<?xml version="1.0" encoding="iso-8859-1" standalone="no"?>
<!DOCTYPE GmsArticle SYSTEM "http://www.egms.de/dtd/2.0.34/GmsArticle.dtd">
<GmsArticle xmlns:xlink="http://www.w3.org/1999/xlink">
  <MetaData>
    <Identifier>zma001651</Identifier>
    <IdentifierDoi>10.3205/zma001651</IdentifierDoi>
    <IdentifierUrn>urn:nbn:de:0183-zma0016518</IdentifierUrn>
    <ArticleType language="en">article</ArticleType>
    <ArticleType language="de">Artikel</ArticleType>
    <TitleGroup>
      <Title language="en">Does prior knowledge affect interaction dynamics and learning achievement in digital problem-based learning&#63; A pilot study</Title>
      <TitleTranslated language="de">Beeinflusst der Vorwissensstand die Interaktionsdynamik und den Lernerfolg im digitalen problemorientierten Lernen&#63; Eine Pilotstudie</TitleTranslated>
    </TitleGroup>
    <CreatorList>
      <Creator>
        <PersonNames>
          <Lastname>M&#246;ser</Lastname>
          <LastnameHeading>M&#246;ser</LastnameHeading>
          <Firstname>Martin</Firstname>
          <Initials>M</Initials>
        </PersonNames>
        <Address language="en">Goethe University Frankfurt, Department of Operative Dentistry, Theodor-Stern-Kai 7, D-60596 Frankfurt&#47;Main, Germany<Affiliation>Goethe University Frankfurt, Department of Operative Dentistry, Frankfurt&#47;Main, Germany</Affiliation></Address>
        <Address language="de">Goethe Universit&#228;t Frankfurt am Main, Carolinum Zahn&#228;rztliches Universit&#228;ts-Institut gGmbH,  Abteilung konservierende Zahnheilkunde, Theodor-Stern-Kai 7, 60596 Frankfurt&#47;Main, Deutschland<Affiliation>Goethe Universit&#228;t Frankfurt am Main, Carolinum Zahn&#228;rztliches Universit&#228;ts-Institut gGmbH,  Abteilung konservierende Zahnheilkunde, Frankfurt&#47;Main, Deutschland</Affiliation></Address>
        <Email>martin-moeser&#64;web.de</Email>
        <Creatorrole corresponding="yes" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Hermkes</Lastname>
          <LastnameHeading>Hermkes</LastnameHeading>
          <Firstname>Rico</Firstname>
          <Initials>R</Initials>
        </PersonNames>
        <Address language="en">
          <Affiliation>Goethe University Frankfurt, Department of Business Ethics and Business Education, Frankfurt&#47;Main, Germany</Affiliation>
        </Address>
        <Address language="de">
          <Affiliation>Goethe Universit&#228;t Frankfurt am Main, Institut f&#252;r Wirtschaftsethik und Wirtschaftsp&#228;dagogik, Frankfurt&#47;Main, Deutschland</Affiliation>
        </Address>
        <Email>hermkes&#64;econ.uni-frankfurt.de</Email>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Filmann</Lastname>
          <LastnameHeading>Filmann</LastnameHeading>
          <Firstname>Natalie</Firstname>
          <Initials>N</Initials>
        </PersonNames>
        <Address language="en">
          <Affiliation>Goethe University Frankfurt, Department of Biostatistics and Mathematical Modelling, Frankfurt&#47;Main, Germany</Affiliation>
        </Address>
        <Address language="de">
          <Affiliation>Goethe Universit&#228;t Frankfurt am Main, Institut f&#252;r Biostatistik und Mathematische Modellierung, Frankfurt&#47;Main, Deutschland</Affiliation>
        </Address>
        <Email>filmann&#64;med.uni-frankfurt.de</Email>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Harsch</Lastname>
          <LastnameHeading>Harsch</LastnameHeading>
          <Firstname>Seon-Yee</Firstname>
          <Initials>SY</Initials>
        </PersonNames>
        <Address language="en">
          <Affiliation>Goethe University Frankfurt, Department of Operative Dentistry, Frankfurt&#47;Main, Germany</Affiliation>
        </Address>
        <Address language="de">
          <Affiliation>Goethe Universit&#228;t Frankfurt am Main, Carolinum Zahn&#228;rztliches Universit&#228;ts-Institut gGmbH,  Abteilung konservierende Zahnheilkunde, Frankfurt&#47;Main, Deutschland</Affiliation>
        </Address>
        <Email>s8038019&#64;stud.uni-frankfurt.de</Email>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>R&#252;ttermann</Lastname>
          <LastnameHeading>R&#252;ttermann</LastnameHeading>
          <Firstname>Stefan</Firstname>
          <Initials>S</Initials>
        </PersonNames>
        <Address language="en">
          <Affiliation>Goethe University Frankfurt, Department of Operative Dentistry, Frankfurt&#47;Main, Germany</Affiliation>
        </Address>
        <Address language="de">
          <Affiliation>Goethe Universit&#228;t Frankfurt am Main, Carolinum Zahn&#228;rztliches Universit&#228;ts-Institut gGmbH,  Abteilung konservierende Zahnheilkunde, Frankfurt&#47;Main, Deutschland</Affiliation>
        </Address>
        <Email>ruettermann&#64;med.uni-frankfurt.de</Email>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Gerhard-Sz&#233;p</Lastname>
          <LastnameHeading>Gerhard-Sz&#233;p</LastnameHeading>
          <Firstname>Susanne</Firstname>
          <Initials>S</Initials>
        </PersonNames>
        <Address language="en">
          <Affiliation>Goethe University Frankfurt, Department of Operative Dentistry, Frankfurt&#47;Main, Germany</Affiliation>
        </Address>
        <Address language="de">
          <Affiliation>Goethe Universit&#228;t Frankfurt am Main, Carolinum Zahn&#228;rztliches Universit&#228;ts-Institut gGmbH,  Abteilung konservierende Zahnheilkunde, Frankfurt&#47;Main, Deutschland</Affiliation>
        </Address>
        <Email>S.Szep&#64;em.uni-frankfurt.de</Email>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
    </CreatorList>
    <PublisherList>
      <Publisher>
        <Corporation>
          <Corporatename>German Medical Science GMS Publishing House</Corporatename>
        </Corporation>
        <Address>D&#252;sseldorf</Address>
      </Publisher>
    </PublisherList>
    <SubjectGroup>
      <SubjectheadingDDB>610</SubjectheadingDDB>
      <Keyword language="en">problem-based learning</Keyword>
      <Keyword language="en">PBL</Keyword>
      <Keyword language="en">video-study</Keyword>
      <Keyword language="en">digital</Keyword>
      <Keyword language="en">interaction</Keyword>
      <Keyword language="en">prior knowledge</Keyword>
      <Keyword language="en">learning achievement</Keyword>
      <Keyword language="de">problemorientiertes Lernen</Keyword>
      <Keyword language="de">POL</Keyword>
      <Keyword language="de">Videostudie</Keyword>
      <Keyword language="de">digital</Keyword>
      <Keyword language="de">Interaktion</Keyword>
      <Keyword language="de">Vorwissen</Keyword>
      <Keyword language="de">Lernerfolg</Keyword>
      <SectionHeading language="en">problem-based learning</SectionHeading>
      <SectionHeading language="de">Problemorientiertes Lernen</SectionHeading>
    </SubjectGroup>
    <DateReceived>20230118</DateReceived>
    <DateRevised>20230601</DateRevised>
    <DateAccepted>20230808</DateAccepted>
    <DatePublishedList>
      
    <DatePublished>20231115</DatePublished></DatePublishedList>
    <Language>engl</Language>
    <LanguageTranslation>germ</LanguageTranslation>
    <License license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
      <AltText language="en">This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.</AltText>
      <AltText language="de">Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).</AltText>
    </License>
    <SourceGroup>
      <Journal>
        <ISSN>2366-5017</ISSN>
        <Volume>40</Volume>
        <Issue>6</Issue>
        <JournalTitle>GMS Journal for Medical Education</JournalTitle>
        <JournalTitleAbbr>GMS J Med Educ</JournalTitleAbbr>
      </Journal>
    </SourceGroup>
    <ArticleNo>69</ArticleNo>
  </MetaData>
  <OrigData>
    <Abstract language="de" linked="yes"><Pgraph><Mark1>Zielsetzung: </Mark1>Forschungsbefunde zum problemorientierten Lernen (POL) zeigen, dass Untersuchungen von Videoaufzeichnungen tutorieller Lernsitzungen bedeutsame Einblicke in kognitive Prozesse erm&#246;glichen. Der Einfluss von Vorwissen auf Lernerfolg unter Einbezug der Lehr-Lern-Interaktionsdynamik wurde in der medizinischen Ausbildung bisher allerdings noch nicht untersucht, obwohl die Faktoren eine Schl&#252;sselrolle f&#252;r den Erfolg von POL darstellen. Ziel der Studie ist es daher, digitale problemorientierten Lernsitzungen (dPOL) anhand von Videoaufzeichnungen zu analysieren und dabei Wissenserwerbsprozesse und die Interaktionsdynamik in den Lerngruppen in Abh&#228;ngigkeit vom Vorwissensstand zu untersuchen.</Pgraph><Pgraph><Mark1>Methoden: </Mark1>In dieser Studie wurde ein Pilotdesign angewandt, bei dem 60 Zahnmedizinstudierende in zw&#246;lf Untergruppen mit geringerem oder h&#246;herem Vorwissen eingeteilt wurden. Die Erhebung des Vorwissens erfolgte durch einen Multiple-Choice-Test (MCQ) zu Beginn des Semesters. Die Gruppen bearbeiteten mit tutorieller Unterst&#252;tzung dPOL-F&#228;lle. Die Gruppeninteraktion und Tutor&#42;innenaktivit&#228;ten wurden videographiert. Der Lernerfolg wurde am Ende des Semesters anhand eines MCQ sowie einer m&#252;ndlichen und praktischen Pr&#252;fung erhoben.</Pgraph><Pgraph><Mark1>Ergebnisse: </Mark1>dPOL-Gruppen mit geringerem Vorwissen weisen eine signifikant h&#246;here Anzahl an Aussagen in Gruppeninteraktionen und eine h&#246;here Tutor&#42;inneneffektivit&#228;t auf. Der zeitliche Umfang der &#196;u&#223;erungen (Prozentsatz, die &#196;u&#223;erungen an der Gesamtzeit einnehmen) ist jedoch in beiden Gruppen gleich. Studierende mit geringerem Vorwissen zeigen einen h&#246;heren Lernzuwachs im MCQ. Signifikante Gruppenunterschiede in den Ergebnissen der m&#252;ndlichen und praktischen Pr&#252;fung zeigen sich allerdings nicht.</Pgraph><Pgraph><Mark1>Schlussfolgerungen: </Mark1>Unterschiedliches Vorwissen der Lernenden f&#252;hrt zu unterschiedlichen Interaktionsdynamiken im dPOL. Im Hinblick auf Lernoutcomes profitieren insbesondere Lernende mit geringerem Vorwissen von dPOL. Die jeweiligen dPOL-Gruppen erreichten am Ende des Semesters &#228;hnliche Lernergebnisse, die Befunde legen aber nahe, dass sich die Charakteristik des Wissenserwerbprozesses in Abh&#228;ngigkeit vom Vorwissen unterscheidet.</Pgraph></Abstract>
    <Abstract language="en" linked="yes"><Pgraph><Mark1>Objective: </Mark1>Previous research on problem-based learning (PBL) describes that videotaped observations develop meaningful insights into cognitive processes in tutorial groups. Analysis regarding the amount of prior knowledge on learning achievement has not been investigated in medical education so far, although both are key factors of PBL success. Thus, we intended to analyse videos of digital problem-based learning (dPBL) sessions, focusing on knowledge acquisition and interaction dynamics among groups with different levels of prior knowledge to reveal any distinctions.</Pgraph><Pgraph><Mark1>Methods: </Mark1>This study employed a pilot design by dividing 60 dental students into twelve subgroups with less or more prior knowledge, determined by a pre-semester multiple choice test (MCQ). The groups engaged in videotaped dPBL cases, which were examined regarding group interactions and tutor effectiveness. The learning achievement was assessed through a post-semester MCQ, an oral and practical exam.</Pgraph><Pgraph><Mark1>Results: </Mark1>The video analysis showed that dPBL groups with less prior knowledge achieved significantly higher tutor effectiveness and group interaction utterances, but that the percentage of time in which utterances occurred was similar in both groups. Related to the MCQ results, the students with less prior knowledge learned four times more than those with profound previous abilities, but no significant difference was found in the results of the oral exam and practical exam.</Pgraph><Pgraph><Mark1>Conclusions: </Mark1>The interaction dynamics in dPBL depend on the group&#8217;s amount of prior knowledge. Especially groups including participants with less prior knowledge seemed to benefit from dPBL in comparison to groups with more prior knowledge. The dPBL groups acquired knowledge in different ways during the courses but, finally, all students arrived at a similar level of knowledge.</Pgraph></Abstract>
    <TextBlock language="en" linked="yes" name="Introduction">
      <MainHeadline>Introduction</MainHeadline><Pgraph>More than 50 years after its first implementation, problem-based learning (PBL) continues to be approved and has spread throughout medical education, enhancing students&#8217; abilities and preparedness for real-life challenges <TextLink reference="1"></TextLink>. </Pgraph><Pgraph>Research in the last decade has revealed several benefits of PBL as being a more enjoyable experience that can foster students&#8217; knowledge construction processes and it has been described that participants relish the self-directed nature of PBL <TextLink reference="2"></TextLink>. Students who frequently take part in PBL sessions achieve notably better results in assessments of knowledge and evaluate it as a more pleasing way to study than teacher-centred lectures <TextLink reference="3"></TextLink>. Furthermore, current developments such as the interprofessional PBL also showed a high level of acceptance among the participants <TextLink reference="4"></TextLink>.</Pgraph><Pgraph>There are even educators who consider PBL as a universal remedy for educational shortcomings while others vehemently refuse its implementation and call the impact and value of PBL on learning into question due to its unconventional philosophy and instructional practices <TextLink reference="5"></TextLink>, <TextLink reference="6"></TextLink>. Indeed, there is also evidence that traditional courses tend to lead to an increased achievement of scientific knowledge in comparison to PBL <TextLink reference="7"></TextLink>. </Pgraph><Pgraph>Today we know several factors affecting the outcomes of learning in PBL: the way it is used in various domains, for participants of different ages and subject matters are some of the parameters that influence PBL results <TextLink reference="8"></TextLink>. The effectiveness of PBL and the participants&#8217; learning are largely dependent on the tutors&#8217; pedagogical abilities, academic background, training concept and maintenance to the quality of discussion <TextLink reference="9"></TextLink>, <TextLink reference="10"></TextLink>, <TextLink reference="11"></TextLink>, <TextLink reference="12"></TextLink>. However, there is still no final conclusion on the best way to optimise PBL-teaching <TextLink reference="13"></TextLink>.