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Original Communication

Diagnosis and Repair?

How Experts Identify and Respond to a Layperson’s Misconceptions in Online Medical Counseling

Published Online:https://doi.org/10.1024/1421-0185/a000135

Responding to misconceptions is an essential part of adaptive instruction. Nevertheless, research on both tutoring and expert–layperson communication has identified at least two problems that online counselors share with both face-to-face and online tutors. First, they generally do not notice when laypersons’ understanding differs from correct content knowledge. Second, even when they do notice this discrepancy, they do not handle misconceptions appropriately (e.g., they simply present the correct information instead of explaining why the layperson’s understanding is incorrect). This paper presents two studies on experts’ responses to laypersons’ misconceptions in online medical counseling. The results indicate that experts do not address the misconceptions communicated by laypersons, even when they are aware that such misunderstandings exist. The discussion concentrates on two explanations for these results: One is related to the differences between reflection and speech production and the cognitive processes underlying the two operations, while the other concerns the role of face-threatening acts in instructional contexts.

References

  • Azevedo, R., Landis, R., Feyzi-Behnagh, R., Duffy, M., Trevors, G., Harley, J., ... Hossain, G. (2012). The effectiveness of pedagogical agents’ prompting and feedback in facilitating co-adapted learning with MetaTutor. In S. Cerri, W. Clancey, G. Papadourakis, K. Panourgia (Eds.), Lecture notes in computer science: Vol. 7315. Intelligent tutoring systems (pp. 212–221). Berlin, Germany: Springer. doi 10.1007/978-3-642-30950-2_27 First citation in articleCrossrefGoogle Scholar

  • Becker, B.-M., Bromme, R., Jucks, R. (2008). College students’ knowledge of concepts related to the metabolic syndrome. Psychology, Health and Medicine, 13, 367–379. doi 10.1080/13548500701405525 First citation in articleGoogle Scholar

  • Böhm, B. O., Palitzsch, K.-D., Rosak, D., Spinas, G. A. (2001). Klinische Diabetologie [Clinical diabetology]. Berlin, Germany: Springer-Verlag. First citation in articleCrossrefGoogle Scholar

  • Bonnefon, J.-F., Feeney, A., De Neys, W. (2011). The risk of polite misunderstandings. Current Directions in Psychological Science, 20, 321–324. doi 10.1177/0963721411418472 First citation in articleCrossrefGoogle Scholar

  • Bransford, J., Brown, A. L., Cocking, R. R. (2000). How people learn: Brain, mind, experience, and school. Washington, DC: National Academy Press. First citation in articleGoogle Scholar

  • Bromme, R., Brummernhenrich, B., Becker, B.-M., Jucks, R. (2012). The effects of politeness-related instruction on medical tutoring. Communication Education, 61, 358–379. doi 10.1080/03634523.2012.691979 First citation in articleCrossrefGoogle Scholar

  • Bromme, R., Jucks, R., Runde, A. (2005). Barriers and biases in computer-mediated expert–layperson communication: An overview and insights into the field of medical advice. In R. Bromme, F. W. Hesse, H. Spada (Eds.), Barriers and biases in computer-mediated knowledge communication – and how they may be overcome (pp. 89–118). New York: Springer-Verlag. First citation in articleCrossrefGoogle Scholar

  • Bromme, R., Jucks, R., Wagner, T. (2005). How to refer to “diabetes”? Language in online health advice. Applied Cognitive Psychology, 19, 569–586. doi 10.1002/acp.1099 First citation in articleCrossrefGoogle Scholar

  • Brown, J. S., Burton, R. R. (1978). Diagnostic models for procedural bugs in basic mathematical skills. Cognitive Science, 2, 155–192. doi 10.1207/s15516709cog0202_4 First citation in articleCrossrefGoogle Scholar

  • Brown, P., Levinson, S. C. (1987). Politeness: Some universals in language usage. Cambridge, UK: Cambridge University Press. First citation in articleCrossrefGoogle Scholar

