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One of the important goals of problem-based learning (PBL) in medical education is to enhance medical students’ clinical reasoning—hypothetico-deductive reasoning (HDR) in particular—through small group discussions. However, few studies have focused on explicit strategies for promoting students’ HDR during group discussions in PBL. This paper proposes a novel conceptual framework that integrates Toulmin’s argumentation model (1958) into Barrows’s HDR process (1994). This framework explains the structure of argumentation (a claim, data, and a warrant) contextualized in each phase of HDR during PBL. This paper suggests four instructional strategies—understanding argument structures, questioning, elaborating on structural knowledge, and assessing argumentation—for promoting medical students’ argumentation in relation to HDR processes. Further implications of the proposed framework for other disciplines, such as science, legal, and engineering education, are also discussed.
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Addae, J. I., Wilson, J. I., & Carrington, C. (2012). Students’ perception of a modified form of PBL using concept mapping. Medical Teacher, 34(11), e756–e762. https://doi.org/10.3109/0142159X.2012.689440
Anderson, R. C., Nguyen-Jahiel, K., McNurlen, B., Archodidou, A., Kim, S., Reznitskaya, A., . . . Gilbert, L. (2001). The snowball phenomenon: Spread of ways of talking and ways of thinking across groups of children. Cognition and Instruction, 19(1), 1–46. https://doi.org/10.1207/S1532690XCI1901_1
Andrews, R. (2005). Models of argumentation in educational discourse.Text Interdisciplinary Journal for the Study of Discourse, 25(1), 107–127. https://doi.org/10.1515/text.2005.25.1.107
Andriessen, J. (2006). Arguing to learn. In R. K. Sawyer (Ed.), The Cambridge Handbook of Learning Sciences (pp. 443–459). New York: Cambridge University Press.
Azer, S. A. (2005). Facilitation of students’ discussion in problem-based learning tutorials to create mechanisms: The use of five key questions. Annals of the Academy of Medicine Singapore, 34(8), 492–498.
Azevedo, R., Cromley, J. G., & Seibert, D. (2004). Does adaptive scaffolding facilitate students’ ability to regulate their learning with hypermedia? Contemporary Educational Psychology, 29(3), 344–370. https://doi.org/10.1016/j.cedpsych.2003.09.002
Baker, M. (2003). Computer-mediated argumentative interactions for the co-elaboration of scientific notions. In J. Andriessen, M. Baker, & D. Suthers (Eds.), Arguing to learn: Confronting cognitions in computer-supported collaborative learning environments (Vol. 1, pp. 1–25). Dordrecht: Kluwer.
Barrows, H. S. (1985). How to design a problem-based curriculum for the preclinical years. New York: Springer.
Barrows, H. S. (1994). Practice-based learning: Problem- based learning applied to medical education. Springfield, IL: Southern Illinois University.
Barrows, H. S., & Tamblyn, R. M. (1980). Problem-based learning: An approach to medical education. New York: Springer.
Belland, B., Glazewski, K., & Richardson, J. (2011). Problem- based learning and argumentation: Testing a scaffolding framework to support middle school students’ creation of evidence-based arguments. Instructional Science, 39(5), 667–694. https://doi.org/10.1007/s11251-010-9148-z
Berland, L. K., & Reiser, B. J. (2009). Making sense of argumentation and explanation. Science Education, 93(1), 26–55. https://doi.org/10.1002/sce.20286
Blair, J. A. (2011). Argumentation as rational persuasion. Argumentation, 26(1), 71–81. https://doi.org/10.1007/s10503-011-9235-6
Boshuizen, H. P., & Schmidt, H. G. (1992). On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cognitive Science, 16(2), 153– 184. https://doi.org/10.1207/s15516709cog1602_1
Brown, R., & Redmond, T. (2007). Collective argumentation and modelling mathematics practices outside the classroom. In J. Watson & K. Beswick (Eds.), Mathematics: Essential research, essential practice (Vol. 1, pp. 163–171). Canberra, ACT: Mathematical Education Research Group of Australasia.
Buckingham Shum, S. J., MacLean, A., Bellotti, V., & Hammond, N. V. (1997). Graphical argumentation and design cognition. Human-Computer Interaction, 12(3), 267–300. https://doi.org/10.1207/s15327051hci1203_2
Cerbin, B. (1988). The nature and development of informal reasoning skills in college students. Retrieved from ERIC database (ED298805).
