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Medical Education 2010: 44: 340–346

Objectives  This article discusses the need for, and value of, providing students with instruction in how to use comprehension strategies as well as the effectiveness of inducing strategy use through cognitive disequilibrium. The leading assumption that guides this article is that learning facts and figures is not enough. Students need to build deep knowledge that is interconnected, coherent and includes understanding of potential causal mechanisms. Doing so requires going beyond the printed page by generating inferences and developing coherent explanations. Inferences and explanations allow the student to make links between concepts in the material and, importantly, to make connections to prior knowledge. These connections render students’ understanding of new material more coherent and, in consequence, deeper and more stable.

Discussion  This article describes two means of inducing students to construct a deeper understanding of new material. One means of challenging students is through cohesion gaps in a text (or a lecture) that require the student to generate inferences to understand the relationships between concepts. Although low-knowledge readers are not able to generate these inferences, relatively high-knowledge readers (e.g. medical students) are more likely to successfully generate inferences to bridge conceptual gaps, and doing so results in a deeper understanding of the material. A second means of inducing active processing is to provide students with instruction and practice in how to use comprehension strategies. This article describes methods of providing such instruction, including the intelligent tutoring system, iSTART.

Conclusions  The overarching goal of the research described in this article is to scaffold students towards ideal learning strategies. This cannot happen simply by telling students about good strategies. It is ineffective to inform a student that the content will be better understood if it is explained or evaluated. Such an approach is a victim of learning by consumption attitudes towards education.