  • Brummernhenrich, B., Jucks, R. (2013). Managing face threats and instructions in online tutoring. Journal of Educational Psychology, 105, 341–350. doi 10.1037/a0031928 First citation in articleCrossrefGoogle Scholar

  • Chi, M. T. H. (1996). Constructing self-explanations and scaffolded explanations in tutoring. Applied Cognitive Psychology, 10, 33–49. doi 10.1002/(SICI)1099-0720(199611)10:7<33::AID-ACP436>3.3.CO;2-5 First citation in articleCrossrefGoogle Scholar

  • Chi, M. T. H., Feltovich, P. J., Glaser, R. (1981). Categorization and representation of physics problems by experts and novices. Cognitive Science, 5, 121–152. doi 10.1207/ s15516709cog0502_2 First citation in articleCrossrefGoogle Scholar

  • Chi, M. T. H., Roy, M. (2010). How adaptive is an expert human tutor? In V. Aleven, J. Kay, J. Mostow (Eds.), Lecture notes in computer science: Vol. 6094. Intelligent tutoring systems (pp. 401–412). Berlin, Germany: Springer-Verlag. doi 10.1007/978-3-642-13388-6_44 First citation in articleCrossrefGoogle Scholar

  • Chi, M. T. H., Siler, S. A., Jeong, H. (2004). Can tutors monitor students’ understanding accurately? Cognition and Instruction, 22, 363–387. doi 10.1207/s1532690xci2203_4 First citation in articleCrossrefGoogle Scholar

  • Chi, M. T. H., Siler, S. A., Jeong, H., Yamauchi, T., Hausmann, R. G. M. (2001). Learning from human tutoring. Cognitive Science, 25, 471–533. doi 10.1016/S0364-0213(01)00044-1 First citation in articleCrossrefGoogle Scholar

  • Clark, H. H., Brennan, S. E. (1991). Grounding in communication. In L. B. Resnick, J. M. Levine, S. D. Teasley (Eds.), Perspectives on socially shared cognition (pp. 127–149). Washington, DC: American Psychological Association. First citation in articleCrossrefGoogle Scholar

  • Clark, H. H., Murphy, G. L. (1982). Audience design in meaning and reference. In J. F. LeNy, W. Kintsch (Eds.), Language and comprehension (pp. 287–299). Amsterdam, The Netherlands: North-Holland. First citation in articleCrossrefGoogle Scholar

  • Cromley, J. G., Azevedo, R. (2005). What do reading tutors do? A naturalistic study of more and less experienced tutors in reading. Discourse Processes, 40, 83–113. doi 10.1207/ s15326950dp4002_1 First citation in articleCrossrefGoogle Scholar

  • Derry, S. J., Potts, M. K. (1998). How tutors model students: A study of personal constructs in adaptive tutoring. American Educational Research Journal, 35, 65–99. doi 10.3102/ 00028312035001065 First citation in articleCrossrefGoogle Scholar

  • D’Mello, S., Lehman, B., Person, N. (2010). Expert tutors’ feedback is immediate, direct, and discriminating. In H. W. Guesgen, R. C. Murray (Eds.), Proceedings of the Twenty-Third International Florida Artificial Intelligence Research Society Conference (FLAIRS 2010) (pp. 595–604). Menlo Park, CA: AAAI Press. First citation in articleGoogle Scholar

  • Duthler, K. W. (2006). The politeness of requests made via email and voicemail: Support for the hyperpersonal model. Journal of Computer-Mediated Communication, 11, 500–521. doi 10.1111/j.1083-6101.2006.00024.x First citation in articleCrossrefGoogle Scholar

  • Fitz-Gibbon, C. T. (1977). An analysis of the literature of cross-age tutoring. Washington, DC: National Institute of Education. First citation in articleGoogle Scholar