Chin, C., & Osborne, J. (2010). Supporting argumentation through students’ questions: Case studies in science class- rooms. Journal of the Learning Sciences, 19(2), 230–284. https://doi.org/10.1080/10508400903530036
Cho, K. L., & Jonassen, D. H. (2002). The effects of argumentation scaffolds on argumentation and problem solving. Educational Technology Research and Development, 50(3), 5–22. https://doi.org/10.1007/BF02505022
Dee, F. R., Haugen, T. H., & Kreiter, C. D. (2014). New web-based applications for mechanistic case diagramming. Medical Education Online, 19(1), 24708. https://doi.org/10.3402/meo.v19.24708
Dickinson, H. D. (1998). Evidence-based decision-making: An argumentative approach. International Journal of Medical Informatics, 51(2–3), 71–81. https://doi.org/10.1016/S1386-5056(98)00105-1
Diemers, A. D., van de Wiel, M. W. J., Scherpbier, A. J. J. A., Heineman, H., & Dolmans, D. H. J. M. (2011). Pre-clinical patient contacts and the application of biomedical and clinical knowledge. Medical Education, 45(3), 280– 288. https://doi.org/10.1111/j.1365-2923.2010.03861.x
Dixon, R. A., & Brown, R. A. (2012). Transfer of learning: Connecting concepts during problem solving. Journal of Technology Education, 24(1), 2–17. https://doi.org/10.21061/jte.v24i1.a.1
Driver, R., Newton, P., & Osborne, J. (2000). Establishing the norms of scientific argumentation in classrooms. Science Education, 84(3), 287–312. https://doi.org/10.1002/(SICI)1098-237X(200005)84:3<287::AID-SCE1>3.0.CO;2-A
d.school. (2013). bootcamp bootleg. Hasso Plattner Institute of Design at Stanford. Retrieved from https://static1.squarespace.com/static/57c6b79629687fde090a0fdd/t/58890239db29d6cc6c3338f7/1485374014340/METHODCARDS-v3-slim.pdf
Duschl, R. A., & Osborne, J. (2002). Supporting and promoting argumentation discourse in science education. Studies in Science Education, 38(1), 39–72. https://doi.org/10.1080/03057260208560187
Dym, C. L., Agogino, A. M., Eris, O., Frey, D. D., & Leifer, L. J. (2005). Engineering design thinking, teaching, and learning. Journal of Engineering Education, 94(1), 103– 120. https://doi.org/10.1002/j.2168-9830.2005.tb00832.x
Edmondson, K. M. (1994). Concept maps and the development of cases for problem-based learning. Academic Medicine, 69(2), 108–110. https://doi.org/10.1097/00001888-199402000-00004
Elstein, A. S. (1995). Clinical reasoning in medicine. In J. Higgs & M. A. Jones (Eds.), Clinical reasoning in the health professions (pp. 49–59). Boston: Butterworth-Heinemann.
Feinstein, A. R. (1973a). An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology. Yale Journal Biology Medicine, 46(3), 212–232.
Feinstein, A. R. (1973b). An analysis of diagnostic reasoning. II. The strategy of intermediate decisions. Yale Journal Biology Medicine, 46(4), 264–283.
Frederiksen, C. H. (1999). Learning to reason through discourse in a problem‐based learning group. Discourse Processes, 27(2), 135–160. https://doi.org/10.1080/01638539909545055
Golanics, J. D., & Nussbaum, E. M. (2008). Enhancing online collaborative argumentation through question elaboration and goal instructions. Journal of Computer Assisted Learning, 24(3), 167–180. https://doi.org/10.1111/j.1365-2729.2007.00251.x
Gonzalez, H. L., Palencia, A. P., Umana, L. A., Galindo, L., & Villafrade M., L. A. (2008). Mediated learning experience and concept maps: A pedagogical tool for achieving meaningful learning in medical physiology students. Advances in Physiology Education, 32(4), 312–316. https://doi.org/10.1152/advan.00021.2007
Graesser, A. C., Baggett, W., & Williams, K. (1996). Question-driven explanatory reasoning. Applied Cognitive Psychology, 10(7), 17–31. https://doi.org/10.1002/(SICI)1099-0720(199611)10:7%3C17::AID-ACP435%3E3.0.CO;2-7
Groves, M. (2007). The diagnostic process in medical practice: The role of clinical reasoning. In E. M. Vargios (Ed.), Educational psychology research focus (pp. 133–184). New York: Nova Science Publisher.