</Pgraph><Pgraph>During the COVID-19 pandemic, PBL research showed new insights regarding synchronous online learning and many faculties provide meaningful results by digitalising their curricula into an e-learning platform <TextLink reference="14"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="18"></TextLink>, <TextLink reference="19"></TextLink>, <TextLink reference="20"></TextLink>, <TextLink reference="21"></TextLink>, <TextLink reference="22"></TextLink>. Furthermore, it has been described that direct or videotaped observations or corpus analysis of recordings develop unadulterated information about cognitive processes in small groups <TextLink reference="23"></TextLink>, <TextLink reference="24"></TextLink>. Previous research on the analysis of group interactions and tutor effectiveness in PBL has shown promising results <TextLink reference="24"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="31"></TextLink>, however, the influence of the amount of prior knowledge on learning achievement has never been investigated in medical education, although both are considered as key factors of PBL success <TextLink reference="32"></TextLink>. Research in other sciences, e.g. social science and mathematics, has already successfully investigated this relationship and clarified its significance <TextLink reference="33"></TextLink>, <TextLink reference="34"></TextLink>.</Pgraph><Pgraph>Due to the current state of research, we intended to analyse videos of digital PBL (dPBL) sessions to concentrate on group interactions, tutor effectiveness and knowledge acquisition between groups with a different amount of prior knowledge. To search for distinctions of both groups and to receive multi-perspective options, videotaped dPBL sessions, multiple-choice tests (MCQ), a structured oral exam (SOE) and an objective structured practical exam (OSPE) were analysed.</Pgraph><Pgraph>Research questions:</Pgraph><Pgraph><UnorderedList><ListItem level="1">Are there significant differences regarding the group interactions between the two groups&#63;</ListItem><ListItem level="1">Are there significant differences regarding the tutor effectiveness between the two groups&#63;</ListItem><ListItem level="1">Are there significant differences regarding the knowledge acquisition of the two groups&#63;</ListItem></UnorderedList></Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Einleitung">
      <MainHeadline>Einleitung</MainHeadline><Pgraph>Mehr als 50 Jahre nach seiner erstmaligen Implementierung ist das problemorientierte Lernen (POL) weltweit anerkannt und hat sich in der gesamten medizinischen Ausbildung verbreitet, um F&#228;higkeiten von Studierenden zu verbessern und sie auf die Herausforderungen des Berufslebens vorzubereiten <TextLink reference="1"></TextLink>.</Pgraph><Pgraph>Forschungsergebnisse des letzten Jahrzehnts haben verschiedene Vorteile von POL aufgezeigt. So geht POL bspw. mit einer h&#246;heren Lernfreude einher, was wiederum Wissenserwerbsprozesse positiv beeinflusst und besonders das selbstgesteuerte Lernen, das im Rahmen von POL erfolgt, wird von Lernenden als positiv eingesch&#228;tzt <TextLink reference="2"></TextLink>. Studierende, die regelm&#228;&#223;ig an POL-Sitzungen teilnehmen, erzielen bessere Ergebnisse in Wissenstests und erleben POL als eine angenehmere Art des Lernens im Vergleich zu lehrerzentrierten Lernangeboten <TextLink reference="3"></TextLink>. Dar&#252;ber hinaus hat sich gezeigt, dass neuere Entwicklungen wie das interprofessionelle POL ebenfalls auf hohe Akzeptanz bei den Lernenden sto&#223;en <TextLink reference="4"></TextLink>.</Pgraph><Pgraph>W&#228;hrend Lernende vom POL profitieren, zeigen Befunde aber auch, dass Lehrende Vorbehalte gegen&#252;ber POL-Formen haben und deren Effektivit&#228;t kritisch sehen <TextLink reference="5"></TextLink>, <TextLink reference="6"></TextLink>. Zudem gibt es auch Hinweise darauf, dass POL zwar Praxiswissen f&#246;rdert, dass aber lehrerzentrierte Kurse im Vergleich zu POL-Kursen zu einer h&#246;heren Auspr&#228;gung im wissenschaftlichen Theoriewissen bei Studierenden f&#252;hren <TextLink reference="7"></TextLink>.</Pgraph><Pgraph>Heute kennt man eine Reihe von Faktoren, die die Lernergebnisse in POL-Kursen beeinflussen. Die Art und Weise, wie POL in verschiedenen Dom&#228;nen implementiert und durchgef&#252;hrt wird, die Spezifika der Implementation f&#252;r Lernende unterschiedlichen Alters und unterschiedlicher Fachrichtungen, sind nur einige Parameter, die die Wirksamkeit von POL beeinflussen k&#246;nnen <TextLink reference="8"></TextLink>. Die Effektivit&#228;t von POL (und die Qualit&#228;t der Lernprozesse selbst) h&#228;ngen zudem ma&#223;geblich von den p&#228;dagogischen F&#228;higkeiten der Tutor&#42;innen und deren akademischen Hintergrund ab <TextLink reference="9"></TextLink>, <TextLink reference="10"></TextLink>. Auch spielt das Training, das Tutor&#42;innen durchlaufen haben, eine Rolle und ebenso die F&#228;higkeiten, qualitativ hochwertige Diskussionen zu initiieren <TextLink reference="11"></TextLink>, <TextLink reference="12"></TextLink>. Es gibt jedoch noch keine endg&#252;ltige L&#246;sung dazu, wie POL-Unterricht am besten optimiert werden kann <TextLink reference="13"></TextLink>.</Pgraph><Pgraph>Im Kontext COVID-19-Pandemie und die damit verbundene Digitalisierung von universit&#228;ren Lehrveranstaltungen konnte die POL-Forschung eine Reihe neuer Erkenntnisse im Hinblick auf (synchrones) Online-Lernen gewinnen <TextLink reference="14"></TextLink>, <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink>, <TextLink reference="17"></TextLink>, <TextLink reference="18"></TextLink>, <TextLink reference="19"></TextLink>, <TextLink reference="20"></TextLink>, <TextLink reference="21"></TextLink>, <TextLink reference="22"></TextLink>. Auch die Erhebungsm&#246;glichkeiten f&#252;r Lernprozesse verbesserten sich dadurch. So kann z. B. konstatiert werden, dass kognitive Prozesse der Lernenden (in tutoriell unterst&#252;tzten Kleingruppen) zug&#228;nglicher werden, da verbalsprachlicher oder schriftlicher Austausch im digitalen Medium aufgezeichnet werden kann <TextLink reference="23"></TextLink>, <TextLink reference="24"></TextLink>. Studien zur Analyse von Gruppeninteraktionen und Tutor&#42;inneneffektivit&#228;t im POL haben zudem wertvolle Kenntnisse aufgezeigt, allerdings wurde der Einfluss der H&#246;he des Vorwissens und der Interaktionsdynamik beim POL auf den Lernerfolg in der medizinischen Ausbildung bisher nicht untersucht, obwohl die Faktoren eine Schl&#252;sselrolle f&#252;r den Erfolg von POL darstellen <TextLink reference="24"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="32"></TextLink>. In anderen wissenschaftlichen Disziplinen, wie den Sozialwissenschaften und der Mathematik, konnte der Einfluss von Vorwissen und Interaktionsdynamik dagegen bereits empirisch belegt werden <TextLink reference="33"></TextLink>, <TextLink reference="34"></TextLink>.</Pgraph><Pgraph>Ziel unserer Studie ist es daher, die Interaktionsdynamiken (Gruppeninteraktionen, Tutor&#42;inneneffektivit&#228;t) digitaler POL-Sitzungen (dPOL) zu untersuchen und im Hinblick auf Unterschiede in den Lern- und Wissenserwerbsprozessen zwischen Gruppen mit unterschiedlichem Vorwissensstand zu analysieren. Datengrundlage sind videographierte dPOL-Sitzungen sowie zur Erfassung von Vorwissen und Lernoutcomes Multiple-Choice-Tests (MCQ), Noten einer strukturierten m&#252;ndlichen Pr&#252;fung (SOE) und eine objektiv strukturierte praktische Pr&#252;fung (OSPE).</Pgraph><Pgraph>Forschungsfragen:</Pgraph><Pgraph><UnorderedList><ListItem level="1">Gibt es signifikante Unterschiede hinsichtlich der Gruppeninteraktionen zwischen den Gruppen&#63; </ListItem><ListItem level="1">Gibt es signifikante Unterschiede hinsichtlich der Tutor&#42;inneneffektivit&#228;t zwischen den Gruppen&#63; </ListItem><ListItem level="1">Gibt es signifikante Unterschiede hinsichtlich der Lernoutcomes der Gruppen&#63;</ListItem></UnorderedList></Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Materials and method">
      <MainHeadline>Materials and method</MainHeadline><SubHeadline>1. Context and participants</SubHeadline><Pgraph>This study was conducted at the dental school of the Goethe University in Frankfurt, Germany. </Pgraph><Pgraph>The students of the first clinical semester (n&#61;60) were divided into two groups assessed by their prior knowledge, which was amongst others determined by a completion of a pre-semester multiple-choice test (MCQ). The division of the two groups was based on the number of points reached in the pre-semester multiple-choice test, the preclinical examination grade and the general qualification grade for university entrance in Germany (Abitur). The gender also played a role in the division so that women (n&#61;37) and men (n&#61;23) were equally distributed in the final twelve dPBL subgroups. Students with less prior knowledge were assigned to group A (n&#61;30) and students with more prior knowledge were assigned to group B respectively (n&#61;30). Both groups were further separated into subgroups (A 1-6 and B 1-6) using the above described parameters to establish similar subgroups, each with five participants and a tutor. </Pgraph><Pgraph>During the semester, the twelve groups worked on five dPBL cases. Based on the seven-step PBL model established at the University of Maastricht <TextLink reference="35"></TextLink>, the first five steps were processed in the first digital session, the sixth step in a self-study period and the seventh step in the second digital session. As Barrows <TextLink reference="36"></TextLink> recommended, an eighth step was added in the second digital session to evaluate the dPBL process.</Pgraph><Pgraph>An established expert (Master of Medical Education) trained the tutors on how to supply dPBL in a so-called non-facilitative and facilitative style <TextLink reference="37"></TextLink>. Tutors were instructed first to guide the dPBL sessions in a facilitative style, then, as the students gained more experience throughout their dPBL cases, the tutors were told to guide them in a non-facilitative manner. All of the tutors were dentists and each of them attended to a group of students with less prior knowledge and a group of students with more prior knowledge. </Pgraph><Pgraph>Neither the students nor the tutors knew about the assessment of previous knowledge and the determination to group A or B (double-blind setting). Finally, the sessions were accomplished on Vydeo<Superscript>&#174;</Superscript> (Vydeo, Berlin, Germany), an online platform where the students and the tutor could see each other via video camera and were able to work on a shared document. At the end of the semester, the students were required to pass a post-semester MCQ, a graded SOE and OSPE.</Pgraph><SubHeadline>2. Video material and coding scheme</SubHeadline><SubHeadline2>2.1. Setting</SubHeadline2><Pgraph>For the quantitative and qualitative analysis of the videotaped dPBL sessions the software Interact<Superscript>&#174;</Superscript> (Version 18, Mangold International GmbH, Arnstorf, Germany) was used. A second rater independently coded seven hours of a randomly selected part (about 20&#37; of the total video material <TextLink reference="26"></TextLink>) after passing a two-week rater training. The inter-rater reliability to Cohen&#8217;s kappa was 0.81, thus the first rater analysed all subsequent videos.</Pgraph><SubHeadline2>2.2. Analysis variables and coding scheme</SubHeadline2><Pgraph>Based on Visschers-Pleijers&#8217; coding scheme <TextLink reference="26"></TextLink>, we analysed three different types of group interaction: learning-orientated interactions (i.e. exploratory questioning, cumulative reasoning, and handling conflicts about knowledge), procedural interactions and irrelevant&#47;off-task interactions (see table 1 <ImgLink imgNo="1" imgType="table"/>). Irrelevant&#47;off-task interactions contained the subtype &#8220;a period silence&#8221; which was also measured and analysed.</Pgraph><Pgraph>Furthermore, we examined the tutor effectiveness using a coding scheme based on the evaluation sheet developed by Dolmans <TextLink reference="38"></TextLink> (see table 2 <ImgLink imgNo="2" imgType="table"/>) as video analysis criteria. Therefore, four approaches of how the tutors stimulated the students&#8217; learning were observed: constructive&#47;active learning, self-directed learning, contextual learning and collaborative learning. The intra-personal behaviour as a tutor was also examined.</Pgraph><Pgraph>As soon as a participant (student or tutor) made an utterance, with a possible range from one word to several sentences, it was classified according to the given criteria <TextLink reference="26"></TextLink>, <TextLink reference="38"></TextLink>. Every single utterance of the students and the tutors of both groups was examined by the frequency of occurrence and as a percentage of the total session time. From the moment that the utterance began, it was coded and its length determined (see figure 1 <ImgLink imgNo="1" imgType="figure"/>). Thus, a total of 12,766 student utterances and 1,476 tutor utterances were examined.</Pgraph><SubHeadline>3. Multiple-choice test</SubHeadline><Pgraph>The pre- and post-semester MCQ contained 50 questions that dealt with dental materials and instruments, dental treatment instructions and diagnoses. The MCQ content was also included in the dPBL sessions. The tests were based on a validated template, a previous analysis of which showed a Cronbach&#8217;s &#945; of 0.63 (pre-test) and 0.67 (post-test) <TextLink reference="37"></TextLink>.</Pgraph><SubHeadline>4. Statistical analysis</SubHeadline><Pgraph>In order to analyse the pre- and post-semester MCQ, SOE and OSPE data, the software BiAs<Superscript>&#174;</Superscript> (Version 11.12, Frankfurt, Germany) was used and significant differences (p&#60;0.05) were identified by using a Wilcoxon-Mann-Whitney U Test. </Pgraph><Pgraph>The video rater&#8217;s data were examined using mixed effect models as linear mixed models and generalised linear mixed models <TextLink reference="39"></TextLink>. An Interact<Superscript>&#174;</Superscript> software tool especially developed for analysing inter-rater reliability was used to check Cohen&#8217;s kappa.</Pgraph><Pgraph>A rough sample estimation was adjusted by examining several factors. Firstly, the PBL time analysed in previous research or the number of PBL sessions conducted were examined as reference points <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="46"></TextLink>. Secondly, the units of analysis, such as individual videos or segments within videos, were evaluated. By averaging these aspects, we found that at least 15 videos were needed to gather statistically significant information for this pilot study. </Pgraph><SubHeadline>5. Application for ethical approval</SubHeadline><Pgraph>According to the chairman of the ethics committee of the Goethe University in Frankfurt, no ethical approval was required, because relating to the video material, being recorded was voluntary. The participants knew that they were recorded on video and could approve or decline the recording before each session was started. There were no disadvantages for the participants if they did not agree to be videotaped. All data protection requirements were met. Participation in the dPBL sessions and all exams was mandatory to pass the semester.</Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Erhebungsmethode und Daten">
