Fostering diagnostic knowledge through computer-supported, case-based worked examples: effects of erroneous examples and feedback


Veronika Kopp, Klinikum der Universität München, Medizinische Klinik Innenstadt, Schwerpunkt Medizindidaktik, Ziemssenstrasse 1, 80336 Munich, Germany. Tel: 00 49 89 5160 2374; Fax: 00 49 89 5160 4931; E-mail:


Objectives  A case-based, worked example approach was realised in a computer-based learning environment with the intention of facilitating medical students’ diagnostic knowledge. In order to enhance the effectiveness of the approach, two additional measures were implemented: erroneous examples and elaborated feedback. In the context of an experimental study, the two measures were varied experimentally.

Methods  A total of 153 medical students were randomly assigned to four experimental conditions of a 2 × 2-factor design (errors versus no errors, elaborated feedback versus knowledge of correct result [KCR]). In order to verify the sustainability of the effects, a subgroup of subjects (= 52) was compared with a control group of students who did not participate in the experiment (= 145) on a regular multiple-choice question (MCQ) test.

Results  Results show that the acquisition of diagnostic knowledge is mainly supported by providing erroneous examples in combination with elaborated feedback. These effects were independent from differences in time-on-task and prior knowledge. Furthermore, the effects of the learning environment proved sustainable.

Conclusions  Our results demonstrate that the case-based, worked example approach is effective and efficient.