Guerrero, A. (2001). Mechanistic case diagramming: A tool for problem-based learning. Academic Medicine, 76(4), 385– 389. https://doi.org/10.1097/00001888-200104000-00020
Hewson, M. G., & Ogunniyi, M. B. (2010). Argumentation-teaching as a method to introduce indigenous knowledge into science classrooms: Opportunities and challenges. Cultural Studies of Science Education, 6(3), 679–692. https://doi.org/10.1007/s11422-010-9303-5
Hmelo, C. E. (1998). Problem-based learning: Effects on the early acquisition of cognitive skill in medicine. The Journal of the Learning Sciences, 7(2), 173–208. https://doi.org/10.1207/s15327809jls0702_2
Hmelo-Silver, C. E. (2004). Problem-based learning: What and how do students learn? Educational Psychology Review, 16(3), 235–266. https://doi.org/10.1023/B:EDPR.0000034022.16470.f3
Hmelo-Silver, C. E., & Barrows, H. S. (2008). Facilitating collaborative knowledge building. Cognition and Instruction, 26(1), 48–94. https://doi.org/10.180/07370000701798495
Hsu, Li-Ling. (2004). Developing concept maps from problem-based learning scenario discussions. Journal of Advanced Nursing, 48(5), 510–518. https://doi.org/10.1111/j.1365-2648.2004.03233.x
Hung, W. (2011). Theory to reality: A few issues in implementing problem-based learning. Educational Technology Research and Development, 59(4), 529–552. https://doi.org/10.1007/s11423-011-9198-1
Jiménez-Aleixandre, M. P., & Rodriguez, A. B. (2000). “Doing the lesson” or “Doing science”: Argument in high school genetics. Science Education, 84(6), 757–792. https://doi.org/10.1002/1098-237X(200011)84:6<757::AID-SCE5>3.0.CO;2-F
Johnson, D., Johnson, R., & Smith, K. (2007). The state of cooperative learning in postsecondary and professional settings. Educational Psychology Review, 19(1), 15–29. https://doi.org/10.1007/s10648-006-9038-8
Jonassen, D. H. (2011). Learning to solve problems: A handbook for designing problem-solving learning environments. New York: Routledge.
Jonassen, D. H., Beissner, K., & Yacci, M., (1993). Structural knowledge: Techniques for representing, conveying, and acquiring structural knowledge. Hillsdale, NJ: Lawrence Erlbaum Associates.
Ju, H., Choi, I., Rhee, B., & Lee, J. (2016). Challenges experienced by Korean medical students and tutors during problem-based learning: A cultural perspective. Interdisciplinary Journal of Problem-Based Learning, 10(1). https://doi.org/10.7771/1541-5015.1565
Khoo, H. E. (2003). Implementation of problem-based learning in Asian medical schools and students’ perceptions of their experience. Medical Education, 37(5), 401–409. https://doi.org/10.1046/j.1365-2923.2003.01489.x
Kovacs, G., & Croskerry, P. (1999). Clinical decision making: An emergency medicine perspective. Academic Emergency Medicine, 6(9), 947–952. https://doi.org/10.1111/j.1553-2712.1999.tb01246.x
Kuhn, D. (1992). Thinking as argument. Harvard Educational Review, 62(2), 155–178. https://doi.org/10.4324/9780203435854_chapter_7
Kurtz, S., Wylie, M., & Gold, N. (1990). Problem-based learning: An alternative approach to legal education. Dalhousie Law Journal, 13(2), 797–816.