      <MainHeadline>Erhebungsmethode und Daten</MainHeadline><SubHeadline>1. Studienkontext und Teilnehmer&#42;innen</SubHeadline><Pgraph>Diese Studie wurde am zahnmedizinischen Institut der Goethe-Universit&#228;t in Frankfurt am Main, Deutschland, durchgef&#252;hrt. Die Studierenden des ersten klinischen Semesters (n&#61;60) wurden anhand ihres Vorwissens in zwei Gruppen eingeteilt. Die Gruppeneinteilung erfolgte dabei auf Basis der Punkteanzahl im Pr&#228;-Test (Multiple-Choice). Zudem wurden auch die Pr&#252;fungsnote des ersten zahn&#228;rztlichen Staatsexamens und der allgemeinen Qualifikationsnote f&#252;r den Hochschulzugang in Deutschland (Abitur) ber&#252;cksichtigt. Auch das Geschlecht spielte bei der Gruppeneinteilung eine Rolle. Angestrebt war, dass weibliche (n&#61;37) und m&#228;nnliche Studierende (n&#61;23) gleichm&#228;&#223;ig in den insgesamt zw&#246;lf dPOL-Gruppen verteilt waren. Studierende mit geringerem Vorwissen bildeten die Untersuchungsgruppe A (n&#61;30), Studierende mit h&#246;herem Vorwissen die Gruppe B (n&#61;30). Beide Untersuchungsgruppen wurden in Untergruppen (A 1-6 und B 1-6) mit je f&#252;nf Lernenden unterteilt, wobei die Einteilung unter den oben beschriebenen Parametern erfolgte. Jeder Untergruppe wurde ein Tutor bzw. eine Tutorin zugewiesen.</Pgraph><Pgraph>W&#228;hrend des Semesters bearbeiteten die zw&#246;lf Gruppen jeweils f&#252;nf dPOL-F&#228;lle. Basierend auf dem siebenstufigen POL-Modell, das an der Universit&#228;t Maastricht entwickelt wurde <TextLink reference="35"></TextLink>, wurden die ersten f&#252;nf Schritte in der ersten digitalen Sitzung bearbeitet, der sechste Schritt in einer Selbstlernphase und der siebte Schritt in der zweiten digitalen Sitzung. Wie von Barrows <TextLink reference="36"></TextLink> empfohlen, wurde in der zweiten digitalen Sitzung ein achter Schritt hinzugef&#252;gt, um den dPOL-Prozess zu evaluieren.</Pgraph><Pgraph>Eine Expertin (Master of Medical Education) schulte die Tutor&#42;innen darin, dPOL-Sitzungen situationsabh&#228;ngig entweder in einem nicht-unterst&#252;tzenden Stil (&#8222;non-facilitative&#8220;) oder in einer unterst&#252;tzenden Weise (&#8222;facilitative&#8220;) zu f&#252;hren <TextLink reference="37"></TextLink>. Zu Beginn sollten die Tutor&#42;innen die dPOL-Sitzungen unterst&#252;tzend leiten. Im Laufe der dPOL-Fallbearbeitungen sollten sie dann die Studierenden immer weniger unterst&#252;tzen. Alle Tutor&#42;innen waren Zahn&#228;rzte bzw. Zahn&#228;rztinnen. Jeder Tutor bzw. jede Tutorin betreute je eine Gruppe von Studierenden mit geringerem und mit h&#246;herem Vorwissen.</Pgraph><Pgraph>Weder die Studierenden noch die Tutor&#42;innen kannten die vorgenommene Bewertung des Vorwissens und die Zuordnung zu Gruppe A oder B (double-blind setting). Die Sitzungen wurden auf der Online-Plattform Vydeo<Superscript>&#174;</Superscript> (Vydeo, Berlin, Deutschland) abgehalten. Die Studierenden und Tutor&#42;innen konnten einander &#252;ber Videokameras sehen und gemeinsam an Dokumenten arbeiteten. Am Ende des Semesters absolvierten die Studierenden einen Post-Semester MCQ, eine bewertete SOE und OSPE.</Pgraph><SubHeadline>2. Video-Material und Kodierschema</SubHeadline><SubHeadline2>2.1. Setting</SubHeadline2><Pgraph>F&#252;r die quantitative und qualitative Analyse der aufgezeichneten dPOL-Sitzungen wurde die Software Interact<Superscript>&#174;</Superscript> (Version 18, Mangold International GmbH, Arnstorf, Deutschland) verwendet. Ein zweiter Rater kodierte unabh&#228;ngig vom Erstrater zuf&#228;llig ausgew&#228;hlte sieben Stunden des Videomaterials (20&#37; des gesamten Videomaterials <TextLink reference="26"></TextLink>). Vor dem Rating fand eine zweiw&#246;chige Rater-Schulung statt. Die Inter-Rater-Reliabilit&#228;t (Cohen&#8217;s Kappa) der kodierten sieben Stunden betrug &#954;&#61;0.81. Die &#252;brigen Videos wurden anschlie&#223;end vom Erstrater ausgewertet.</Pgraph><SubHeadline2>2.2. Analysevariablen und Kodierschema</SubHeadline2><Pgraph>Basierend auf dem Kodierschema von Visschers-Pleijers <TextLink reference="26"></TextLink> werden drei verschiedene Arten von Gruppeninteraktion analysiert: lernorientierte Interaktionen (z. B. exploratives Fragen, kumulative Argumentation und Umgang mit Wissenskonflikten), prozedurale Interaktionen und irrelevante&#47;&#8222;off-task&#8220; Interaktionen (siehe Tabelle 1 <ImgLink imgNo="1" imgType="table"/>). Irrelevante&#47;&#8222;off-task&#8220; Interaktionen umfassten auch das Ereignis &#8222;Stille&#8220;, das ebenfalls analysiert wurde.</Pgraph><Pgraph>Dar&#252;ber hinaus wurde die Tutor&#42;inneneffektivit&#228;t erhoben. Basis bildete ein Kodierschema, das auf den von Dolman entwickelten Evaluationsbogen beruht <TextLink reference="38"></TextLink> (siehe Tabelle 2 <ImgLink imgNo="2" imgType="table"/>). Kodiert wurden vier Strategien, die die Anregung von Lernprozessen durch die Tutor&#42;innen betrafen. Das sind konstruktives&#47;aktives Lernen, selbstgesteuertes Lernen, kontextuelles Lernen und kollaboratives Lernen. Auch das intrapersonale Verhalten als Tutor&#42;in wurde untersucht.</Pgraph><Pgraph>Alle &#196;u&#223;erungen der Studierenden und Tutor&#42;innen (die von einem Wort bis zu mehreren S&#228;tzen reichten), wurden gem&#228;&#223; diesem Schemas klassifiziert <TextLink reference="26"></TextLink>, <TextLink reference="38"></TextLink>. Anschlie&#223;end wurde jede &#196;u&#223;erung hinsichtlich ihrer Auftretensh&#228;ufigkeit und ihres prozentualen Anteils an der Gesamtsitzungszeit untersucht. Ab dem Zeitpunkt, zu dem eine &#196;u&#223;erung begann, wurde sie entsprechend kodiert und bis zum Ende der &#196;u&#223;erung dokumentiert (siehe Abbildung 1 <ImgLink imgNo="1" imgType="figure"/>). Insgesamt wurden 12.766 &#196;u&#223;erungen der Studierenden und 1.476 &#196;u&#223;erungen der Tutor&#42;innen untersucht.</Pgraph><SubHeadline>3. Multiple-Choice-Test</SubHeadline><Pgraph>Der Pr&#228;- und der Post-Semester Multiple-Choice-Test umfassten je 50 Fragen, die sich mit zahn&#228;rztlichen Materialien und Instrumenten, zahn&#228;rztlichen Behandlungsverfahren und Diagnosestellungen befassten. Die durch den MCQ abgefragten Inhalte waren alle Gegenstand der dPOL-Sitzungen. Die Tests basieren auf einer validierten Vorlage, wobei die interne Konsistenz der Items einen Cronbach&#8217;s &#945;-Wert von 0.63 f&#252;r den Pr&#228;-Test und 0.67 f&#252;r den Post-Test ergab <TextLink reference="37"></TextLink>.</Pgraph><SubHeadline>4. Statistische Analyse</SubHeadline><Pgraph>Die Datenanalyse (MCQ, SOE, OSPE) erfolgte mittels der Software BiAs<Superscript>&#174;</Superscript> (Version 11.12, Frankfurt, Deutschland). Signifikante Gruppenunterschiede (p&#60;0,05) wurden anhand des Wilcoxon-Mann-Whitney U-Test berechnet.</Pgraph><Pgraph>Die kodierten Videodaten wurden statistisch mit Mixed-Effect-Models wie lineare gemischte Modelle und generalisierte lineare gemischte Modelle untersucht <TextLink reference="39"></TextLink>. Zur Berechnung der Inter-Rater-Reliabilit&#228;t (Cohen&#8217;s Kappa) wurde ein Interact<Superscript>&#174;</Superscript>-Software-Tool verwendet, das speziell f&#252;r diese Analyse entwickelt wurde.</Pgraph><Pgraph>F&#252;r eine Stichprobenabsch&#228;tzung wurden mehrere Faktoren einbezogen. Erstens wurden die in fr&#252;heren Untersuchungen (Pilotstudien ausgeschlossen) analysierte POL-Zeit bzw. die Anzahl der durchgef&#252;hrten POL-Sitzungen als Referenzpunkte genutzt <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="46"></TextLink>. Zweitens wurden die in den Studien gew&#228;hlten Analyseeinheiten (Session, Segmente) herangezogen. Die Analyse ergab, dass eine Mindestanzahl von 15 Videos ausreichend ist, um relevante Effekte zu identifizieren und signifikante Informationen im Rahmen der Pilotstudie zu erhalten.</Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Results">
      <MainHeadline>Results</MainHeadline><SubHeadline>1. Analysis of the video data</SubHeadline><Pgraph>As the recording of the dPBL sessions was optional, 34 out of 120 PBL sessions were recorded and analysed (dropout rate of 70.9&#37;). The 34 videos consisted of 15 videos from group A with less prior knowledge and 19 videos from group B with more prior knowledge. In both groups the first and second dPBL sessions were evenly divided.</Pgraph><SubHeadline2>1.1. Learning-orientated interactions analysis</SubHeadline2><Pgraph>Both groups spent most of the time on cumulative reasoning (group A: 67.3&#37;; group B: 65.7&#37;), while procedural tasks took the least time in both groups (group A: 2.5&#37;; group B: 1.9&#37;). The data group with the highest score of utterances was cumulative reasoning (group A: n&#61;364.9; group B: n&#61;229.6), while the most rare utterances concerned procedural (group A: n&#61;18.7; group B: n&#61;5.1).</Pgraph><Pgraph>Related to the frequency of the occurrence of group interactions, group A scored significantly more utterances in handling conflicts about knowledge, open questions, other questions, statements, disagreements and in procedural interactions (all p&#60;0.05), than group B. There was no significant difference between the groups in the percentage of total session time spent on that types of interactions (see table 1 <ImgLink imgNo="1" imgType="table"/>). </Pgraph><SubHeadline2>1.2. Tutor effectiveness analysis</SubHeadline2><Pgraph>Most utterances in the tutor data groups were focussed on constructive&#47;active learning in both groups (group A: 59.3&#37;; group B: 58.3&#37;). The intra-personal behaviour of the tutor engaged the least amount of time (group A: 5&#37;; group B: 7.6&#37;). Constructive&#47;active learning was the data group with the most tutor utterances (group A: n&#61;39; group B: n&#61;30.2), while the least time was spent in collaborative learning (group A: n&#61;4.3; group B: n&#61;2.5) (see table 2 <ImgLink imgNo="2" imgType="table"/>).</Pgraph><SubHeadline>2. Knowledge acquisition </SubHeadline><Pgraph>Group A scored significantly fewer points in the MCQ pre-test but had significantly more points in the MCQ post-test, both compared to group B (see table 3 <ImgLink imgNo="3" imgType="table"/>).</Pgraph><Pgraph>Group A had a significant increase of knowledge of 13.7 points and group B of 3.7 points. On average, all students significantly increase their knowledge of 8.7 points (see table 4 <ImgLink imgNo="4" imgType="table"/>).</Pgraph><Pgraph>There were no significant differences between both groups in structured oral exam or objective structured practical exam grades (see table 5 <ImgLink imgNo="5" imgType="table"/>).</Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Ergebnisse">
      <MainHeadline>Ergebnisse</MainHeadline><SubHeadline>1. Analyse der Videodaten</SubHeadline><Pgraph>Von insgesamt 120 PBL-Sitzungen wurden 34 aufgezeichnet und analysiert (Drop-out 70,9&#37;). Die 34 Videos bestanden aus 15 Videos von Gruppen mit geringerem Vorwissen und 19 Videos von Gruppen mit h&#246;herem Vorwissen und umfassten die erste und zweite dPOL-Sitzung.</Pgraph><SubHeadline2>1.1. Analyse der lernorientierten Interaktionen</SubHeadline2><Pgraph>Beide Gruppen verbrachten die meiste Zeit mit kumulativer Argumentation (Gruppe A: 67,3&#37;; Gruppe B: 65,7&#37;), w&#228;hrend &#196;u&#223;erungen bezogen auf das Prozedere in beiden Gruppen am wenigsten Zeit in Anspruch nahmen (Gruppe A: 2,5&#37;; Gruppe B: 1,9&#37;). Das gleiche Bild zeigte sich im Hinblick auf die Anzahl der &#196;u&#223;erungen (kumulative Argumentation Gruppe A: n&#61;364,9; Gruppe B: n&#61;229,6; prozedurale &#196;u&#223;erungen Gruppe A: n&#61;18,7; Gruppe B: n&#61;5,1). Hinsichtlich der H&#228;ufigkeit des Auftretens von Gruppeninteraktionen traten in Gruppe A signifikant mehr &#196;u&#223;erungen in Bezug auf den Umgang mit Wissenskonflikten, offene Fragen, andere Fragen, Stellungnahmen, Urteilsverneinungen&#47;Uneinigkeiten und prozedurale Interaktionen (alle p&#60;0,05) als Gruppe B auf. Bezogen auf den prozentualen Anteil der Gesamtzeit gab es bei diesen Interaktionen keine Unterschiede zwischen den beiden Gruppen (siehe Tabelle 1 <ImgLink imgNo="1" imgType="table"/>).</Pgraph><SubHeadline2>1.2. Analyse der Tutor&#42;inneneffektivit&#228;t</SubHeadline2><Pgraph>Die Mehrzahl der Tutor&#42;innen&#228;u&#223;erungen waren in beiden Untersuchungsgruppen auf konstruktives&#47;aktives Lernen ausgerichtet (Gruppe A: 59,3&#37;; Gruppe B: 58,3&#37;). Auf intrapersonales Verhalten des&#47;der Tutor&#42;in bezogene &#196;u&#223;erungen nahmen die geringste Zeit ein (Gruppe A: 5&#37;; Gruppe B: 7,6&#37;). &#196;u&#223;erungen, die konstruktives&#47;aktives Lernen betrafen, wiesen auch die gr&#246;&#223;te numerische H&#228;ufigkeit auf (Gruppe A: n&#61;39; Gruppe B: n&#61;30,2). Die geringste Anzahl wiesen hier &#196;u&#223;erungen zum kollaborativen Lernen auf (Gruppe A: n&#61;4,3; Gruppe B: n&#61;2,5) (siehe Tabelle 2 <ImgLink imgNo="2" imgType="table"/>).</Pgraph><SubHeadline>2. Wissenserwerb</SubHeadline><Pgraph>Gruppe A erzielte im Pr&#228;-Semester MCQ signifikant weniger Punkte als Gruppe B, weist jedoch im Post-Semester MCQ signifikant mehr Punkte als Gruppe B auf (siehe Tabelle 3 <ImgLink imgNo="3" imgType="table"/>).</Pgraph><Pgraph>Gruppe A erreicht dabei einen Wissenszuwachs von 13,7 Punkten, Gruppe B lediglich von 3,7 Punkten. Der Durchschnitt des Wissenszuwachses &#252;ber beide Gruppen hinweg liegt dementsprechend bei 8,7 Punkten (siehe Tabelle 4 <ImgLink imgNo="4" imgType="table"/>).</Pgraph><Pgraph>Es gab keine signifikanten Unterschiede zwischen beiden Gruppen in den Noten der strukturierten m&#252;ndlichen Pr&#252;fung sowie der objektiv strukturierten praktischen Pr&#252;fung (siehe Tabelle 5 <ImgLink imgNo="5" imgType="table"/>).</Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Discussion">
