Heath, S., Higgs, J. & Ambruso, D.R. (2008). Evidence of knowledge acquisition in a cognitive flexibility-based computer learning environment. Medical Education Online, Retrieved from www.med-ed-online.org.

What was/were the research question(s) in the article?

1. Is completing the computer program 'Handling Transfusion Hazards' an effective way to learn topics in Transfusion Medicine?
2. Does completing this program in collaboration with another student enhance its effect?

Also, during this study the authors wanted to find how much time the students spent on the program and how they felt about the learning experience.

Was the literature review relevant to the research question(s)?

The authors used the principles of Cognitive Flexibility Theory (CFT) in their study. They are:

• Avoid oversimplifying instruction
• Emphasize case-based instruction
• Provide multiple representations of content
• Support context- dependent knowledge
• Emphasize knowledge construction, not transmission
• Support complexity

What was the methodology used and was it sound?

The three test cases contained a total of 172 lab tests options, 19 assessment issues and 16 management choices. Appropriate responses could earn 30 lab test points, 9 assessment points and 8 management points for a total perfect score of 47 points.

One-hundred thirty-two second-year medical students participated in the study, however only 101 students were included in the final analysis because of missing or inaccurate data. They completed "Handling Transfusion Hazards" during the three-week segment of a course. Students were randomly selected and 1/3 worked individually and 2/3 of the class formed pairs.

On the first day of the study students were introduced to the computer module. Three test cases as a pretest, five practice cases and then the same three test cases were given to the students to complete either individually or with a partner. Subjects were then given the opportunity to provide constructive feedback after finishing the program.

What were the results?

Overall test scores improved 7.8 points from pretest to post-test, however the study didn't show a significant difference between the pairs and individuals. It should be noted that the individuals did take 3.6 minutes longer to complete the practice case.

 The authors also sought how students felt about the learning process. The following table represents the students' comments:

Were the conclusions consistent with the methodology and results?

The authors provided quantitative and qualitative information and the study examined the effects of collaboration on knowledge acquired by advanced learners in a cognitive flexibility theory-based computer world.

The study's components were aligned with the strategies identified earlier in the paper. The study contained a variety of cases to avoid the reductive bias issues (emphasize case-based instruction). Also, the cases included a series of opinions and observations by colleagues and a bank of 24 similar cases that showed how such situations had been handled by other doctors (provide multiple representations of content).

What interested you most about the article? What questions did it raise?

Many second-year medical students are accustomed to memorizing and reproducing information and may not been ready to analyze and synthesize the information as done so in this study. The study may have better results from third-year students since they are interpreting lab results and managing cases as their predominant approach to learning.

The authors also stated that they think a qualitative study may produce more insight into the dynamics of knowledge acquision and case-based instructional simulations. 

This study points to the need to address what conditions are needed to implement an active, student-centered learning environment for medical students.