Lawson, A. E. (2000). The generality of hypotheticodeductive reasoning: Making scientific thinking explicit. The American Biology Teacher, 62(7). 482–495. https://doi.org/10.2307/445095
Lu, J., Chiu, M. M., & Law, N. W. (2011). Collaborative argumentation and justifications: A statistical discourse analysis of online discussions. Computers in Human Behavior, 27(2), 946–955. https://doi.org/10.1016/j.chb.2010.11.021
McNeill, K. L., Lizotte, D. J., Krajcik, J., & Marx, R. W. (2006). Supporting students’ construction of scientific explanations by fading scaffolds in instructional materials. The Journal of the Learning Sciences, 15(2), 153–191. https://doi.org/10.1207/s15327809jls1502_1
McNeill, K. L., & Pimentel, D. S. (2010). Scientific discourse in three urban classrooms: The role of the teacher in engaging high school students in argumentation. Science Education, 94(2), 203–229. https://doi.org/10.1002/sce.20364
Means, M. L., & Voss, J. F. (1996). Who reasons well? Two studies of informal reasoning among children of different grad, ability and knowledge levels. Cognition and Instruction, 14(2), 139–179. https://doi.org/10.1207/s1532690xci1402_1
Miller, R. A., & Geissbuler, A. (2007). Diagnostic decision support systems. In E. S. Berner (Ed.). Clinical decision support systems: Theory and practice (2nd ed.) (pp. 99–125). New York: Springer.
Neville, A. J. (2009). Problem-based learning and medical education forty years on: A review of its effects on knowledge and clinical performance. Medical Principles and Practice, 18(1), 1–9. https://doi.org/10.1159/000163038
Newton, P., Driver, R., & Osborne, J. (1999). The place of argumentation in the pedagogy of school science. International Journal of Science Education, 21(5), 553–576. https://doi.org/10.1080/095006999290570
Novak, J. D., & Gowin, D. B. (1984). Learning how to learn. Cambridge: Cambridge University Press.
Nussbaum, E. M. (2011). Argumentation, dialogue theory, and probability modeling: Alternative frameworks for argumentation research in education. Educational Psy- chologist, 46(2), 84–106. https://doi.org/10.1080/00461520.2011.558816
Patel, V. L., Arocha, J. F., & Zhang, J. (2005). Thinking and reasoning in medicine. In K. J. Holyoak & R. G. Morrison (Eds.), The Cambridge handbook of thinking and reasoning (pp. 727–750). New York: Cambridge University Press.
Patel, V. L., Evans, A. E., & Groen, G. J. (1989). Biomedical knowledge and clinical reasoning. In D. A. Evans & V. L. Patel (Eds.), Cognitive science in medicine: Biomedical modeling (pp. 53–112). Cambridge: MIT Press.
Patel, V. L., Groen, G. J., & Norman, G. R. (1993). Reasoning and instruction in medical curricula. Cognition and Instruction, 10(4), 335–378. https://doi.org/10.1207/s1532690xci1004_2
Patel, V. L., Groen, G. J., & Scott, H. M. (1988). Biomedical knowledge in explanations of clinical problems by medical students. Medical Education, 22(5), 398–406. https://doi.org/10.1111/j.1365-2923.1988.tb00774.x
Prince, K., van de Wiel, M., Scherpbier, A., van der Vleuten, C., & Boshuizen, H. (2000). A qualitative analysis of the transition from theory to practice in undergraduate training in a PBL medical school. Advances in Health Sciences Education, 5(2), 105–116. https://doi.org/10.1023/A:1009873003677
Puntambekar, S., & Hübscher, R. (2005). Tools for scaffolding students in a complex learning environment: What have we gained and what have we missed? Educational Psychologist, 40(1), 1–12. https://doi.org/10.1207/s15326985ep4001_1
Rendas, A. B., Fonseca, M., & Pinto, P. R. (2006). Toward meaningful learning in undergraduate medical education using concept maps in a PBL pathophysiology course. Advances in Physiology Education, 30(1–4), 23–29. https://doi.org/10.1152/advan.00036.2005
Reznitskaya, A., Anderson, R. C., & Kuo, L.-J. (2007). Teaching and learning argumentation. The Elementary School Journal, 107(5), 449–472. https://doi.org/10.1086/518623
Sackett, D. L., Rosenberg, W. C., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. BMJ: British Medical Journal, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71
Sampson, V., & Clark, D. B. (2008). Assessment of the ways students generate arguments in science education: Current perspectives and recommendations for future directions. Science Education, 92(3), 447–472. https://doi.org/10.1002/sce.20276
Savery, J. R. (2006). Overview of problem-based learning: Definitions and distinctions. Interdisciplinary Journal of Problem-based learning, 1(1), 9–20. https://doi.org/10.7771/1541-5015.1002
Saye, J. W., & Brush, T. (2002). Scaffolding critical reasoning about history and social issues in multimedia-supported learning environments, Educational Technology Research and Development, 50(3), 77-96. https://doi.org/10.1007/BF02505026
Schwartz, P., Mennin, S., & Webb, G. (Eds.). (2001). Problem-based learning: Case studies, experience and practice. London: Kogan Page.
