technologies were designed to address ecosystem science learning goals for middle school students, and aid in their understanding and interpretation of water quality measurements. The intervention was conducted with five classes of sixth graders from a northeastern school district as a pilot study for the larger EcoMOBILE project, and included pre-field trip training, a field trip to a local pond environment, and post-field trip discussions in the classroom. During the field experience, students used mobile wireless devices with FreshAiR™, an augmented reality application, to navigate the pond environment and to observe virtual media and information overlaid on the physical pond. This AR experience was combined with probeware, in that students collected water quality measurements at designated AR hotspots during the experience. We studied the characteristics of learning and instruction using measures of student attitudes, content learning gains, and opinions teachers provided via written and verbal feedback. We observed gains in student affective measures and content understanding following the intervention. Teachers reported that the combined technologies promoted student interaction with the pond and with classmates in a format that was student-centered rather than teacher-directed. Teachers also reported that students demonstrated deeper understanding of the principles of water quality measurement than was typical on prior field trips without these technologies and that students had expanded opportunities to engage in activities that resemble scientific practice. Overall, results of the students' surveys and teacher feedback suggest that there are multiple benefits to using this suite of technologies for teaching and for learning

Turning Transfer Inside Out: The Affordances of Virtual Worlds and Mobile Devices in Real World Contexts for Teaching About Causality Across Time and Distance in Ecosystems

Reasoning about ecosystems includes consideration of causality over temporal and spatial distances; yet learners typically focus on immediate time frames and local contexts. Teaching students to reason beyond these boundaries has met with some success based upon tests that cue students to the types of reasoning required. Virtual worlds offer an opportunity to assess what students actually do in a simulated context. Beyond this, mobile devices make it possible to scaffold and assess learning in the real world. Situating learning outside, in the target contexts, bypasses many of the challenges of transfer. A study investigated the learning of fifth and sixth graders (n = 38) while they used a virtual world called EcoMUVE, designed to support learning of ecosystems concepts and complex causal dynamics, and mobile broadband device (MBDs) components, designed to assess and support learning and transfer in a real pond ecosystem. The experiences of two classes were contrasted as reference populations; one class participated in the MBD experience first, followed by the learning components in EcoMUVE; the other participated in EcoMUVE first, followed by the MBD components. Rich and triangulated data was collected to illuminate how students experienced and responded to the curriculum components. Both classes made learning gains in EcoMUVE. Students who completed EcoMUVE prior to their MBD experience transferred concepts to their pond explorations. Both classes made learning gains at the pond following the MBD support and revealed more expert reasoning about the importance of change over time and distant drivers in ecosystem dynamics

Mobile Phone Use and Brain Tumors in Children and Adolescents: A Multicenter Case-Control Study

Background It has been hypothesized that children and adolescents might be more vulnerable to possible health effects from mobile phone exposure than adults. We investigated whether mobile phone use is associated with brain tumor risk among children and adolescents. Methods CEFALO is a multicenter case-control study conducted in Denmark, Sweden, Norway, and Switzerland that includes all children and adolescents aged 7-19 years who were diagnosed with a brain tumor between 2004 and 2008. We conducted interviews, in person, with 352 case patients (participation rate: 83%) and 646 control subjects (participation rate: 71%) and their parents. Control subjects were randomly selected from population registries and matched by age, sex, and geographical region. We asked about mobile phone use and included mobile phone operator records when available. Odds ratios (ORs) for brain tumor risk and 95% confidence intervals (CIs) were calculated using conditional logistic regression models. Results Regular users of mobile phones were not statistically significantly more likely to have been diagnosed with brain tumors compared with nonusers (OR = 1.36; 95% CI = 0.92 to 2.02). Children who started to use mobile phones at least 5 years ago were not at increased risk compared with those who had never regularly used mobile phones (OR = 1.26, 95% CI = 0.70 to 2.28). In a subset of study participants for whom operator recorded data were available, brain tumor risk was related to the time elapsed since the mobile phone subscription was started but not to amount of use. No increased risk of brain tumors was observed for brain areas receiving the highest amount of exposure. Conclusion The absence of an exposure-response relationship either in terms of the amount of mobile phone use or by localization of the brain tumor argues against a causal associatio

Spectrum and prevalence of genetic predisposition in medulloblastoma: a retrospective genetic study and prospective validation in a clinical trial cohort.