  • Fussell, S. R., Krauss, R. M. (1992). Coordination of knowledge in communication: Effects of audience design on message comprehension: Reference in a common ground framework. Journal of Experimental Social Psychology, 25, 203–219. doi 10.1016/0022-1031(89)90019-X First citation in articleCrossrefGoogle Scholar

  • Glass, M., Kim, J. H., Evens, M. W., Michael, J. A., Rovick, A. A. (1999). Novice vs. expert tutors: A comparison of style. In U. Priss (Ed.), Proceedings of the Tenth Midwest Artificial Intelligence and Cognitive Science Conference (pp. 43–49). Menlo Park, CA: AAAI Press. First citation in articleGoogle Scholar

  • Goffman, E. (1967). Interaction ritual: Essays on face-to-face interaction. Oxford, UK: Aldine. First citation in articleGoogle Scholar

  • Graesser, A. C., Person, N. K., Magliano, J. P. (1995). Collaborative dialog patterns in naturalistic one-to-one tutoring. Applied Cognitive Psychology, 9, 495–522. First citation in articleCrossrefGoogle Scholar

  • Greten, H. (2002). Innere Medizin [Internal medicine]. Stuttgart: Thieme. First citation in articleGoogle Scholar

  • Hien, P., Böhm, B. O. (2001). Diabetes Handbuch: Eine Anleitung für Praxis und Klinik (3. Aufl.) [Diabetes guide: Instructions for practices and clinics (3rd ed.)]. Berlin: Springer-Verlag. First citation in articleCrossrefGoogle Scholar

  • Hinds, P. J. (1999). The curse of expertise: The effects of expertise and debiasing methods on predictions of novice performance. Journal of Experimental Psychology Applied, 5, 205–221. doi 10.1037//1076-898X.5.2.205 First citation in articleCrossrefGoogle Scholar

  • Hmelo-Silver, C. E., Pfeffer, M. G. (2004). Comparing expert and novice understanding of a complex system from the perspective of structures, behaviors, and functions. Cognitive Science, 28, 127–138. doi 10.1207/s15516709cog2801_7 First citation in articleCrossrefGoogle Scholar

  • Isaacs, E. A., Clark, H. H. (1987). References in conversation between experts and novices. Journal of Experimental Psychology: General, 116, 26–37. doi http://dx.doi.org/ 10.1037/0096-3445.116.1.26 First citation in articleCrossrefGoogle Scholar

  • Jucks, R., Bromme, R. (2007). Choice of words in doctor- patient communication: An analysis of health-related Internet sites. Health Communication, 21, 267–277. doi 10.1080/ 10410230701307865 First citation in articleCrossrefGoogle Scholar

  • Jucks, R., Bromme, R. (2011). Perspective taking in computer-mediated instructional communication. Journal of Media Psychology, 23, 192–199. doi 10.1027/1864-1105/a000056 First citation in articleLinkGoogle Scholar

  • Jucks, R., Bromme, R., Runde, A. (2007). Explaining with nonshared illustrations: How they constrain explanations. Learning and Instruction, 17, 204–218. doi 10.1016/j.learninstruc.2007.01.006 First citation in articleCrossrefGoogle Scholar

  • Jucks, R., Paus, E., Bromme, R. (2012). Patients’ medical knowledge and health counseling: What kind of information helps to make communication patient-centered? Patient Education and Counseling, 88, 177–183. doi 10.1016/ j.pec. 2012.01.011 First citation in articleCrossrefGoogle Scholar

  • Lepper, M. R., Woolverton, M. (2002). The wisdom of practice: Lessons learned from the study of highly effective tutors. In J. Aronson (Ed.), Improving academic achievement: Impact of psychological factors on education (pp. 135–158). San Diego, CA: Academic Press. First citation in articleCrossrefGoogle Scholar

  • McArthur, D., Stasz, C., Zmuidzinas, M. (1990). Tutoring techniques in algebra. Cognition and Instruction, 7, 197–244. doi 10.1207/s1532690xci0703_2 First citation in articleCrossrefGoogle Scholar