Sefton, A., Gordon, J., & Field, M. (2008). Teaching clinical reasoning to medical students. In J. Higgs & M. A. Jones (Eds.), Clinical reasoning in the health professions (3rd ed.) (pp. 469–476). Boston: Butterworth-Heinemann.
Siegel, H. (1995). Why should educators care about argumentation? Informal Logic, 17(2), 159–176.
Suthers, D., & Hundhausen, C. (2003). An empirical study of the effects of representational guidance on collaborative learning processes. Journal of the Learning Sciences, 12(2), 183–219. https://doi.org/10.1207/S15327809JLS1202_2
Szolovits, P., Patil, R. S., & Schwartz, W. B. (1988). Artificial intelligence in medical diagnosis. Annals of Internal Medicine, 108(1), 80–87. https://doi.org/10.7326/0003-4819-108-1-80
Torre, D. M., Durning, S. J., & Daley, B. J. (2013). Twelve tips for teaching with concept maps in medical education. Medical Teacher, 35(3), 201–208. https://doi.org/10.3109 /0142159X.2013.759644
Toth, E. E., Suthers, D. D., & Lesgold, A. M. (2002). “Mapping to know”: The effects of representational guidance and reflective assessment on scientific inquiry. Science Education, 86(2), 264–286. https://doi.org/10.1002/sce.10004
Toulmin, S. (1958). The uses of argument. Cambridge: Cambridge University Press.
University of Florida 3rd Year Medicine Clerkship. (2012). Introduction to clinical reasoning and clinical decision making Doc-in-the Box (DIB) [Data file]. Retrieved from http://clerkship.medicine.ufl.edu/files/2012/07/Doc-in-the-Box-Handout-7-17-12.pdf
van de Wiel, M. J., Boshuizen, H. A., & Schmidt, H. G. (2000). Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians. European Journal of Cognitive Psychology, 12(3), 323–355. https://doi.org/10.1080/09541440050114543
van Eemeren, F. H., Grootendorst, R., Henkemans, F. S., Blair, J. A., Johnson, R. H., Krabbe, E. C. W., . . . Zarefsky, D. (1996). Fundamentals of argumentation theory: A handbook of historical backgrounds and contemporary developments. Mahwah, NJ: Lawrence Erlbaum Associates.
von Aufschnaiter, C., Erduran, S., Osborne, J., & Simon, S. (2008). Arguing to learn and learning to argue: Case studies of how students’ argumentation relates to their scientific knowledge. Journal of Research in Science Teaching, 45(1), 101–131. https://doi.org/10.1002/tea.20213
Walton, D. (2007). Dialog theory for critical argumentation. Philadelphia: John Benjamins.
Watson, G. R. (1989). What is . . . concept mapping? Medical Teacher, 11(3–4), 265–269. https://doi.org/10.3109/01421598909146411
Wood, D., Bruner, J. S., & Ross, G. (1976). The role of tutoring in problem solving. Journal of Child Psychology and Child Psychiatry, 17(2), 89–100. https://doi.org/10.1111/j.1469-7610.1976.tb00381.x
Woods, N. N., Brooks, L. R., & Norman, G. R. (2007). The role of biomedical knowledge in diagnosis of difficult clinical cases. Advances in Health Sciences Education, 12(4), 417–426. https://doi.org/10.1007/s10459-006-9054-y
Zeidler, D. L. (1997). The central role of fallacious thinking in science education. Science Education, 81(4), 483–496. https://doi.org/10.1002/(SICI)1098-237X(199707)81:4<483::AID-SCE7>3.0.CO;2-8