      <MainHeadline>Discussion</MainHeadline><Pgraph>This study&#8217;s scientific relevance lies in exploring significant differences in group interactions, tutor effectiveness, and knowledge acquisition between two groups having a different level of prior knowledge. By investigating these aspects, it contributes to understanding the dynamics of group interactions, the effectiveness of tutors, and the impact of prior knowledge on knowledge acquisition. These findings provide valuable insights for educational practitioners and researchers, informing the design and implementation of instructional strategies and interventions to enhance group interactions, optimize tutor effectiveness, and promote effective knowledge acquisition in educational settings. Furthermore, this research provides new information into the influence of prior knowledge to dPBL functioning and gives an example of how dPBL could still be used and analysed during pandemic situations.</Pgraph><Pgraph>Although this study is titled as a pilot study, we examined almost 34 hours and 26 minutes of video material including 14,366 utterances; this is substantially more material than comparable studies based on analysing group interactions or tutor effectiveness in PBL <TextLink reference="24"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="46"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="48"></TextLink>, <TextLink reference="49"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>. Nevertheless, we have scheduled a follow-up study with an exact sample estimation to verify our findings and to produce further results.</Pgraph><SubHeadline>1. Group interaction </SubHeadline><Pgraph>Students with less prior knowledge (group A) performed significantly more utterances on several types of interactions with nearly the same time spent on that interactions as those with more prior knowledge (group B), because group A&#8217;s utterances were mostly shorter. </Pgraph><Pgraph>A possible explanation is that group may not have had the prior knowledge to discuss, argue, ask or explain in depth with each other due to the missing prior knowledge <TextLink reference="54"></TextLink>, <TextLink reference="55"></TextLink>. Additionally, it is also possible that a PBL task is more cognitively activating for one group of learners compared to another, depending on the groups level of prior knowledge. The concept of cognitive activation stems from constructivist learning, refers to the adaptivity of different problems and tasks for different learners and involves evoking cognitive conflicts to initiate learning processes <TextLink reference="56"></TextLink>, <TextLink reference="57"></TextLink>. It might be beneficial to include the measurement of how learners were cognitively activated by the tasks in subsequent research. Cognitive activation can be assumed to be affective for subsequent group discussions, whereby groups with less activating tasks should be less engaged in the discussion. </Pgraph><Pgraph>Therefore, group A showed a higher rate of conversation tasks and they exchanged information more often which may have supported the elaboration of their prior knowledge <TextLink reference="49"></TextLink>.</Pgraph><Pgraph>Furthermore, we cannot confirm the results of Visschers-Pleijers et al. <TextLink reference="26"></TextLink> and De Grave et al. <TextLink reference="58"></TextLink> who believed that if pre-set working rules and role division are retained, then off-task interactions would rarely be measured. Our observation suggests that a period of silence in dPBL was mostly used by students as an &#8220;individual thinking period&#8221; before the group consensus was reached, an idea that Gukas et al. <TextLink reference="47"></TextLink> also considered. In further research, it would be useful to create &#8220;silence&#8221; as a new topic of interaction, without it being a part of the off-task interactions, because there is evidence that the groups scored highly on the indices of learning, even when they kept silent for some time and that the periods of silence did not indicate that the students were not learning effectively <TextLink reference="44"></TextLink>, <TextLink reference="47"></TextLink>.</Pgraph><SubHeadline>2. Tutor effectiveness </SubHeadline><Pgraph>The only difference concerning the tutor effectiveness was that in group A, the tutor stimulated the students significantly more often to understand the underlying mechanisms&#47;theories regarding the frequency of occurrence. In relation to the percentage of the total session time, there was no difference between the groups on this point. These findings show that the tutors spent less time per utterance for stimulating students with less prior knowledge to understand the underlying mechanisms&#47;theories. A possible reason for this is that the students with more prior knowledge may have demanded explanations of the underlying mechanisms in more detail while group A may have been satisfied with less profound statements.</Pgraph><Pgraph>Overall, the tutors spent more than half of their speaking time on stimulating active learning while only a mere 10&#37;, approximately, on stimulating self-directed learning. Previous research has suggested that self-directed learning is a key to medical skill development in undergraduate curricula <TextLink reference="59"></TextLink>. Thus, if the tutors generally spend less time on stimulating self-directed learning, then it may be useful to examine this effect in further research in order to optimise the teaching and training of tutors in the future.</Pgraph><SubHeadline>3. Knowledge acquisition</SubHeadline><Pgraph>In relation to their knowledge acquisition, students with more prior knowledge attained 3.7 points more in the MCQ post-test than in the MCQ pre-test, while students with less prior knowledge achieved 13.7 points more on average. It is remarkable that group A increased their knowledge during the dPBL sessions almost four times more than group B. However, group B started with a relatively high result in the pre-test, so it would be more difficult to raise their own achievement in the post-test (ceiling-effect). In addition, group A scored significantly fewer points in the pre-test and significantly more points in the post-test compared to group B. Some of the tutoring approaches could explain group A&#8217;s relatively high level of knowledge acquisition when compared to group B. Firstly, group A had about 180 utterances more per dPBL session on average than group B (group A: 489.3; group B: 306.7); this suggests that there may have been more conversations and more information flow inside group A which would consequently support their knowledge acquisition. Secondly, group A had significantly higher scores in terms of the frequency of occurrence of handling conflicts about knowledge. It is thoroughly valuable to engage on this type of interaction because PBL indicates learning by provoking cognitive conflicts from controversies between the students&#8217; knowledge and the problem they are dealing with <TextLink reference="60"></TextLink>. Thirdly, as the participants&#8217; prior knowledge is activated, they become more easily able to find gaps in their knowledge to work on (activation&#8211;elaboration hypothesis) and group B may have hindered their knowledge acquisition because they did not have extensive knowledge gaps to elaborate on <TextLink reference="61"></TextLink>. Lastly, it could be possible that group A may have prepared themselves better for the dPBL cases, knowing that they had performed worse in the pre-semester MCQ and that they lacked the knowledge of how to deal with the cases instead of trusting in their solid prior knowledge as group B had done. However, there were no significant differences between both groups in the SOE or OSPE grades at the end of the semester. These findings suggest that both groups ended the semester with a similar level of knowledge, but that the two groups acquired this in different ways during the dPBL cases. In addition, dPBL may stimulate the learning process of those participants who had less prior knowledge the most, which may be a possible hint to answer Dolman&#8217;s question of &#8220;under which conditions is PBL effective and for what kinds of students&#63;&#8221; <TextLink reference="7"></TextLink>. To answer this question more precisely further research should also consider the ceiling-effect <TextLink reference="62"></TextLink>.</Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Diskussion">
      <MainHeadline>Diskussion</MainHeadline><Pgraph>In dieser Pilotstudie wurde der Einfluss der Interaktionsdynamik (Lerngruppeninteraktionen, Tutor&#42;inneneffektivit&#228;t) auf den Wissenserwerb in einem digitalen POL-Setting untersucht. Hierbei zeigten sich signifikante Unterschiede zwischen Lerngruppen, die sich durch unterschiedliches Vorwissen auszeichnen. Die Ergebnisse k&#246;nnen dazu beitragen, die Rolle, die Interaktionen zwischen Lernenden und Tutor&#42;innen sowie zwischen den Lernenden untereinander im POL-Unterricht spielen, aufzukl&#228;ren und liefern wertvolle Informationen im Hinblick auf die didaktische Gestaltung von POL-Unterricht. Die Erkenntnisse umfassen zudem die Abh&#228;ngigkeit des Gelingens von POL vom Vorwissen der Lernenden sowie die Umsetzung als digitales Lernszenario.</Pgraph><Pgraph>Obwohl es sich zun&#228;chst um eine Pilotstudie handelt, wurden insgesamt 34 Stunden und 26 Minuten Videomaterial analysiert, (mit insg. 14.366 &#196;u&#223;erungen), was ein umfassenderes Bild auf das Gelingen von POL-Prozessen zul&#228;sst, als das in vergleichbaren Studien, die sich mit der Analyse von Gruppeninteraktionen und der Effektivit&#228;t von Tutor&#42;innen in POL-Settings besch&#228;ftigten, m&#246;glich ist <TextLink reference="24"></TextLink>, <TextLink reference="25"></TextLink>, <TextLink reference="26"></TextLink>, <TextLink reference="27"></TextLink>, <TextLink reference="28"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="40"></TextLink>, <TextLink reference="41"></TextLink>, <TextLink reference="42"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="46"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="48"></TextLink>, <TextLink reference="49"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="52"></TextLink>, <TextLink reference="53"></TextLink>. Nichtsdestotrotz ist eine Follow-Up-Studie mit gr&#246;&#223;erer Stichprobe und einer genauen Stichprobenabsch&#228;tzung geplant.</Pgraph><SubHeadline>1. Gruppeninteraktionen</SubHeadline><Pgraph>Bei Studierenden mit geringerem Vorwissen (Gruppe A) traten mehr &#196;u&#223;erungen in den Interaktionskategorien auf. Dennoch unterschied sich die aufgewendete Interaktionszeit nicht von der in der Gruppe mit h&#246;herem Vorwissen (Gruppe B). Die ge&#228;u&#223;erten Beitr&#228;ge in Gruppe A waren dementsprechend im Durchschnitt k&#252;rzer. Eine m&#246;gliche Erkl&#228;rung daf&#252;r ist, dass Gruppe A nicht &#252;ber ausreichendes Vorwissen verf&#252;gte, um tiefer greifende Diskussionen miteinander zu f&#252;hren, die Argumentationen elaborierter zu gestalten oder Sachverhalte in ihren Erkl&#228;rungen aufeinander zu beziehen <TextLink reference="54"></TextLink>, <TextLink reference="55"></TextLink>. Hierbei kann auch eine Rolle spielen, dass bestimmte POL-Aufgaben (vorwissensabh&#228;ngig) unterschiedlich kognitiv aktivierend f&#252;r die beiden Gruppen waren. Das Konzept der kognitiven Aktivierung ist im Rahmen konstruktivistischen Lernens verankert und bezieht sich auf die Adaptivit&#228;t von Lernproblemen und -aufgaben f&#252;r bestimmte Lerngruppen. Zentrales Element ist dabei die Evozierung kognitiver Konflikte, die als Lernanl&#228;sse aufgefasst werden und die Lernprozesse initiieren sollen <TextLink reference="56"></TextLink>, <TextLink reference="57"></TextLink>. Hier k&#246;nnte es insofern sinnvoll sein, in nachfolgenden Studien auch das Ausma&#223; an kognitiver Aktivierung (zumindest als Kontrollgr&#246;&#223;e) mit einzubeziehen. Es kann davon ausgegangen werden, dass eine kognitive Aktivierung, die zu Beginn einer Lernsequenz geschieht, f&#252;r die Qualit&#228;t der nachfolgenden Sch&#252;lergruppendiskussionen relevant ist. So ist zu erwarten, dass Gruppen, f&#252;r die die Lernaufgaben weniger kognitiv aktivierend sind, auch eine geringere Qualit&#228;t in ihrer Gruppendiskussion zeigen (was sich in k&#252;rzeren Beitr&#228;gen manifestieren kann). </Pgraph><Pgraph>Daf&#252;r zeigte Gruppe A eine h&#246;here Rate an &#196;u&#223;erungen und tauschte insofern h&#228;ufiger Informationen aus, was die Elaboration ihres Vorwissens unterst&#252;tzt haben k&#246;nnte <TextLink reference="49"></TextLink>.</Pgraph><Pgraph>Im Hinblick auf die &#8222;off-task&#8220;-Phasen kann die Pilotstudie die Ergebnisse von Visschers-Pleijers et al. <TextLink reference="26"></TextLink> und De Grave et al. <TextLink reference="58"></TextLink> nicht best&#228;tigen, die aufgezeigt haben, dass, wenn Arbeitsregeln vorgegeben und die Rollenaufteilung in der Gruppe klar ist, &#8222;off-task&#8220;-Interaktionen wie Stille, selten gemessen w&#252;rden. Unsere Beobachtung legt nahe, dass eine Phase der Stille im dPOL von den Studierenden meist als &#8222;individuelle Denkphase&#8220; genutzt wurde, bevor ein Gruppenkonsens erreicht wurde. Dies wird auch von Gukas et al. <TextLink reference="47"></TextLink> in dieser Weise interpretiert. Eine systematische Untersuchung m&#252;ssten hier nachfolgende Studien leisten, auch weil es sein kann, dass w&#228;hrend Schweigephasen kognitive Verarbeitungsprozesse stattfinden und die nicht nur im Sinne eines Wartens auf Beitr&#228;ge anderer Gruppenmitglieder zu verstehen sind <TextLink reference="44"></TextLink>, <TextLink reference="47"></TextLink>. Dazu w&#228;re &#8222;Stille&#8220; in Gruppenarbeitsphasen als eine eigenst&#228;ndige Kategorie zu erfassen, die nicht Teil der &#8222;off-task&#8220;-Zeit ist, da es Hinweise darauf gibt, dass die Gruppen hohe Lernaktivit&#228;ten erzielten, auch wenn sie eine Zeit lang schwiegen, und dass die Phasen der Stille nicht darauf hinwiesen, dass die Studierenden nicht effektiv lernten <TextLink reference="44"></TextLink>, <TextLink reference="47"></TextLink>.