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The case for metacognitive reflection: a theory integrative review with implications for medical education

The concepts of metacognitive refection, refection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive refection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive refection in the concept of metacognition and moving beyond it to engage in cycles of refection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive refection works is elusive. Debates address whether metacognition drives refection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related refection, to self-refection, and finally to metacognitive refection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive refection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive refection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.

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The liminal space of metacognitive reflection: the art of contradistinction (a response to define or not define)

In this commentary, the authors respond to Ellaway & Patocka’s “To define or not to define: A commentary on the Case for Metacognitive Reflection,” which raised several thoughtful and discerning questions concerning the implications of defining, or alternatively, refraining from defining constructs. The authors advocate for navigating the liminal space between precision and flexibility, acknowledging the dynamic and permeable nature of conceptual boundaries while striving for clarity. Moreover, they emphasize that only after a boundary is described can the tensions, gaps, exceptions, and contradictions around that boundary be explored. Finally, the authors highlight the significance of contextual definitions, fostering shared understanding, and embracing abductive reasoning (when is becomes as) to promote dialogue and advance knowledge in health professions education.

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Is self reflection dangerous?

Reflection is considered necessary and beneficial within career learning and is deemed to be a condition for successful career-identity development. Indeed, reflection is generally seen as a key competency in learning how to respond effectively to a complex and dynamic post-modern world in which individuals are increasingly exposed to risk. Paradoxically however, reflection can itself form a risk when it results in rumination. It is therefore important to identify the conditions and personal (risk) factors that make reflection a detrimental or beneficial activity and to identify elements within career learning interventions that promote benefit. The purpose here is to increase awareness about reflective versus ruminative processes and promote responsible use of interventions that aim to stimulate reflection in the process of career-identity formation. Based on the “career writing” method, the authors conclude that a successful career intervention must especially provide good facilitation and a safe holding environment. https://doi.org/10.1177/1038416216670675 LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/

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TORPEDO, a digital learning environment for developing mathematical problem-solving ability in primary teacher education

Torpedo is a digital learning environment for developing mathematical problem-solving ability through self-study for pre-service teachers in primary teacher education. To achieve this, Torpedo supports and challenges pre-service teachers’ reflection during and after solving non-routine mathematics problems. To investigate the feasibility of the Torpedo approach, 271 pre-service teachers used Torpedo during one month in a pilot study. They used and evaluated Torpedo’s reflective elements differently. The results varied from pre-service teachers who experienced that reflection really contributed to the development of their problem-solving ability, to pre-service teachers who hardly reflected. The last group consisted of those who found the problems too difficult to reflect upon and those who used Torpedo to prepare for the National Mathematics Test and preferred to do so by drill and practice. As a conclusion, the study provides clues for improving Torpedo so that it invites more reflective self-study behaviour. For pre-service teachers who consider reflection valueless, however, self-study in a digital learning environment may be insufficient to change this attitude.

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TORPEDO, a digital learning environment for developing mathematical problem-solving ability in primary teacher education

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To what extent do student teachers develop their mathematical problem solving ability by self-study?

A primary teacher needs mathematical problem solving ability. That is why Dutch student teachers have to show this ability in a nationwide mathematics test that contains many non-routine problems. Most student teachers prepare for this test by working on their own solving test-like problems. To what extent does these individual problem solving activities really contribute to their mathematical problem solving ability? Developing mathematical problem solving ability requires reflective mathematical behaviour. Student teachers need to mathematize and generalize problems and problem approaches, and evaluate heuristics and problem solving processes. This demands self-confidence, motivation, cognition and metacognition. To what extent do student teachers show reflective behaviour during mathematical self-study and how can we explain their study behaviour? In this study 97 student teachers from seven different teacher education institutes worked on ten non-routine problems. They were motivated because the test-like problems gave them an impression of the test and enabled them to investigate whether they were already prepared well enough. This study also shows that student teachers preparing for the test were not focused on developing their mathematical problem solving ability. They did not know that this was the goal to strive for and how to aim for it. They lacked self-confidence and knowledge to mathematize problems and problem approaches, and to evaluate the problem solving process. These results indicate that student teachers do hardly develop their mathematical problem solving ability in self-study situations. This leaves a question for future research: What do student teachers need to improve their mathematical self-study behaviour? EAPRIL Proceedings, November 29 – December 1, 2017, Hämeenlinna, Finland

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Teacher Feedback during Active Learning

