Investigating the Role of Cognitive Feedback in Practice-Oriented Learning for Clinical Diagnostics

  • Bei Yuan
  • Minhong WangEmail author
  • Jeroen van Merriënboer
  • Xu Tao
  • Andre Kushniruk
  • Jun Peng
Original Paper


Reflection plays an important role in medical students’ ability to develop diagnostic competence through practice with clinical cases. However, it is not easy for students to develop expert-like performance through self-reflection alone; conversely, seeking feedback from experts constantly in practice is impractical. This study investigates the design and effects of computer-based cognitive feedback in practice-oriented learning in an online system. The system allows learners to work with simulated cases and self-review and reflect on their diagnostic processes that the system captures visually. Moreover, the system provides learners with feedback about the gap between their performance and expert performance on a set of key components of the diagnostic task, i.e., selecting clinical examinations, making intermediate judgements, and reaching diagnostic conclusions. The findings show that cognitive feedback on task performance can reduce learners’ anxiety and frustration while working with complex tasks. Moreover, by providing feedback on learners’ performance on a set of key components of the task, the proposed approach has shown promising effects on improving learners’ diagnostic performance. Compared with its effects on learners’ diagnostic conclusions, the approach is more effective in enhancing learners’ performance when selecting clinical examinations and making intermediate judgements, both of which may improve learners’ understanding of the mechanism underlying the diagnostic process.


Reflective practice Cognitive feedback Clinical diagnostic reasoning Computer-supported learning Emotion 



This research is supported by the General Research Fund from the Research Grants Council of the Hong Kong SAR Government (Project No. 17201415) and the Seeding Fund for Basic Research from the University of Hong Kong (Project No. 201811159019). The authors would thank Professor David Carless for his advice on the review of the feedback literacy.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Zhongshan Teachers Education InstituteZhongshanChina
  2. 2.KM&EL Lab, Faculty of EducationThe University of Hong KongHong KongChina
  3. 3.Department of Educational Information TechnologyEast China Normal UniversityShanghaiChina
  4. 4.Graduate School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
  5. 5.Department of Ear, Nose and ThroatXiangtan Central HospitalXiangtanChina
  6. 6.School of Health Information ScienceUniversity of VictoriaVictoriaCanada
  7. 7.School of EducationCity University of MacauMacauChina

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