</Pgraph><SubHeadline>2. Tutor&#42;inneneffektivit&#228;t</SubHeadline><Pgraph>Bezogen auf die Tutor&#42;innen&#228;u&#223;erungen zeigte sich ein Effekt, der darin bestand, dass in Gruppe A der&#47;die Tutor&#42;in die Studierenden signifikant h&#228;ufiger dazu anregte, die den diskutierten Sachverhalten zugrunde liegenden Mechanismen&#47;Theorien zu verstehen. In Bezug auf den prozentualen Anteil der Gesamtsitzungszeit zeigten sich allerdings keine Unterschiede zwischen den beiden Gruppen. Hier l&#228;sst sich wieder schlussfolgern, dass die Tutor&#42;innen k&#252;rzere &#196;u&#223;erungen realisierten, um Studierende mit weniger Vorwissen dazu anzuregen, die zugrunde liegenden Mechanismen&#47;Theorien zu verstehen. Ein m&#246;glicher Grund daf&#252;r kann sein, dass Interaktionen mit Lernenden, die ein h&#246;heres Vorwissen aufweisen, detailliertere Erkl&#228;rungen der zugrunde liegenden Mechanismen verlangt, um diese zufriedenzustellen als das in Interaktionen mit geringerem Vorwissen der Fall ist, die sich m&#246;glicherweise mit weniger tiefgreifenden Ausf&#252;hrungen zufriedengeben.</Pgraph><Pgraph>Insgesamt wendeten die Tutor&#42;innen mehr als die H&#228;lfte ihrer Interaktionszeit damit auf, konstruktives&#47;aktives Lernen anzuregen, w&#228;hrend sie nur etwa 10&#37; f&#252;r die Anregung zu selbstgesteuertem Lernen aufwendeten. Der Befund ist auch deshalb bedeutsam, da Studien nahelegen, dass gerade selbstgesteuertes Lernen ein Schl&#252;ssel zur Entwicklung medizinischer F&#228;higkeiten bei Studierenden ist <TextLink reference="59"></TextLink>. Auch hier k&#246;nnen nachfolgende Studien anschlie&#223;en. Wenn sich zeigt, dass den die Tutor&#42;innen generell weniger Zeit f&#252;r die Anregung des selbstgesteuerten Lernens aufwenden, sich dieser Befund also in weiteren Studien best&#228;tigt, k&#246;nnte es sinnvoll sein, darauf den Fokus bei der POL-Schulung von Tutor&#42;innen zu legen.</Pgraph><SubHeadline>3. Wissenserwerb</SubHeadline><Pgraph>Der Wissenszuwachs im MCQ lag bei Studierenden mit h&#246;herem Vorwissen bei durchschnittlich 3,7 Punkten mehr, bei Studierenden mit geringerem Vorwissen durchschnittlich bei 13,7 Punkten. Der Unterschied zwischen den beiden Gruppen ist zun&#228;chst einmal hervorhebenswert. Allerdings muss einschr&#228;nkend gesagt werden, dass hier auch Deckeneffekte anzunehmen sind. Die Gruppe B wies im Pr&#228;test bereits einen relativ hohen Wert auf, was einer Steigerung Grenzen setzt. Ein weiterer Befund ist, dass die Gruppe A im Vortest signifikant weniger Punkte als Gruppe B aufwies, dagegen im Post- Test signifikant mehr Punkte als Gruppe B erzielte.</Pgraph><Pgraph>Der vergleichsweise hohe Wissenszuwachs in Gruppe A k&#246;nnte durch Interaktionsmuster in den tutoriell unterst&#252;tzen Gruppendiskussionen erkl&#228;rt werden. Zum einen lagen in Gruppe A im Durchschnitt 180 &#196;u&#223;erungen mehr pro dPOL-Sitzung als Gruppe B vor (Gruppe A: 489,3; Gruppe B: 306,7). Das legt nahe, dass in Gruppe A m&#246;glicherweise ein gr&#246;&#223;erer interaktiver Austausch und Informationsfluss stattfanden, was schlie&#223;lich den Wissenserwerb unterst&#252;tzte. Zum anderen traten in Gruppe A signifikant h&#246;here Werte in Bezug auf den Umgang mit Wissenskonflikten auf. Dies k&#246;nnte sich als lernwirksam erwiesen haben, da, wie weiter oben bereits angesprochen, die Evozierung kognitiver Konflikte ein zentraler Aspekt von POL ist <TextLink reference="60"></TextLink>. Daraus folgt ein weiterer, dritter Punkt. Wenn kognitive Konflikte dazu f&#252;hren, dass von den Lernenden L&#252;cken im (Vor-)Wissen erkannt werden, dann k&#246;nnen sie auch gezielter daran arbeiten, diese L&#252;cken zu schlie&#223;en (vgl. Aktivierungs-Elaborations-Hypothese). Das war m&#246;glicherweise in Gruppe B weniger der Fall <TextLink reference="61"></TextLink>. Es gab jedoch keine signifikanten Unterschiede zwischen beiden Gruppen in den Ergebnissen des SOE und OSPE zum Ende des Semesters. Das legt nahe, dass, obwohl beide Gruppen das Semester mit einem &#228;hnlichen Wissensstand beendet haben, der Erwerbsprozess w&#228;hrend der dPOL-Sessions selbst auf unterschiedliche Weise ablief. Hier kann die Studie insofern einen Beitrag leisten um die von Dolman gestellte Frage zu beantworten &#8222;under which conditions is PBL effective and for what kinds of students&#63;&#8220; <TextLink reference="7"></TextLink>. Neben der Frage der kognitiven Aktivierung ist hier nat&#252;rlich auch der angesprochene Deckeneffekt im Wissenszuwachs zu ber&#252;cksichtigen <TextLink reference="62"></TextLink>.</Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Limitations">
      <MainHeadline>Limitations</MainHeadline><Pgraph>Several factors limit the generalisability of this study. Firstly, previous research has shown that when being recorded during PBL the participants are not as spontaneous as they are naturally, thus, being videotaped can influence the participant&#8217;s behaviour <TextLink reference="29"></TextLink>. Furthermore, the participants&#8217; knowledge acquisition may not be entirely based on dPBL as the students also had other lectures and practical trainings during the semester that imparted knowledge. Another point affecting our results is that the participants gained experience during their dPBL cases and this may have changed their group interaction by increasing their expertise or by changing tutoring style (facilitative to non-facilitative <TextLink reference="37"></TextLink>). However, our findings only reflect the entirety of the group interaction and, thus, not its trends.</Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Limitationen">
      <MainHeadline>Limitationen</MainHeadline><Pgraph>Nat&#252;rlich gibt es eine Reihe von Limitationen, die die Verallgemeinerbarkeit der Ergebnisse dieser Pilot-Studie einschr&#228;nken. So gibt es z.B. Befunde fr&#252;herer Studien, die nahelegen, dass Lernende, wenn sie videographiert werden (zun&#228;chst) weniger spontan agieren als wenn sie in ihrer gewohnten Lernumgebung unbeobachtet sind <TextLink reference="29"></TextLink>. Auch ist zu konstatieren, dass der Wissenserwerb der Studierenden sicher nicht ausschlie&#223;lich auf die dPOL-Sessions beschr&#228;nkt geblieben ist und im Semester stattfindende weitere Vorlesungen und praktische Kurse umfasst, die im Rahmen der Studie nicht kontrolliert worden sind. Ein weiterer Punkt, der zudem zu ber&#252;cksichtigen ist, ist, dass der Lernprozessverlauf selbst nicht kontrolliert wurde und ob die Studierenden erfahrungsbedingt ihre Interaktionen in den Lerngruppen &#252;ber die Sessions hinweg ver&#228;nderten. Das gleiche gilt f&#252;r Ver&#228;nderungen und Anpassungen des Verhaltens der Tutor&#42;innen bei der Unterst&#252;tzung der Lerngruppen &#252;ber die Sessions hinweg <TextLink reference="37"></TextLink>. Unsere Ergebnisse spiegeln insofern nur ein durchschnittliches Gesamtbild der Gruppeninteraktion wider, geben aber keine Ausk&#252;nfte &#252;ber Trend-Entwicklungen innerhalb des Untersuchungszeitraums.</Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Conclusion">
      <MainHeadline>Conclusion</MainHeadline><Pgraph>Interaction dynamics in dPBL depend on the group&#8217;s amount of prior knowledge. In particular, groups including participants with less prior knowledge seem to benefit from dPBL by tending towards a fast information flow with shorter utterances in a high frequency in comparison to groups with more prior knowledge. The groups acquired knowledge in different ways during the courses, however, all students did not achieve any significant differences regarding the structured oral exam and objective structured practical exam in relation to their prior knowledge.</Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Schlussfolgerungen">
      <MainHeadline>Schlussfolgerungen</MainHeadline><Pgraph>Die Interaktionsdynamik von Lernenden im dPOL wird ma&#223;geblich vom Vorwissensstand beeinflusst, der in der Lerngruppe vorliegt. Insbesondere Gruppen mit Lernenden mit geringerem Vorwissen k&#246;nnen von digitalen problemorientierten Lernangeboten profitieren, indem ein problembezogener rascherer Informationsaustausch zwischen den Lernenden erfolgen kann. Die in der strukturierten m&#252;ndlichen Pr&#252;fung und der strukturierten praktischen Pr&#252;fung gemessenen Lernoutcomes unterscheiden sich nicht, jedoch legen die Befunde nahe, dass sich die Charakteristik des Wissenserwerbprozesses in Abh&#228;ngigkeit vom Vorwissen differenziert.</Pgraph></TextBlock>
    <TextBlock language="en" linked="yes" name="Competing interests">
      <MainHeadline>Competing interests</MainHeadline><Pgraph>The authors declare that they have no competing interests. </Pgraph></TextBlock>
    <TextBlock language="de" linked="yes" name="Interessenkonflikt">
      <MainHeadline>Interessenkonflikt</MainHeadline><Pgraph>Die Autor&#42;innen erkl&#228;ren, dass sie keinen Interessenkonflikt im Zusammenhang mit diesem Artikel haben.</Pgraph></TextBlock>
    <References linked="yes">
      <Reference refNo="1">
        <RefAuthor>Moallem M</RefAuthor>
        <RefTitle>Section 1: Understanding PBL: Historical and Theoretical Foundations</RefTitle>
        <RefYear>2019</RefYear>
        <RefBookTitle>The Wiley handbook of problem-based learning</RefBookTitle>
        <RefPage>1-3</RefPage>
        <RefTotal>Moallem M. Section 1: Understanding PBL: Historical and Theoretical Foundations. In: Moallem M, Hung W, Dabbagh N, editors. The Wiley handbook of problem-based learning. Hoboken, Nj: John Wiley &#38; Sons; 2019. p.1-3. DOI: 10.1002&#47;9781119173243</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1002&#47;9781119173243</RefLink>
      </Reference>
      <Reference refNo="2">
        <RefAuthor>Anderson V</RefAuthor>
        <RefAuthor>Reid K</RefAuthor>
        <RefTitle>Students&#8217; perception of a problem-based learning scenario in dental nurse education</RefTitle>
        <RefYear>2012</RefYear>
        <RefJournal>Eur J Dent Educ</RefJournal>
        <RefPage>218-223</RefPage>
        <RefTotal>Anderson V, Reid K. Students&#8217; perception of a problem-based learning scenario in dental nurse education. Eur J Dent Educ. 2012;16(4):218-223. DOI: 10.1111&#47;j.1600-0579.2012.00745.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1600-0579.2012.00745.x</RefLink>
      </Reference>
      <Reference refNo="3">
        <RefAuthor>McHarg J</RefAuthor>
        <RefAuthor>Kay EJ</RefAuthor>
        <RefAuthor>Coombes LR</RefAuthor>
        <RefTitle>Students&#8217; engagement with their group in a problem-based learning curriculum</RefTitle>
        <RefYear>2011</RefYear>
        <RefJournal>Eur J Dent Educ</RefJournal>
        <RefPage>e106-e110</RefPage>
        <RefTotal>McHarg J, Kay EJ, Coombes LR. Students&#8217; engagement with their group in a problem-based learning curriculum. Eur J Dent Educ. 2011;16(1):e106-e110. DOI: 10.1111&#47;j.1600-0579.2011.00682.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1600-0579.2011.00682.x</RefLink>
      </Reference>
      <Reference refNo="4">
        <RefAuthor>Dreier-Wolfgramm A</RefAuthor>
        <RefAuthor>Homeyer S</RefAuthor>
        <RefAuthor>Oppermann RF</RefAuthor>
        <RefAuthor>Hoffmann W</RefAuthor>
        <RefTitle>A model of interprofessional problem-based learning for medical and nursing students: Implementation, evaluation and implications for future implementation</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc13</RefPage>
        <RefTotal>Dreier-Wolfgramm A, Homeyer S, Oppermann RF, Hoffmann W. A model of interprofessional problem-based learning for medical and nursing students: Implementation, evaluation and implications for future implementation. GMS J Med Educ. 2018;35(1):Doc13. DOI: 10.3205&#47;zma001160</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001160</RefLink>
      </Reference>
      <Reference refNo="5">
        <RefAuthor>Servant-Miklos V</RefAuthor>
        <RefAuthor>Norman GR</RefAuthor>
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefTitle>A Short Intellectual History of Problem-Based Learning</RefTitle>
        <RefYear>2019</RefYear>
        <RefBookTitle>The Wiley handbook of problem-based learning</RefBookTitle>
        <RefPage>3-24</RefPage>
        <RefTotal>Servant-Miklos V, Norman GR, Schmidt HG. A Short Intellectual History of Problem-Based Learning. In: Moallem M, Hung W, Dabbagh N, editors. The Wiley handbook of problem-based learning. Hoboken, Nj: John Wiley &#38; Sons; 2019. p.3-24. DOI: 10.1002&#47;9781119173243.ch1</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1002&#47;9781119173243.ch1</RefLink>
      </Reference>
      <Reference refNo="6">
        <RefAuthor>Moallem M</RefAuthor>
        <RefAuthor>Hung W</RefAuthor>
        <RefAuthor>Dabbagh N</RefAuthor>
        <RefTitle>Section II, Research in PBL</RefTitle>
        <RefYear>2019</RefYear>
        <RefBookTitle>The Wiley handbook of problem-based learning</RefBookTitle>
        <RefPage>105-106</RefPage>
        <RefTotal>Moallem M, Hung W, Dabbagh N. Section II, Research in PBL. In: Moallem M, Hung W, Dabbagh N, editors. The Wiley handbook of problem-based learning. Hoboken, Nj: John Wiley &#38; Sons; 2019. p.105-106. DOI: 10.1002&#47;9781119173243.part2</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1002&#47;9781119173243.part2</RefLink>
      </Reference>
      <Reference refNo="7">
        <RefAuthor>Dolmans D</RefAuthor>
        <RefAuthor>Gijbels D</RefAuthor>
        <RefTitle>Research on problem-based learning: future challenges</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>214-218</RefPage>
        <RefTotal>Dolmans D, Gijbels D. Research on problem-based learning: future challenges. Med Educ. 2013;47(2):214-218. DOI: 10.1111&#47;medu.12105</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;medu.12105</RefLink>
      </Reference>
      <Reference refNo="8">
        <RefAuthor>Moallem M</RefAuthor>
        <RefTitle>Effects of PBL on Learning Outcomes, Knowledge Acquisition, and Higher-Order Thinking Skills</RefTitle>
        <RefYear>2019</RefYear>
        <RefBookTitle>The Wiley handbook of problem-based learning</RefBookTitle>
        <RefPage>107-111</RefPage>
        <RefTotal>Moallem M. Effects of PBL on Learning Outcomes, Knowledge Acquisition, and Higher-Order Thinking Skills. In: Moallem M, Hung W, Dabbagh N, editors. The Wiley handbook of problem-based learning. Hoboken, Nj: John Wiley &#38; Sons; 2019. p.107-111. DOI: 10.1002&#47;9781119173243.ch5</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1002&#47;9781119173243.ch5</RefLink>
