Semantic competency as a marker of clinical reasoning performance

Background: This study sought to explore the relationship between semantic competence (or dyscompetence) displayed during “think-alouds” performed by resident and attending physicians and clinical reasoning performance. Methods: Internal medicine resident physicians and practicing internists participated in think-alouds performed after watching videos of typical presentations of common diseases in internal medicine. The think-alouds were evaluated for the presence of semantic competence and dyscompetence and these results were correlated with clinical reasoning performance. Results: We found that the length of think-aloud was negatively correlated with clinical reasoning performance. Beyond this finding, however, we did not find any other significant correlations between semantic competence or dyscompetence and clinical reasoning performance. Conclusions: While this study did not produce the previously hypothesized findings of correlation between semantic competence and clinical reasoning performance, we discuss the possible implications and areas of future study regarding the relationship between semantic competency and clinical reasoning performance.

NS and NNS processing of idioms and nonidiom formulaic sequences: What can reaction times and think-alouds tell us?

Although researchers generally agree that native speakers (NSs) process formulaic sequences (FSs) holistically to some extent, findings about nonnative speakers (NNSs) are conflicting, potentially because not all FSs are psychologically equal or because in some studies NNSs may not have fully understood the FSs. We address these issues by investigating Chinese NSs and NNSs processing of idioms and matched nonidiom FSs in phrase acceptability judgment tasks with and without think-alouds (TAs). Reaction times show that NSs processed idioms faster than nonidioms regardless of length, but NNSs processed 3-character FSs faster than 4-character FSs regardless of type. TAs show NSs’ understanding of FSs has reached ceiling, but NNSs’ understanding was incomplete, with idioms being understood more poorly than nonidioms. Although we conclude that idioms and nonidioms have different mental statuses in NSs’ lexicons, it is inconclusive how they are represented by NNSs. TAs also show that NNSs employed various strategies to compensate for limited idiom knowledge, causing comparable processing speed for idioms and nonidioms. The findings highlight the importance of distinguishing subtypes of FSs and considering NNSs’ quality of understanding in discussions of the psychological reality of FSs.

The Interplay between Heritage Learners’ Prior Knowledge and Instruction on a Linguistically Complex Structure

Current HL pedagogy recommends focus on form approaches (Beaudrie, Ducar, & Potowski, 2014; Kisselev, Dubinina, & Polinsky, 2020) but within this broad category there are many techniques. To date only a few studies have compared HL learning gains on explicit and implicit focus on form instruction, and these have found explicit instruction to be more beneficial. The present study isolated the role of rule presentation on learning gains by comparing Spanish HL learners in a Processing Instruction condition (n = 26) who received rule presentation and explicit information about the target structure (indicative and subjunctive in adverbial clauses of time) prior to structured input, to HL learners in a Structured Input condition (n = 16) who received only structured input. Pretest/posttest/delayed posttest comparisons revealed that both PI and SI resulted in lasting learning gains, as well as a complex interplay between learners’ initial knowledge of the structure and the type of instruction, such that learners with little or no initial knowledge benefited from rule presentation, whereas learners with greater initial knowledge did not. Furthermore, data from think-alouds and retrospective interviews shows that all learners did not process the instruction similarly, and pedagogical implications are discussed.

Pre-Clerkship EPA Assessments: A Thematic Analysis of Rater Cognition

Background. Entrustable Professional Activities (EPAs) assessments measure learners’ competence with an entrustment or supervisory scale. Designed for workplace-based assessment EPA assessments have also been proposed for undergraduate medical education (UME), where assessments frequently occur outside the workplace and may be less intuitive, raising validity concerns. This study explored how assessors make entrustment determinations in UME, to include the impact of longitudinal student-assessor relationships.Methods. A qualitative approach using think-alouds was employed. Assessors assessed two students (familiar and unfamiliar) completing a history and physical exam using a supervisory scale and then thought-aloud after each assessment. We conducted a thematic analysis of assessors’ response processes and compared them based on their familiarity with a student.Results. Four themes and fifteen subthemes were identified. The most prevalent theme related to “student performance.” The other three themes included “frame of reference,” “assessor uncertainty,” and “the patient.” “Previous student performance” and “affective reactions” were subthemes more likely to inform scoring when faculty were familiar with a student, while unfamiliar faculty were more likely to reference “self” and “lack confidence in their ability to assess.”Conclusions. Student performance appears to be assessors’ main consideration for all students, providing some validity evidence for the response process in EPA assessments. Several problematic themes could be addressed with faculty development while others appear to be inherent to entrustment and may be more challenging to mitigate. Differences based on assessor familiarity with student merits further research on how trust develops over time.

Formative Assessment through Think Alouds

We describe a formative assessment approach called whole-class think alouds, which foster evidence-based instructional practices and promote the goal of assessment to promote learning. They allow students to collaborate and orally communicate their problem solving.

I Suck at This Game: “Let’s Play” Videos, Think-Alouds, and the Pedagogy of Bad Feelings

This article explores the pedagogical usefulness of “Let’s Play” videos (LPs), a wildly popular paratext in which video gamers record and narrate their gameplay. I designed and implemented an LP creation assignment in two English Literature classes that focused on digital children’s literature and culture. I imagined my LP assignment as a variation on a cognitive “think-aloud” activity, wherein students and/or instructors vocalize their approach to solving a particular problem. I was curious how these habits of mind might differ when students engage with interactive digital texts as opposed to print literature. What this study exposed is the centrality of feelings—in particular, “bad” feelings like anxiety and frustration, and the silences that often accompany these feelings—to the initial stages of critical thinking. When students contemplated bad feelings and their origins, eventually they were able to offer incisive analyses of their digital texts. Ultimately, this study argues that cognitive and affective “think-and-feel-aloud” activities such as the LP exercise, which allow students to dwell momentarily in bad feelings and silence, create rich teaching and learning opportunities.

I Suck at This Game: “Let’s Play” Videos, Think-Alouds, and the Pedagogy of Bad Feelings

This article explores the pedagogical usefulness of “Let’s Play” videos (LPs), a wildly popular paratext in which video gamers record and narrate their gameplay. I designed and implemented an LP creation assignment in two English Literature classes that focused on digital children’s literature and culture. I imagined my LP assignment as a variation on a cognitive “think-aloud” activity, wherein students and/or instructors vocalize their approach to solving a particular problem. I was curious how these habits of mind might differ when students engage with interactive digital texts as opposed to print literature. What this study exposed is the centrality of feelings—in particular, “bad” feelings like anxiety and frustration, and the silences that often accompany these feelings—to the initial stages of critical thinking. When students contemplated bad feelings and their origins, eventually they were able to offer incisive analyses of their digital texts. Ultimately, this study argues that cognitive and affective “think-and-feel-aloud” activities such as the LP exercise, which allow students to dwell momentarily in bad feelings and silence, create rich teaching and learning opportunities.