Interacting with computer-based simulation: The role of dialogue

Abstract

Simulations have established a role in the teaching of medicine, since their dynamic qualities lend themselves to training students to deal with high risk situations in a safe environment. However, when used to teach at a more conceptual level, students often encounter difficulties in learning from simulation. This has led to the conclusion that additional learning support needs to be included. The paper describes a formative evaluation study in which medical students were recorded interacting with a simulation model of calcium balance. Video protocols were analysed according to students' performance on diagnostic and patient management tasks, and the quality of their understanding of the physiological model that lies behind the simulation. The role of dialogue interaction, between students and between experimenter and student, was investigated as a potential source of learning support. Since existing dialogue analysis techniques required extension and synthesis to serve our goals, a specially devised mark-up scheme DISCOUNT was used for the analysis. Insights were gained from an examination of learning in relation to types of dialogue and these were further supported by students' own views concerning the value of the system. Although all students demonstrated learning gains, these were greater amongst single students interacting with the experimenter than amongst students co-operating on tasks in pairs. Dialogue analysis revealed that experimenter-student interaction contained many more inquiries causing students to explain their reasoning, justify their conclusions, or state implications from data. This prompting of reflective activity seemed to result in a deeper understanding of the physiological model. The implications of this are that interaction of an inquiry style needs to be encouraged for maximum learning benefit to be gained and, if support can be built in to the simulation which renders interaction with the system closer to that of inquiry dialogue, then learning at a conceptual level should be enhanced.