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In medical education, the use of flipped classrooms is on the increase. The complex, interdependent active- and social learning activities often built into the 'in-class' phase of this new approach may, however, cause cognitive overload, impeding learning. Computer-supported collaborative learning could play a role in reducing such cognitive load. The current study investigated how four constituent factors of 'in-class' scenarios for 'flipped' classrooms affect the intrinsic, germane and extraneous cognitive load for students. After participating in a computer-supported 'in-class' scenario for a radiology training course that combined face-to-face individual activities, small-group work and class-wide activities, undergraduate medical students ( n  = 135) completed a questionnaire rating the cognitive load perceived. Computer support comprised a program for radiology assessment and a learning dashboard that captured and visualized the assessment results. Total intrinsic load, germane load, and extraneous load (EL) were calculated from the results obtained. The 'high' intrinsic load, 'high' germane load, and 'low' EL indicate that the computer-supported 'in-class' scenario was cognitively challenging but that sufficient mental effort could be spent on task performance and learning. We attribute the successful management of the cognitive load imposed by this complex in-class scenario to the specially designed learning dashboard.

Aim: To examine how collaborative diagramming affects discussion and knowledge construction when learning complex basic science topics in medical education, including its effectiveness in the reformulation phase of problem-based learning., Methods: Opinions and perceptions of students (n = 70) and tutors (n = 4) who used collaborative diagramming in tutorial groups were collected with a questionnaire and focus group discussions. A framework derived from the analysis of discourse in computer-supported collaborative leaning was used to construct the questionnaire. Video observations were used during the focus group discussions., Results: Both students and tutors felt that collaborative diagramming positively affected discussion and knowledge construction. Students particularly appreciated that diagrams helped them to structure knowledge, to develop an overview of topics, and stimulated them to find relationships between topics. Tutors emphasized that diagramming increased interaction and enhanced the focus and detail of the discussion. Favourable conditions were the following: working with a shared whiteboard, using a diagram format that facilitated distribution, and applying half filled-in diagrams for non-content expert tutors and\or for heterogeneous groups with low achieving students., Conclusion: The empirical findings in this study support the findings of earlier more descriptive studies that diagramming in a collaborative setting is valuable for learning complex knowledge in medicine.

Background: Medical workplace learning consists largely of individual activities, since workplace settings do not lend themselves readily to group learning. An electronic Learning Management with System Computer-Supported Collaborative Learning (CSCL) could enable learners at different workplace locations to discuss personal clinical experiences at a distance to enhance learning., Aim: To explore whether CSCL-enabled structured asynchronous discussions on an authentic task has additional value for learning in the medical workplace., Methods: Between January 2008 and June 2010, we conducted an exploratory evaluation study among senior medical students that were engaged in clinical electives. Students wrote a Critical Appraisal of a Topic paper about a clinical problem they had encountered and discussed it in discipline homogeneous subgroups on an asynchronous forum in a CSCL environment. A mixed method design was used to explore students' perceptions of the CSCL arrangement with respect to their preparation and participation, the design and knowledge gains. We analysed the messages recorded during the discussions to investigate which types of interactions occurred., Results: Students perceived knowledge improvement of their papers. The discussions were mostly task-focused. The students considered an instruction session and a manual necessary to prepare for CSCL. A high amount of sent messages and a high activity in discussion seem to influence scores on perceptions: 'participation' and 'knowledge gain' positively., Conclusion: CSCL appears to offer a suitable environment for peers to provide formative feedback on a Critical Appraisal of a Topic paper during workplace learning. The CSCL environment enabled students to collaborate in asynchronous discussions, which positively influenced their learning.