Feedback is one of the most powerful tools teachers can use to enhance student learning. In 2006, the Dutch Inspectorate of Education concluded from classroom observations that it is difficult for Dutch teachers to give their students good feedback in order to stimulate students' learning process and developmental progress. Similar problems were revealed in other school levels and countries, for example in secondary education and in Finland. Giving feedback during active learning may be even more troublesome for teachers. During active learning, students are working in small groups on different learning goals and undertake different learning activities at the same time. They need to achieve task-related goals as well as to develop the meta-cognitive knowledge and skills that are needed for active learning. Yet, teachers often seem unable to provide the feedback that is needed and they do not know how to support the development of meta-cognitive knowledge and skills.Therefore, this research project focused on ways to improve primary school teachers' feedback giving practices during active learning. The central research question is: How can primary school teachers learn to give optimal feedback to pupils during active learning? To answer this question, five studies have been conducted. In the first study, knowledge regarding teachers' feedback practices was gathered. A category system was developed based on the literature and empirical data. A total of 1465 teacher-student interactions of 32 teachers who practiced active learning in the domain of environmental studies in the sixth, seventh or eighth grade of 13 Dutch primary schools were videotaped and assessed using this system. Results showed that about half of the teacher-student interactions contained feedback. This feedback was usually focused on the tasks that were being performed by the students and on the ways in which these tasks were processed. Only 5% of the feedback was explicitly related to a learning goal. In their feedback, the teachers were directing (rather than facilitating) the learning processes. During active learning, however, feedback on meta-cognition and social learning is important. Feedback should be explicitly related to learning goals. In practice, these kinds of feedback appear to be scarce. In the second study, the problems these 32 primary school teachers perceive and the beliefs they hold regarding the provision of feedback were investigated. A writing task and an interview were conducted. It appeared that teachers believed that conditional teacher skills, especially time management, hindered them most from giving good feedback. The most widely held belief was that 'feedback should be positive'. Teachers also believed that it is important to adopt a facilitative way of giving feedback, but they found this difficult to implement. Only some teachers believed goal-directedness and a focus on student meta-cognition were important during active learning and teachers did not perceive problems regarding these aspects. In the third study, a professional development program (PDP) was developed, implemented and evaluated. The goals and content of the PDP were based on a review of the literature regarding feedback and active learning and on the results of the preceding studies. The design of the PDP was based on the extant literature regarding the features which are considered to be important for PDPs, including structural features, goal setting and characteristics of the professional development activities that are part of the program. Effects of this PDP on 16 primary schoolteachers' knowledge, beliefs, perceived problems and classroom behavior were examined via observations, a writing task and a questionnaire prior and twice after the program was implemented. Results showed that several aspects of feedback during active learning were improved, both in the short and in the long term. For example, teachers learned to believe that feedback must be goal-directed and that learning goals need to be communicated to students. In the classrooms, teachers related their feedback more often explicitly to the learning goals. In the fourth study, the extent to which teachers attributed the success of the PDP to each of the purposefully implemented features of the PDP was examined. The 16 teachers that participated in the PDP completed a questionnaire and four focus group interviews were conducted. Results indicated that teachers value most features quite highly; all features contributed to teachers' professional development according to the teachers themselves. The qualitative data was used to illustrate and specify the theoretical knowledge regarding the features that appeared to be effective in PDP's. Finally, in the fifth study, the learning process of two of the participating teachers was described in detail. Written reflections, as well as videotaped reflections during the video interaction training meetings were analyzed and related to the effects of the PDP on both teachers' knowledge, beliefs, perceived problems and classroom behavior during te course of the PDP. By relating the learning processes of these two teachers to the literature regarding professional development, we aimed for a rich understanding of the impact of the PDP on teachers' professional development.

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Constructivist learning theories and complex learning environments

Learning theories broadly characterised as constructivist, agree on the importance to learning of the environment, but differ on what exactly it is that constitutes this importance. Accordingly, they also differ on the educational consequences to be drawn from the theoretical perspective. Cognitive constructivism focuses on the active role of the learner, and on real-life learning. Social-learning theories, comprising the socio-historical, socio-cultural theories as well as the situated-learning and community-of-practice approaches, emphasise learning as being a process within and a product of the social context. Critical-learning theory stresses that this social context is a man-made construction, which should be approached critically and transformed in order to create a better world. We propose to view these different approaches as contributions to our understanding of the learning-environment relationship, and their educational impact as questions to be addressed to educational contexts.

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The integrated recovery Scales

Introduction The Integrated Recovery Scales (IRS) was developed by the Dutch National Expertise board for routine outcome monitoring with severe mental illnesses. This board aimed to develop a multidimensional recovery measure directed at 1. clinical recovery, 2. physical health, 3. social recovery (work, social contacts, independent living) and 4. existential, personal recovery. The measure had to be short, suited for routine outcome monitoring and present the perspective of both mental health professionals and service users with severe mental illnesses. All aspects are assessed over a period of the pas 6 months. Objectives The objective of this research is validation of the Integral Recovery Scales and to test the revelance for clinical practice and police evaluation. Methods The instrument was tested with 500 individuals with severe mental illnesses (80% individuals with a psychotic disorder), of whom 200 were followed up for 1 year. For the questions concerning clinical recovery, physical health and social recovery mental health care workers conducted semi structured interviews with people living with serious illnesses. The questions concerning personal health were self-rated. We analyzed interrater reliability, convergent and divergent validity and sensitivity to change. Results The instrument has a good validity and is easy to complete for service users and mental health care workers and appropriate for clinical and policy evaluation goals. Conclusions The Integrated Recovery Scales can be a useful instrument for a simple and meaningful routine outcome monitoring. Page: 121

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From Flexible Assertive Community Treatment to collaborative mental health care in the community

Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.

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The case for metacognitive reflection: a theory integrative review with implications for medical education