gms | German Medical Science

5th International Conference for Research in Medical Education

15.03. - 17.03.2017, Düsseldorf

Effects of problem-solving procedures in error-based learning in the context of medical education

Meeting Abstract

  • corresponding author presenting/speaker Martin Klein - Saarland University, Department of Education, Saarbrücken, Germany
  • Robin Stark - Saarland University, Department of Education, Saarbrücken, Germany
  • Bärbel Otto - University Hospital Munich, Institute for Medical Education, Munich, Germany
  • Nicole Heitzmann - University Hospital Munich, Institute for Medical Education, Munich, Germany; University of Munich, Department Psychology, Institute for Educational Science and Educational Psychology, Munich, Germany
  • Martin R. Fischer - University Hospital Munich, Institute for Medical Education, Munich, Germany

5th International Conference for Research in Medical Education (RIME 2017). Düsseldorf, 15.-17.03.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocO11

doi: 10.3205/17rime11, urn:nbn:de:0183-17rime117

Published: March 7, 2017

© 2017 Klein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Question: The present study examines effects of additional problem-solving procedures in error-based learning in medical education to foster diagnostic competence. Since diagnostic errors often have dramatic consequences inn medical practice, providing erroneous information to enhance learning seems counterintuitive. However, "negative knowledge" acquired by learning from errors provides an important protection against erroneous decisions and procedures [1]. Additionally, self-explanation processes triggered by the instructional use of errors [2] foster schema induction in the sense of "illness scripts" [3].

Method: In earlier studies, the diagnostic competence of medical students was enhanced by instructional errors in an online learning environment with case-based examples [4]. In the present study, additional problem-solving procedures were integrated in a similar learning environment to support the effectiveness of the error-based approach. Based on the testing-effect [5], learners were either confronted with multiple-choice items focusing on diagnostic errors (MC condition) or prompted to analyse erroneous diagnostic decisions themselves (prompting condition). The prompting condition was expected to be the most effective, followed by the MC and an unsupported example condition.

Results: Both problem-solving procedures did not pay off. In contrast to our hypotheses, the unsupported example condition was most effective with respect to fostering diagnostic competence. The effects of the learning conditions on diagnostic competence was mediated by cognitive load and moderated by the students´ self-efficacy. Both problem-solving procedures increased extraneous cognitive load. For learners with low self-efficacy, the problem-solving procedures interfered with effective error-based learning.

Conclusion: Our error-based instructional approach is an innovative measure to foster diagnostic competence in the context of medical education. However, with respect to additional instructional measures intended to support error-based learning processes, less seems to be more. These unexpected findings show that even theoretically well-founded instructional measures can result in dysfunctional effects.


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