      </Reference>
      <Reference refNo="9">
        <RefAuthor>Du X</RefAuthor>
        <RefAuthor>Nomikos M</RefAuthor>
        <RefAuthor>Ali K</RefAuthor>
        <RefAuthor>Lundberg A</RefAuthor>
        <RefAuthor>Abu&#8208;Hijleh M</RefAuthor>
        <RefTitle>Health educators&#8217; professional agency in negotiating their problem&#8208;based learning (PBL) facilitator roles: Q study</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>847-857</RefPage>
        <RefTotal>Du X, Nomikos M, Ali K, Lundberg A, Abu&#8208;Hijleh M. Health educators&#8217; professional agency in negotiating their problem&#8208;based learning (PBL) facilitator roles: Q study. Med Educ. 2022;56(8):847-857. DOI: 10.1111&#47;medu.14792</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;medu.14792</RefLink>
      </Reference>
      <Reference refNo="10">
        <RefAuthor>Grasl MC</RefAuthor>
        <RefAuthor>Kremser K</RefAuthor>
        <RefAuthor>Breckwoldt J</RefAuthor>
        <RefAuthor>Gleiss A</RefAuthor>
        <RefTitle>Does the tutors&#8217; academic background influence the learning objectives in problem-based learning&#63;</RefTitle>
        <RefYear>2020</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc8</RefPage>
        <RefTotal>Grasl MC, Kremser K, Breckwoldt J, Gleiss A. Does the tutors&#8217; academic background influence the learning objectives in problem-based learning&#63; GMS J Med Educ. 2020;37(1):Doc8. DOI: 10.3205&#47;zma001301</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001301</RefLink>
      </Reference>
      <Reference refNo="11">
        <RefAuthor>Vogt K</RefAuthor>
        <RefAuthor>Pelz J</RefAuthor>
        <RefAuthor>Stroux A</RefAuthor>
        <RefTitle>Refinement of a training concept for tutors in problem-based learning</RefTitle>
        <RefYear>2017</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc38</RefPage>
        <RefTotal>Vogt K, Pelz J, Stroux A. Refinement of a training concept for tutors in problem-based learning. GMS J Med Educ. 2017;34(4):Doc38. DOI: 10.3205&#47;zma001115</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001115</RefLink>
      </Reference>
      <Reference refNo="12">
        <RefAuthor>Abdalla ME</RefAuthor>
        <RefAuthor>Eladl MA</RefAuthor>
        <RefTitle>Student perception of the effect of problem familiarity on group discussion quality in a problem-based learning environment</RefTitle>
        <RefYear>2019</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc29</RefPage>
        <RefTotal>Abdalla ME, Eladl MA. Student perception of the effect of problem familiarity on group discussion quality in a problem-based learning environment. GMS J Med Educ. 2019;36(3):Doc29. DOI: 10.3205&#47;zma001237</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001237</RefLink>
      </Reference>
      <Reference refNo="13">
        <RefAuthor>Ma CW</RefAuthor>
        <RefTitle>How to advance medical education using journal articles&#63; Insight from problem-based learning</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc48</RefPage>
        <RefTotal>Ma CW. How to advance medical education using journal articles&#63; Insight from problem-based learning. GMS J Med Educ. 2022;39(4):Doc48. DOI: 10.3205&#47;zma001569</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001569</RefLink>
      </Reference>
      <Reference refNo="14">
        <RefAuthor>Khan RA</RefAuthor>
        <RefAuthor>Atta K</RefAuthor>
        <RefAuthor>Sajjad M</RefAuthor>
        <RefAuthor>Jawaid M</RefAuthor>
        <RefTitle>Twelve tips to enhance student engagement in synchronous online teaching and learning</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>601-606</RefPage>
        <RefTotal>Khan RA, Atta K, Sajjad M, Jawaid M. Twelve tips to enhance student engagement in synchronous online teaching and learning. Med Teach. 2022;44(6):601-606. DOI: 10.1080&#47;0142159X.2021.1912310</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1080&#47;0142159X.2021.1912310</RefLink>
      </Reference>
      <Reference refNo="15">
        <RefAuthor>Jennebach J</RefAuthor>
        <RefAuthor>Ahlers O</RefAuthor>
        <RefAuthor>Simonsohn A</RefAuthor>
        <RefAuthor>Adler M</RefAuthor>
        <RefAuthor>&#214;zkaya J</RefAuthor>
        <RefAuthor>Raupach T</RefAuthor>
        <RefAuthor></RefAuthor>
        <RefTitle>Digital patient-centred learning in medical education: A national learning platform with virtual patients as part of the DigiPaL project</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc47</RefPage>
        <RefTotal>Jennebach J, Ahlers O, Simonsohn A, Adler M, &#214;zkaya J, Raupach T, et al. Digital patient-centred learning in medical education: A national learning platform with virtual patients as part of the DigiPaL project. GMS J Med Educ. 2022;39(4):Doc47. DOI: 10.1080&#47;0142159X.2021.1912310</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1080&#47;0142159X.2021.1912310</RefLink>
      </Reference>
      <Reference refNo="16">
        <RefAuthor>Winzer A</RefAuthor>
        <RefAuthor>Jansky M</RefAuthor>
        <RefTitle>Digital lesson to convey the CanMEDS roles in general medicine using problem-based learning (PBL) and peer teaching</RefTitle>
        <RefYear>2020</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc64</RefPage>
        <RefTotal>Winzer A, Jansky M. Digital lesson to convey the CanMEDS roles in general medicine using problem-based learning (PBL) and peer teaching. GMS J Med Educ. 2020;37(7):Doc64. DOI: 10.3205&#47;zma001357</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001357</RefLink>
      </Reference>
      <Reference refNo="17">
        <RefAuthor>Ertl S</RefAuthor>
        <RefAuthor>Steinmair D</RefAuthor>
        <RefAuthor>L&#246;ffler-Stastka H</RefAuthor>
        <RefTitle>Encouraging communication and cooperation in e-learning: solving and creating new interdisciplinary case histories</RefTitle>
        <RefYear>2021</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc62</RefPage>
        <RefTotal>Ertl S, Steinmair D, L&#246;ffler-Stastka H. Encouraging communication and cooperation in e-learning: solving and creating new interdisciplinary case histories. GMS J Med Educ. 2021;38(3):Doc62. DOI: 10.3205&#47;zma001458</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001458</RefLink>
      </Reference>
      <Reference refNo="18">
        <RefAuthor>Huber J</RefAuthor>
        <RefAuthor>Witti M</RefAuthor>
        <RefAuthor>Schunk M</RefAuthor>
        <RefAuthor>Fischer MR</RefAuthor>
        <RefAuthor>Tolks D</RefAuthor>
        <RefTitle>The use of the online Inverted Classroom Model for digital teaching with gamification in medical studies</RefTitle>
        <RefYear>2021</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc3</RefPage>
        <RefTotal>Huber J, Witti M, Schunk M, Fischer MR, Tolks D. The use of the online Inverted Classroom Model for digital teaching with gamification in medical studies. GMS J Med Educ. 2021;38(1):Doc3. DOI: 10.3205&#47;zma001399</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001399</RefLink>
      </Reference>
      <Reference refNo="19">
        <RefAuthor>Hege I</RefAuthor>
        <RefAuthor>Kononowicz AA</RefAuthor>
        <RefAuthor>Berman NB</RefAuthor>
        <RefAuthor>Lenzer B</RefAuthor>
        <RefAuthor>Kiesewetter J</RefAuthor>
        <RefTitle>Advancing clinical reasoning in virtual patients &#8211; development and application of a conceptual framework</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc12</RefPage>
        <RefTotal>Hege I, Kononowicz AA, Berman NB, Lenzer B, Kiesewetter J. Advancing clinical reasoning in virtual patients &#8211; development and application of a conceptual framework. GMS J Med Educ. 2018;35(1):Doc12. DOI: 10.3205&#47;zma001159</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001159</RefLink>
      </Reference>
      <Reference refNo="20">
        <RefAuthor>Kollewe T</RefAuthor>
        <RefAuthor>Ochsendorf F</RefAuthor>
        <RefTitle>Medical didactics during the pandemic: the asynchronous online seminar &#8220;Written Examinations&#8221; of the Frankfurter Arbeitsstelle f&#252;r Medizindidaktik</RefTitle>
        <RefYear>2021</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc18</RefPage>
        <RefTotal>Kollewe T, Ochsendorf F. Medical didactics during the pandemic: the asynchronous online seminar &#8220;Written Examinations&#8221; of the Frankfurter Arbeitsstelle f&#252;r Medizindidaktik. GMS J Med Educ. 2021;38(1):Doc18. DOI: 10.3205&#47;zma001414</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001414</RefLink>
      </Reference>
      <Reference refNo="21">
        <RefAuthor>Dadaczynski K</RefAuthor>
        <RefAuthor>Tolks D</RefAuthor>
        <RefTitle>Digital health communication and health literacy in times of COVID-19. Planning and implementation of a special course of study in health promotion and prevention</RefTitle>
        <RefYear>2021</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc31</RefPage>
        <RefTotal>Dadaczynski K, Tolks D. Digital health communication and health literacy in times of COVID-19. Planning and implementation of a special course of study in health promotion and prevention. GMS J Med Educ. 2021;38(1):Doc31. DOI: 10.3205&#47;zma001427</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001427</RefLink>
      </Reference>
      <Reference refNo="22">
        <RefAuthor>Abler M</RefAuthor>
        <RefAuthor>Bachmaier R</RefAuthor>
        <RefAuthor>Hawelka B</RefAuthor>
        <RefAuthor>Prock S</RefAuthor>
        <RefAuthor>Schworm S</RefAuthor>
        <RefAuthor>Merz AK</RefAuthor>
        <RefAuthor>Keil S</RefAuthor>
        <RefTitle>&#8220;It just magically happened overnight&#33;&#8221; - support for the digitalization of medical teaching provided by an interdisciplinary e-tutor team</RefTitle>
        <RefYear>2020</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc75</RefPage>
        <RefTotal>Abler M, Bachmaier R, Hawelka B, Prock S, Schworm S, Merz AK, Keil S. &#8220;It just magically happened overnight&#33;&#8221; - support for the digitalization of medical teaching provided by an interdisciplinary e-tutor team. GMS J Med Educ. 2020;37(7):Doc75. DOI: 10.3205&#47;zma001368</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001368</RefLink>
      </Reference>
      <Reference refNo="23">
        <RefAuthor>Dolmans DH</RefAuthor>
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefTitle>What Do We Know About Cognitive and Motivational Effects of Small Group Tutorials in Problem-Based Learning&#63;</RefTitle>
        <RefYear>2006</RefYear>
        <RefJournal>Adv Health Sci Educ Theory Pract</RefJournal>
        <RefPage>321-336</RefPage>
        <RefTotal>Dolmans DH, Schmidt HG. What Do We Know About Cognitive and Motivational Effects of Small Group Tutorials in Problem-Based Learning&#63; Adv Health Sci Educ Theory Pract. 2006;11(4):321-336. DOI: 10.1007&#47;s10459-006-9012-8</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;s10459-006-9012-8</RefLink>
      </Reference>
      <Reference refNo="24">
        <RefAuthor>Da Silva AL</RefAuthor>
        <RefAuthor>Dennick R</RefAuthor>
        <RefTitle>Corpus analysis of problem-based learning transcripts: an exploratory study</RefTitle>
        <RefYear>2010</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>280-288</RefPage>
        <RefTotal>Da Silva AL, Dennick R. Corpus analysis of problem-based learning transcripts: an exploratory study. Med Educ. 2010;44(3):280-288. DOI: 10.1111&#47;j.1365-2923.2009.03575.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2923.2009.03575.x</RefLink>
      </Reference>
      <Reference refNo="25">
        <RefAuthor>Jaarsma AD</RefAuthor>
        <RefAuthor>Dolmans DD</RefAuthor>
        <RefAuthor>Muijtjens AM</RefAuthor>
        <RefAuthor>Boerboom TT</RefAuthor>
        <RefAuthor>van Beukelen P</RefAuthor>
        <RefAuthor>Scherpbier AJ</RefAuthor>
        <RefTitle>Students&#8217; and teachers&#8217; perceived and actual verbal interactions in seminar groups</RefTitle>
        <RefYear>2009</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>368-376</RefPage>
        <RefTotal>Jaarsma AD, Dolmans DD, Muijtjens AM, Boerboom TT, van Beukelen P, Scherpbier AJ. Students&#8217; and teachers&#8217; perceived and actual verbal interactions in seminar groups. Med Educ. 2009;43(4):368-376. DOI: 10.1111&#47;j.1365-2923.2009.03301.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2923.2009.03301.x</RefLink>
      </Reference>
      <Reference refNo="26">
        <RefAuthor>Visschers-Pleijers AJ</RefAuthor>
        <RefAuthor>Dolmans DH</RefAuthor>
        <RefAuthor>Leng BA</RefAuthor>
        <RefAuthor>Wolfhagen IH</RefAuthor>
        <RefAuthor>Vleuten CP</RefAuthor>
        <RefTitle>Analysis of verbal interactions in tutorial groups: a process study</RefTitle>
        <RefYear>2006</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>129-137</RefPage>
        <RefTotal>Visschers-Pleijers AJ, Dolmans DH, Leng BA, Wolfhagen IH, Vleuten CP. Analysis of verbal interactions in tutorial groups: a process study. Med Educ. 2006;40(2):129-137. DOI: 10.1111&#47;j.1365-2929.2005.02368.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2929.2005.02368.x</RefLink>
      </Reference>
      <Reference refNo="27">
        <RefAuthor>Cianciolo AT</RefAuthor>
        <RefAuthor>Kidd B</RefAuthor>
        <RefAuthor>Murray S</RefAuthor>
        <RefTitle>Observational analysis of near-peer and faculty tutoring in problem-based learning groups</RefTitle>
        <RefYear>2016</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>757-767</RefPage>
        <RefTotal>Cianciolo AT, Kidd B, Murray S. Observational analysis of near-peer and faculty tutoring in problem-based learning groups. Med Educ. 2016;50(7):757-767. DOI: 10.1111&#47;medu.12969</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;medu.12969</RefLink>
      </Reference>
      <Reference refNo="28">
        <RefAuthor>Kindler P</RefAuthor>
        <RefAuthor>Grant C</RefAuthor>
        <RefAuthor>Kulla S</RefAuthor>
        <RefAuthor>Poole G</RefAuthor>
        <RefAuthor>Godolphin W</RefAuthor>
        <RefTitle>Difficult incidents and tutor interventions in problem-based learning tutorials</RefTitle>
        <RefYear>2009</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>866-873</RefPage>