BACKGROUND: Medulloblastoma is associated with rare hereditary cancer predisposition syndromes; however, consensus medulloblastoma predisposition genes have not been defined and screening guidelines for genetic counselling and testing for paediatric patients are not available. We aimed to assess and define these genes to provide evidence for future screening guidelines. METHODS: In this international, multicentre study, we analysed patients with medulloblastoma from retrospective cohorts (International Cancer Genome Consortium [ICGC] PedBrain, Medulloblastoma Advanced Genomics International Consortium [MAGIC], and the CEFALO series) and from prospective cohorts from four clinical studies (SJMB03, SJMB12, SJYC07, and I-HIT-MED). Whole-genome sequences and exome sequences from blood and tumour samples were analysed for rare damaging germline mutations in cancer predisposition genes. DNA methylation profiling was done to determine consensus molecular subgroups: WNT (MBWNT), SHH (MBSHH), group 3 (MBGroup3), and group 4 (MBGroup4). Medulloblastoma predisposition genes were predicted on the basis of rare variant burden tests against controls without a cancer diagnosis from the Exome Aggregation Consortium (ExAC). Previously defined somatic mutational signatures were used to further classify medulloblastoma genomes into two groups, a clock-like group (signatures 1 and 5) and a homologous recombination repair deficiency-like group (signatures 3 and 8), and chromothripsis was investigated using previously established criteria. Progression-free survival and overall survival were modelled for patients with a genetic predisposition to medulloblastoma. FINDINGS: We included a total of 1022 patients with medulloblastoma from the retrospective cohorts (n=673) and the four prospective studies (n=349), from whom blood samples (n=1022) and tumour samples (n=800) were analysed for germline mutations in 110 cancer predisposition genes. In our rare variant burden analysis, we compared these against 53 105 sequenced controls from ExAC and identified APC, BRCA2, PALB2, PTCH1, SUFU, and TP53 as consensus medulloblastoma predisposition genes according to our rare variant burden analysis and estimated that germline mutations accounted for 6% of medulloblastoma diagnoses in the retrospective cohort. The prevalence of genetic predispositions differed between molecular subgroups in the retrospective cohort and was highest for patients in the MBSHH subgroup (20% in the retrospective cohort). These estimates were replicated in the prospective clinical cohort (germline mutations accounted for 5% of medulloblastoma diagnoses, with the highest prevalence [14%] in the MBSHH subgroup). Patients with germline APC mutations developed MBWNT and accounted for most (five [71%] of seven) cases of MBWNT that had no somatic CTNNB1 exon 3 mutations. Patients with germline mutations in SUFU and PTCH1 mostly developed infant MBSHH. Germline TP53 mutations presented only in childhood patients in the MBSHH subgroup and explained more than half (eight [57%] of 14) of all chromothripsis events in this subgroup. Germline mutations in PALB2 and BRCA2 were observed across the MBSHH, MBGroup3, and MBGroup4 molecular subgroups and were associated with mutational signatures typical of homologous recombination repair deficiency. In patients with a genetic predisposition to medulloblastoma, 5-year progression-free survival was 52% (95% CI 40-69) and 5-year overall survival was 65% (95% CI 52-81); these survival estimates differed significantly across patients with germline mutations in different medulloblastoma predisposition genes. INTERPRETATION: Genetic counselling and testing should be used as a standard-of-care procedure in patients with MBWNT and MBSHH because these patients have the highest prevalence of damaging germline mutations in known cancer predisposition genes. We propose criteria for routine genetic screening for patients with medulloblastoma based on clinical and molecular tumour characteristics. FUNDING: German Cancer Aid; German Federal Ministry of Education and Research; German Childhood Cancer Foundation (Deutsche Kinderkrebsstiftung); European Research Council; National Institutes of Health; Canadian Institutes for Health Research; German Cancer Research Center; St Jude Comprehensive Cancer Center; American Lebanese Syrian Associated Charities; Swiss National Science Foundation; European Molecular Biology Organization; Cancer Research UK; Hertie Foundation; Alexander and Margaret Stewart Trust; V Foundation for Cancer Research; Sontag Foundation; Musicians Against Childhood Cancer; BC Cancer Foundation; Swedish Council for Health, Working Life and Welfare; Swedish Research Council; Swedish Cancer Society; the Swedish Radiation Protection Authority; Danish Strategic Research Council; Swiss Federal Office of Public Health; Swiss Research Foundation on Mobile Communication; Masaryk University; Ministry of Health of the Czech Republic; Research Council of Norway; Genome Canada; Genome BC; Terry Fox Research Institute; Ontario Institute for Cancer Research; Pediatric Oncology Group of Ontario; The Family of Kathleen Lorette and the Clark H Smith Brain Tumour Centre; Montreal Children's Hospital Foundation; The Hospital for Sick Children: Sonia and Arthur Labatt Brain Tumour Research Centre, Chief of Research Fund, Cancer Genetics Program, Garron Family Cancer Centre, MDT's Garron Family Endowment; BC Childhood Cancer Parents Association; Cure Search Foundation; Pediatric Brain Tumor Foundation; Brainchild; and the Government of Ontario