        <RefTotal>Kindler P, Grant C, Kulla S, Poole G, Godolphin W. Difficult incidents and tutor interventions in problem-based learning tutorials. Med Educ. 2009;43(9):866-873. DOI: 10.1111&#47;j.1365-2923.2009.03423.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2923.2009.03423.x</RefLink>
      </Reference>
      <Reference refNo="29">
        <RefAuthor>Gilkison A</RefAuthor>
        <RefTitle>Techniques used by &#8220;expert&#8221; and &#8220;non-expert&#8221; tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum</RefTitle>
        <RefYear>2003</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>6-14</RefPage>
        <RefTotal>Gilkison A. Techniques used by &#8220;expert&#8221; and &#8220;non-expert&#8221; tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum. Med Educ. 2003;37(1):6-14. DOI: 10.1046&#47;j.1365-2923.2003.01406.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1046&#47;j.1365-2923.2003.01406.x</RefLink>
      </Reference>
      <Reference refNo="30">
        <RefAuthor>Basu Roy R</RefAuthor>
        <RefAuthor>McMahon GT</RefAuthor>
        <RefTitle>Video-based cases disrupt deep critical thinking in problem-based learning</RefTitle>
        <RefYear>2012</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>426-435</RefPage>
        <RefTotal>Basu Roy R, McMahon GT. Video-based cases disrupt deep critical thinking in problem-based learning. Med Educ. 2012;46(4):426-435. DOI: 10.1111&#47;j.1365-2923.2011.04197.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2923.2011.04197.x</RefLink>
      </Reference>
      <Reference refNo="31">
        <RefAuthor>Nieminen J</RefAuthor>
        <RefAuthor>Sauri P</RefAuthor>
        <RefAuthor>Lonka K</RefAuthor>
        <RefTitle>On the relationship between group functioning and study success in problem-based learning</RefTitle>
        <RefYear>2006</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>64-71</RefPage>
        <RefTotal>Nieminen J, Sauri P, Lonka K. On the relationship between group functioning and study success in problem-based learning. Med Educ. 2006;40(1):64-71. DOI: 10.1111&#47;j.1365-2929.2005.02344.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2929.2005.02344.x</RefLink>
      </Reference>
      <Reference refNo="32">
        <RefAuthor>Norman GR</RefAuthor>
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefTitle>Effectiveness of problem-based learning curricula: theory, practice and paper darts</RefTitle>
        <RefYear>2000</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>721-728</RefPage>
        <RefTotal>Norman GR, Schmidt HG. Effectiveness of problem-based learning curricula: theory, practice and paper darts. Med Educ. 2000;34(9):721-728. DOI: 10.1046&#47;j.1365-2923.2000.00749.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1046&#47;j.1365-2923.2000.00749.x</RefLink>
      </Reference>
      <Reference refNo="33">
        <RefAuthor>Van Blankenstein FM</RefAuthor>
        <RefAuthor>Dolmans DH</RefAuthor>
        <RefAuthor>Van der Vleuten CP</RefAuthor>
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefTitle>Relevant prior knowledge moderates the effect of elaboration during small group discussion on academic achievement</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>Instr Sci</RefJournal>
        <RefPage>729-744</RefPage>
        <RefTotal>Van Blankenstein FM, Dolmans DH, Van der Vleuten CP, Schmidt HG. Relevant prior knowledge moderates the effect of elaboration during small group discussion on academic achievement. Instr Sci. 2013;41(4):729-744. DOI: 10.1007&#47;s11251-012-9252-3</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;s11251-012-9252-3</RefLink>
      </Reference>
      <Reference refNo="34">
        <RefAuthor>Xhomara N</RefAuthor>
        <RefTitle>How prior knowledge, learning, teaching and assessment affect students&#8217; achievements in Mathematics</RefTitle>
        <RefYear>2020</RefYear>
        <RefJournal>Res Educ Learn Innov Arch</RefJournal>
        <RefPage>68-91</RefPage>
        <RefTotal>Xhomara N. How prior knowledge, learning, teaching and assessment affect students&#8217; achievements in Mathematics. Res Educ Learn Innov Arch. 2020;25:68-91. DOI: 10.7203&#47;realia.25.15780</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.7203&#47;realia.25.15780</RefLink>
      </Reference>
      <Reference refNo="35">
        <RefAuthor>Davis MH</RefAuthor>
        <RefAuthor>Harden RM</RefAuthor>
        <RefTitle>AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide</RefTitle>
        <RefYear>1999</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>130-140</RefPage>
        <RefTotal>Davis MH, Harden RM. AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide. Med Teach. 1999;21(2):130-140. DOI: 10.1080&#47;01421599979743</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1080&#47;01421599979743</RefLink>
      </Reference>
      <Reference refNo="36">
        <RefAuthor>Barrows HS</RefAuthor>
        <RefAuthor>Tamblyn RM</RefAuthor>
        <RefTitle></RefTitle>
        <RefYear>1980</RefYear>
        <RefBookTitle>Problem-based learning: an approach to medical education</RefBookTitle>
        <RefPage></RefPage>
        <RefTotal>Barrows HS, Tamblyn RM. Problem-based learning: an approach to medical education. New York: Springer Pub. Co.; 1980.</RefTotal>
      </Reference>
      <Reference refNo="37">
        <RefAuthor>Gerhardt-Szep S</RefAuthor>
        <RefAuthor>Kunkel F</RefAuthor>
        <RefAuthor>Moeltner A</RefAuthor>
        <RefAuthor>Hansen M</RefAuthor>
        <RefAuthor>B&#246;ckers A</RefAuthor>
        <RefAuthor>R&#252;ttermann S</RefAuthor>
        <RefAuthor>Ochsendorf F</RefAuthor>
        <RefTitle>Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study</RefTitle>
        <RefYear>2016</RefYear>
        <RefJournal>BMC Med Educ</RefJournal>
        <RefPage>14</RefPage>
        <RefTotal>Gerhardt-Szep S, Kunkel F, Moeltner A, Hansen M, B&#246;ckers A, R&#252;ttermann S, Ochsendorf F. Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study. BMC Med Educ. 2016;16:14. DOI: 10.1186&#47;s12909-015-0505-0</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1186&#47;s12909-015-0505-0</RefLink>
      </Reference>
      <Reference refNo="38">
        <RefAuthor>Dolmans DH</RefAuthor>
        <RefAuthor>Ginns P</RefAuthor>
        <RefTitle>A short questionnaire to evaluate the effectiveness of tutors in PBL: validity and reliability</RefTitle>
        <RefYear>2005</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>534-538</RefPage>
        <RefTotal>Dolmans DH, Ginns P. A short questionnaire to evaluate the effectiveness of tutors in PBL: validity and reliability. Med Teach. 2005;27(6):534-538. DOI: 10.1080&#47;01421590500136477</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1080&#47;01421590500136477</RefLink>
      </Reference>
      <Reference refNo="39">
        <RefAuthor>Hedderich J</RefAuthor>
        <RefAuthor>Sachs L</RefAuthor>
        <RefTitle></RefTitle>
        <RefYear>2016</RefYear>
        <RefBookTitle>Angewandte Statistik, Methodensammlung mit R</RefBookTitle>
        <RefPage></RefPage>
        <RefTotal>Hedderich J, Sachs L. Angewandte Statistik, Methodensammlung mit R. Berlin: Springer-Verlag Berlin; 2016. DOI: 10.1007&#47;978-3-662-45691-0</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;978-3-662-45691-0</RefLink>
      </Reference>
      <Reference refNo="40">
        <RefAuthor>Oh SA</RefAuthor>
        <RefAuthor>Chung EK</RefAuthor>
        <RefAuthor>Woo YJ</RefAuthor>
        <RefAuthor>Han ER</RefAuthor>
        <RefAuthor>Kim YO</RefAuthor>
        <RefTitle>Analysis of Verbal Interactions in Problem-based Learning</RefTitle>
        <RefYear>2010</RefYear>
        <RefJournal>Korean J Med Educ</RefJournal>
        <RefPage>131-139</RefPage>
        <RefTotal>Oh SA, Chung EK, Woo YJ, Han ER, Kim YO. Analysis of Verbal Interactions in Problem-based Learning. Korean J Med Educ. 2010;22(2):131-139. DOI: 10.3946&#47;kjme.2010.22.2.131</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3946&#47;kjme.2010.22.2.131</RefLink>
      </Reference>
      <Reference refNo="41">
        <RefAuthor>Koschmann T</RefAuthor>
        <RefAuthor>Evensen DH</RefAuthor>
        <RefAuthor>Glenn P</RefAuthor>
        <RefAuthor>Hall R</RefAuthor>
        <RefAuthor>Frederiksen C</RefAuthor>
        <RefTitle>Five readings of single text: transcript of video analysis session</RefTitle>
        <RefYear>2008</RefYear>
        <RefBookTitle>Problem-based learning: a research perspective on learning interaction</RefBookTitle>
        <RefPage>137-166</RefPage>
        <RefTotal>Koschmann T, Evensen DH, Glenn P, Hall R, Frederiksen C. Five readings of single text: transcript of video analysis session. In: Hmelo CE, Evensen DH, editors. Problem-based learning: a research perspective on learning interaction. Mahwah: Lawrence Erlbaum Associates; 2008. p.137-166.</RefTotal>
      </Reference>
      <Reference refNo="42">
        <RefAuthor>Imafuku R</RefAuthor>
        <RefTitle>Japanese first-year PBL students&#8217; learning process: a classroom discourse analysis</RefTitle>
        <RefYear>2012</RefYear>
        <RefBookTitle>Problem-based learning in clinical education. The next generation</RefBookTitle>
        <RefPage>153-170</RefPage>
        <RefTotal>Imafuku R. Japanese first-year PBL students&#8217; learning process: a classroom discourse analysis. In: Bridges S, McGrath C, Whitehill TL, editors. Problem-based learning in clinical education. The next generation. New York: Springer; 2012. p.153-170. DOI: 10.1007&#47;978-94-007-2515-7&#95;10</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;978-94-007-2515-7&#95;10</RefLink>
      </Reference>
      <Reference refNo="43">
        <RefAuthor>Lee GH</RefAuthor>
        <RefAuthor>Lin CS</RefAuthor>
        <RefAuthor>Lin YH</RefAuthor>
        <RefTitle>How experienced tutors facilitate tutorial dynamics in PBL groups</RefTitle>
        <RefYear>2012</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>e935-942</RefPage>
        <RefTotal>Lee GH, Lin CS, Lin YH. How experienced tutors facilitate tutorial dynamics in PBL groups. Med Teach. 2012;35(2):e935-942. DOI: 10.3109&#47;0142159X.2012.714883</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3109&#47;0142159X.2012.714883</RefLink>
      </Reference>
      <Reference refNo="44">
        <RefAuthor>Nest Jin J</RefAuthor>
        <RefTitle>Sounds of silence: examining silence in problem-based learning (PBL) in Asia</RefTitle>
        <RefYear>2012</RefYear>
        <RefBookTitle>Problem-based learning in clinical education. The next generation</RefBookTitle>
        <RefPage>171-188</RefPage>
        <RefTotal>Nest Jin J. Sounds of silence: examining silence in problem-based learning (PBL) in Asia. In: Bridges S, McGrath C, Whitehill TL, editors. Problem-based learning in clinical education. The next generation. New York: Springer; 2012. p.171-188. DOI: 10.1007&#47;978-94-007-2515-7&#95;11</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;978-94-007-2515-7&#95;11</RefLink>
      </Reference>
      <Reference refNo="45">
        <RefAuthor>Visschers-Pleijers AJ</RefAuthor>
        <RefAuthor>Dolmans DH</RefAuthor>
        <RefAuthor>Wolfhagen IH</RefAuthor>
        <RefAuthor>van der Vleuten CP</RefAuthor>
        <RefTitle>Exploration of a method to analyze group interactions in problem-based learning</RefTitle>
        <RefYear>2004</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>471-478</RefPage>
        <RefTotal>Visschers-Pleijers AJ, Dolmans DH, Wolfhagen IH, van der Vleuten CP. Exploration of a method to analyze group interactions in problem-based learning. Med Teach. 2004;26(5):471-478. DOI: 10.1080&#47;01421590410001679064</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1080&#47;01421590410001679064</RefLink>
      </Reference>
      <Reference refNo="46">
        <RefAuthor>Lee GH</RefAuthor>
        <RefAuthor>Lin YH</RefAuthor>
        <RefAuthor>Tsou KI</RefAuthor>
        <RefAuthor>Shiau SJ</RefAuthor>
        <RefAuthor>Lin CS</RefAuthor>
        <RefTitle>When a Problem-Based Learning Tutor Decides to Intervene</RefTitle>
        <RefYear>2009</RefYear>
        <RefJournal>Acad Med</RefJournal>
        <RefPage>1406-1411</RefPage>
        <RefTotal>Lee GH, Lin YH, Tsou KI, Shiau SJ, Lin CS. When a Problem-Based Learning Tutor Decides to Intervene. Acad Med. 2009;84(10):1406-1411. DOI: 10.1097&#47;ACM.0b013e3181b6b433</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1097&#47;ACM.0b013e3181b6b433</RefLink>
      </Reference>
      <Reference refNo="47">
        <RefAuthor>Gukas ID</RefAuthor>
        <RefAuthor>Leinster SJ</RefAuthor>
        <RefAuthor>walker R</RefAuthor>
        <RefTitle>Verbal and nonverbal indices of learning during problem-based learning (PBL) among first year medical students and the threshold for tutor intervention</RefTitle>
        <RefYear>2010</RefYear>
        <RefJournal>Med Teach</RefJournal>
        <RefPage>e5-11</RefPage>
        <RefTotal>Gukas ID, Leinster SJ, walker R. Verbal and nonverbal indices of learning during problem-based learning (PBL) among first year medical students and the threshold for tutor intervention. Med Teach. 2010;32(1):e5-11. DOI: 10.3109&#47;01421590903398232</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3109&#47;01421590903398232</RefLink>
      </Reference>
      <Reference refNo="48">
        <RefAuthor>Hmelo-Silver CE</RefAuthor>
        <RefTitle>Creating a learning space in problem-based learning</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>Interdiscip J Probl Based Learn</RefJournal>
        <RefPage>1</RefPage>
        <RefTotal>Hmelo-Silver CE. Creating a learning space in problem-based learning. Interdiscip J Probl Based Learn. 2013;7:1. DOI: 10.7771&#47;1541-5015.1334</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.7771&#47;1541-5015.1334</RefLink>
      </Reference>
      <Reference refNo="49">
        <RefAuthor>Aarnio M</RefAuthor>
        <RefAuthor>Lindblom-Yl&#228;nne S</RefAuthor>
        <RefAuthor>Nieminen J</RefAuthor>
        <RefAuthor>Py&#246;r&#228;l&#228; E</RefAuthor>
        <RefTitle>Dealing with conflicts on knowledge in tutorial groups</RefTitle>
        <RefYear>2012</RefYear>
        <RefJournal>Adv Health Sci Educ Theory Pract</RefJournal>
        <RefPage>215-230</RefPage>
        <RefTotal>Aarnio M, Lindblom-Yl&#228;nne S, Nieminen J, Py&#246;r&#228;l&#228; E. Dealing with conflicts on knowledge in tutorial groups. Adv Health Sci Educ Theory Pract. 2012;18(2):215-230. DOI: 10.1007&#47;s10459-012-9366-z</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;s10459-012-9366-z</RefLink>
      </Reference>
      <Reference refNo="50">
        <RefAuthor>Azer SA</RefAuthor>
        <RefTitle>Interactions Between Students and Tutor in Problem-Based Learning: The Significance of Deep Learning</RefTitle>
        <RefYear>2009</RefYear>
        <RefJournal>Kaohsiung J Med Scis</RefJournal>
        <RefPage>240-249</RefPage>
        <RefTotal>Azer SA. Interactions Between Students and Tutor in Problem-Based Learning: The Significance of Deep Learning. Kaohsiung J Med Scis. 2009;25(5):240-249. DOI: 10.1016&#47;S1607-551X(09)70068-3</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;S1607-551X(09)70068-3</RefLink>
      </Reference>
      <Reference refNo="51">
        <RefAuthor>Tang S</RefAuthor>
        <RefAuthor>Long M</RefAuthor>
        <RefAuthor>Tong F</RefAuthor>
        <RefAuthor>Wang Z</RefAuthor>
        <RefAuthor>Zhang H</RefAuthor>
        <RefAuthor>Sutton-Jones KL</RefAuthor>
        <RefTitle>A Comparative Study of Problem-Based Learning and Traditional Approaches in College English Classrooms: Analyzing Pedagogical Behaviors Via Classroom Observation</RefTitle>
        <RefYear>2020</RefYear>
        <RefJournal>Behav Sci (Basel)</RefJournal>
        <RefPage>105</RefPage>
        <RefTotal>Tang S, Long M, Tong F, Wang Z, Zhang H, Sutton-Jones KL. A Comparative Study of Problem-Based Learning and Traditional Approaches in College English Classrooms: Analyzing Pedagogical Behaviors Via Classroom Observation. Behav Sci (Basel). 2020;10(6):105. DOI: 10.3390&#47;bs10060105</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3390&#47;bs10060105</RefLink>
      </Reference>
      <Reference refNo="52">
        <RefAuthor>Faidley J</RefAuthor>
        <RefAuthor>Evensen DH</RefAuthor>
        <RefAuthor>Salisbury-Glennon J</RefAuthor>
        <RefAuthor>Glenn J</RefAuthor>
        <RefAuthor>Hmelo CE</RefAuthor>
        <RefTitle>How are we doing&#63; Methods of assessing group processing in a problem-based learning context</RefTitle>
        <RefYear>2008</RefYear>
        <RefBookTitle>Problem-based learning: a research perspective on learning interaction</RefBookTitle>
        <RefPage>109-138</RefPage>
        <RefTotal>Faidley J, Evensen DH, Salisbury-Glennon J, Glenn J, Hmelo CE. How are we doing&#63; Methods of assessing group processing in a problem-based learning context. In: Hmelo CE, Evensen DH, editors. Problem-based learning: a research perspective on learning interaction. Mahwah: Lawrence Erlbaum Associates; 2008. p.109-138.</RefTotal>
      </Reference>
      <Reference refNo="53">
        <RefAuthor>Duek J</RefAuthor>
        <RefTitle>Whose group is it, anyway&#63; Equity of student discourse in problem-based learning (PBL)</RefTitle>
        <RefYear>2008</RefYear>
        <RefBookTitle>Problem-based learning: a research perspective on learning interaction</RefBookTitle>
        <RefPage>75-108</RefPage>
        <RefTotal>Duek J. Whose group is it, anyway&#63; Equity of student discourse in problem-based learning (PBL). In: Hmelo CE, Evensen DH, editors. Problem-based learning: a research perspective on learning interaction. Mahwah: Lawrence Erlbaum Associates; 2008. p.75-108.</RefTotal>
      </Reference>
      <Reference refNo="54">
        <RefAuthor>Zohar A</RefAuthor>
        <RefAuthor>Nemet F</RefAuthor>
        <RefTitle>Fostering students&#39; knowledge and argumentation skills through dilemmas in human genetics</RefTitle>
        <RefYear>2002</RefYear>
        <RefJournal>J Res Sci Teach</RefJournal>
        <RefPage>35-62</RefPage>
        <RefTotal>Zohar A, Nemet F. Fostering students&#39; knowledge and argumentation skills through dilemmas in human genetics. J Res Sci Teach. 2002;39(1):35-62. DOI: 10.1002&#47;tea.10008</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1002&#47;tea.10008</RefLink>
      </Reference>
      <Reference refNo="55">
        <RefAuthor>Schmidt HK</RefAuthor>
        <RefAuthor>Rothgangel M</RefAuthor>
        <RefAuthor>Grube D</RefAuthor>
        <RefTitle>Does prior domain-specific content knowledge influence students&#8217; recall of arguments surrounding interdisciplinary topics&#63;</RefTitle>
        <RefYear>2017</RefYear>
        <RefJournal>J Adolesc</RefJournal>
        <RefPage>96-106</RefPage>
        <RefTotal>Schmidt HK, Rothgangel M, Grube D. Does prior domain-specific content knowledge influence students&#8217; recall of arguments surrounding interdisciplinary topics&#63; J Adolesc. 2017;61:96-106. DOI: 10.1016&#47;j.adolescence.2017.10.001</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.adolescence.2017.10.001</RefLink>
      </Reference>
      <Reference refNo="56">
        <RefAuthor>Kunter M</RefAuthor>
        <RefAuthor>Baumert J</RefAuthor>
        <RefAuthor>Blum W</RefAuthor>
        <RefAuthor>Klusmann U</RefAuthor>
        <RefAuthor>Krauss S</RefAuthor>
        <RefAuthor>Neubrand M</RefAuthor>
        <RefTitle></RefTitle>
        <RefYear>2013</RefYear>
        <RefBookTitle>Cognitive Activation in the Mathematics Classroom and Professional Competence of Teachers</RefBookTitle>
        <RefPage></RefPage>
        <RefTotal>Kunter M, Baumert J, Blum W, Klusmann U, Krauss S, Neubrand M, editors. Cognitive Activation in the Mathematics Classroom and Professional Competence of Teachers. Boston, MA: Springer US; 2013. DOI: 10.1007&#47;978-1-4614-5149-5</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;978-1-4614-5149-5</RefLink>
      </Reference>
      <Reference refNo="57">
        <RefAuthor>Rieser S</RefAuthor>
        <RefAuthor>Decristan J</RefAuthor>
        <RefTitle>Kognitive Aktivierung in Befragungen von Sch&#252;lerinnen und Sch&#252;lern. Unterscheidung zwischen dem Potential zur kognitiven Aktivierung und der individuellen kognitiven Aktivierung</RefTitle>
        <RefYear>2023</RefYear>
        <RefJournal>P&#228;d Psychol</RefJournal>
        <RefPage></RefPage>
        <RefTotal>Rieser S, Decristan J. Kognitive Aktivierung in Befragungen von Sch&#252;lerinnen und Sch&#252;lern. Unterscheidung zwischen dem Potential zur kognitiven Aktivierung und der individuellen kognitiven Aktivierung. P&#228;d Psychol. 2023;1-15. DOI: 10.1024&#47;1010-0652&#47;a000359</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1024&#47;1010-0652&#47;a000359</RefLink>
      </Reference>
      <Reference refNo="58">
        <RefAuthor>De Grave WS</RefAuthor>
        <RefAuthor>Boshuizen HP</RefAuthor>
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefTitle>Problem based learning: Cognitive and metacognitive processes during problem analysis</RefTitle>
        <RefYear>1996</RefYear>
        <RefJournal>Instr Sci</RefJournal>
        <RefPage>321-341</RefPage>
        <RefTotal>De Grave WS, Boshuizen HP, Schmidt HG. Problem based learning: Cognitive and metacognitive processes during problem analysis. Instr Sci. 1996;24(5):321-341.</RefTotal>
      </Reference>
      <Reference refNo="59">
        <RefAuthor>R&#246;cker N</RefAuthor>
        <RefAuthor>Lottspeich C</RefAuthor>
        <RefAuthor>Braun LT</RefAuthor>
        <RefAuthor>Lenzer B</RefAuthor>
        <RefAuthor>Frey J</RefAuthor>
        <RefAuthor>Fischer MR</RefAuthor>
        <RefAuthor>Schmidmaier R</RefAuthor>
        <RefTitle>Implementation of self-directed learning within clinical clerkships</RefTitle>
        <RefYear>2021</RefYear>
        <RefJournal>GMS J Med Educ</RefJournal>
        <RefPage>Doc43</RefPage>
        <RefTotal>R&#246;cker N, Lottspeich C, Braun LT, Lenzer B, Frey J, Fischer MR, Schmidmaier R. Implementation of self-directed learning within clinical clerkships. GMS J Med Educ. 2021;38(2):Doc43. DOI: 10.3205&#47;zma001439</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;zma001439</RefLink>
      </Reference>
      <Reference refNo="60">
        <RefAuthor>Boelens R</RefAuthor>
        <RefAuthor>De Wever B</RefAuthor>
        <RefAuthor>Rosseel Y</RefAuthor>
        <RefAuthor>Verstraete AG</RefAuthor>
        <RefAuthor>Derese A</RefAuthor>
        <RefTitle>What are the most important tasks of tutors during the tutorials in hybrid problem-based learning curricula&#63;</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>BMC Med Educ</RefJournal>
        <RefPage>84</RefPage>
        <RefTotal>Boelens R, De Wever B, Rosseel Y, Verstraete AG, Derese A. What are the most important tasks of tutors during the tutorials in hybrid problem-based learning curricula&#63; BMC Med Educ. 2015;15:84. DOI: 10.1186&#47;s12909-015-0368-4</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1186&#47;s12909-015-0368-4</RefLink>
      </Reference>
      <Reference refNo="61">
        <RefAuthor>Schmidt HG</RefAuthor>
        <RefAuthor>Rotgans JI</RefAuthor>
        <RefAuthor>Yew EH</RefAuthor>
        <RefTitle>The process of problem-based learning: what works and why</RefTitle>
        <RefYear>2011</RefYear>
        <RefJournal>Med Educ</RefJournal>
        <RefPage>792-806</RefPage>
        <RefTotal>Schmidt HG, Rotgans JI, Yew EH. The process of problem-based learning: what works and why. Med Educ. 2011;45(8):792-806. DOI: 10.1111&#47;j.1365-2923.2011.04035.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1365-2923.2011.04035.x</RefLink>
      </Reference>
      <Reference refNo="62">
        <RefAuthor>Garin O</RefAuthor>
        <RefTitle>Ceiling Effect</RefTitle>
        <RefYear>2014</RefYear>
        <RefBookTitle>Encyclopedia of Quality of Life and Well-Being Research</RefBookTitle>
        <RefPage></RefPage>
        <RefTotal>Garin O. Ceiling Effect. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer; 2014. DOI: 10.1007&#47;978-94-007-0753-5&#95;296</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;978-94-007-0753-5&#95;296</RefLink>
      </Reference>
    </References>
    <Media>
      <Tables>
        <Table format="png">
          <MediaNo>1</MediaNo>
          <MediaID language="en">1en</MediaID>
          <MediaID language="de">1de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Table 1: The mean interaction times as percentages of session time and the mean frequencies of the occurrence of utterances in relation to learning-orientated interactions. </Mark1><LineBreak></LineBreak>SD&#61;standard deviation.</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Tabelle 1: Durchschnittliche Interaktionszeiten, angegeben als Prozentsatz der Gesamtzeit, sowie durchschnittliche H&#228;ufigkeiten des Auftretens von &#196;u&#223;erungen, die lernorientierte Interaktionen betreffen. </Mark1><LineBreak></LineBreak>SD&#61;Standardabweichung, M&#61;Durchschnitt.</Pgraph></Caption>
        </Table>
        <Table format="png">
          <MediaNo>2</MediaNo>
          <MediaID language="en">2en</MediaID>
          <MediaID language="de">2de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Table 2: The mean percentages of the session time related to tutor utterances and the mean frequencies of tutor utterances.</Mark1><LineBreak></LineBreak><LineBreak></LineBreak>SD&#61;standard deviation</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Tabelle 2: Durchschnittliche Interaktionszeiten, angegeben als prozentualer Anteil an der Gesamtzeit, sowie durchschnittliche H&#228;ufigkeiten des Auftretens von &#196;u&#223;erungen in Bezug auf Tutor&#42;innen&#228;u&#223;erungen.</Mark1><LineBreak></LineBreak>SD&#61;Standardabweichung, M&#61;Durchschnitt.</Pgraph></Caption>
        </Table>
        <Table format="png">
          <MediaNo>3</MediaNo>
          <MediaID language="en">3en</MediaID>
          <MediaID language="de">3de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Table 3: The multiple-choice questions (MCQ) grades in relation to group A and B.</Mark1> <LineBreak></LineBreak>SD&#61;standard deviation</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Tabelle 3: Ergebnisse des Multiple-Choice-Tests der beiden Untersuchungsgruppen. </Mark1><LineBreak></LineBreak>M&#61;Durschnitt, SD&#61;Standardabweichung.</Pgraph></Caption>
        </Table>
        <Table format="png">
          <MediaNo>4</MediaNo>
          <MediaID language="en">4en</MediaID>
          <MediaID language="de">4de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Table 4: The multiple-choice questions (MCQ) grades in relation to the pre- and post-test. </Mark1><LineBreak></LineBreak>SD&#61;standard deviation</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Tabelle 4: Zusammenhang zwischen Pr&#228;- und Postmessung des Multiple-Choice-Tests. </Mark1><LineBreak></LineBreak>M&#61;Durschnitt, SD&#61;Standardabweichung.</Pgraph></Caption>
        </Table>
        <Table format="png">
          <MediaNo>5</MediaNo>
          <MediaID language="en">5en</MediaID>
          <MediaID language="de">5de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Table 5: The objective structured practical exam (OSPE) and structured oral exam (SOE) grades. </Mark1><LineBreak></LineBreak>SD&#61;standard deviation</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Tabelle 5: Noten der objektiv strukturierten praktischen Pr&#252;fung (OSPE) und der strukturierten m&#252;ndlichen Pr&#252;fung (SOE). </Mark1><LineBreak></LineBreak>M&#61;Durschnitt, SD&#61;Standardabweichung.</Pgraph></Caption>
        </Table>
        <NoOfTables>5</NoOfTables>
      </Tables>
      <Figures>
        <Figure format="png" height="400" width="1056">
          <MediaNo>1</MediaNo>
          <MediaID language="en">1en</MediaID>
          <MediaID language="de">1de</MediaID>
          <Caption language="en"><Pgraph><Mark1>Figure 1:  A typical coding result of the first 60 minutes of a dPBL session including steps 1-4. </Mark1><LineBreak></LineBreak>The codes &#8220;statements&#8221; and &#8220;judgement confirmation&#8221; are predominant, while at the beginning of step 3 mainly &#8220;off-task&#47;irrelevant&#8221; codes occurred.</Pgraph></Caption>
          <Caption language="de"><Pgraph><Mark1>Abbildung 1: Ein typisches Kodierergebnis der ersten 60 Minuten einer dPOL-Sitzung (die die Schritte 1-4 umfasste). </Mark1><LineBreak></LineBreak>Die Codes &#8222;Stellungnahme&#8220; und &#8222;Urteilsannahme&#47;-best&#228;tigung&#8220; dominieren, w&#228;hrend zu Beginn von Schritt 3 haupts&#228;chlich &#8222;off-task&#47;irrelevante&#8220; Codes auftraten.</Pgraph></Caption>
        </Figure>
        <NoOfPictures>1</NoOfPictures>
      </Figures>
      <InlineFigures>
        <NoOfPictures>0</NoOfPictures>
      </InlineFigures>
      <Attachments>
        <NoOfAttachments>0</NoOfAttachments>
      </Attachments>
    </Media>
  </OrigData>
</GmsArticle>