  • Narciss, S., Huth, K. (2006). Fostering achievement and motivation with bug-related tutoring feedback in a computer-based training for written subtraction. Learning and Instruction, 16, 310–322. doi http://dx.doi.org/10.1016/ j.learninstruc.2006. 07.003 First citation in articleCrossrefGoogle Scholar

  • Nickerson, R. S. (1999). How we know – and sometimes misjudge – what others know: Imputing one’s own knowledge to others. Psychological Bulletin, 125, 737–759. doi http://dx.doi.org/ 10.1037//0033-2909.125.6.737 First citation in articleCrossrefGoogle Scholar

  • Person, N. K., Graesser, A. C., Magliano, J. P., Kreuz, R. J. (1994). Inferring what the student knows in one-to-one tutoring: The role of student questions and answers. Learning and Individual Differences, 6, 205–229. doi 10.1016/1041-6080(94)90010-8 First citation in articleCrossrefGoogle Scholar

  • Person, N. K., Kreuz, R. J., Zwaan, R. A., Graesser, C. A. (1995). Pragmatics and pedagogy: Conversational rules and politeness strategies may inhibit effective tutoring. Cognition and Instruction, 13, 161–188. doi 10.1207/ s1532690xci1302_1 First citation in articleCrossrefGoogle Scholar

  • Pratt, M. W., Savoy-Levine, K. M. (1998). Contingent tutoring of long-division skills in fourth and fifth graders: Experimental tests of some hypotheses about scaffolding. Journal of Applied Developmental Psychology, 19, 287–304. doi 10.1016/S0193-3973(99)80041-0 First citation in articleCrossrefGoogle Scholar

  • Putnam, R. T. (1987). Structuring and adjusting content for students: A study of live and simulated tutoring of addition. American Educational Research Journal, 24, 13–48. doi 10.3102/00028312024001013 First citation in articleCrossrefGoogle Scholar

  • Scardamalia, M., Bereiter, C. (1987). Knowledge telling and knowledge transforming in written composition. In S. Rosenberg (Ed.), Advances in psycholinguistics (pp. 143–175). Cambridge, UK: Cambridge University Press. First citation in articleGoogle Scholar

  • Scherbaum, W. A. (2002). Pschyrembel Wörterbuch Diabetologie [Pschyrembel dictionary of diabetology]. Berlin: de Gruyter. First citation in articleGoogle Scholar

  • Shrout, P. E., Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420–428. doi 10.1037/0033-2909.86.2.420 First citation in articleCrossrefGoogle Scholar

  • Slotta, J. D., Chi, M. T. H. (2006). Helping students understand challenging topics in science through ontology training. Cognition and Instruction, 24, 261–289. doi 10.1207/ s1532690xci2402_3 First citation in articleCrossrefGoogle Scholar

  • Skinner, C. S., Campbell, M. K., Rimer, B. K., Curry, S., Prochaska, J. O. (1999). How effective is tailored print communication? Annals of Behavioral Medicine, 21, 290–298. doi 10.1007/BF02895960 First citation in articleCrossrefGoogle Scholar

  • Sussman, S. W., Sproull, L. (1999). Straight talk: Delivering bad news through electronic communication. Information Systems Research, 10, 150–166. doi 10.1287/isre.10.2.150 First citation in articleCrossrefGoogle Scholar

  • VanLehn, K., Siler, S., Murray, C., Yamauchi, T., Baggett, W. B. (2003). Why do only some events cause learning during human tutoring? Cognition and Instruction, 21, 209–249. doi 10.1207/S1532690XCI2103_01 First citation in articleCrossrefGoogle Scholar

  • Walther, J. B. (1996). Computer-mediated communication: Impersonal, interpersonal, and hyperpersonal interaction. Communication Research, 23, 3–43. doi 10.1177/ 009365096023001001 First citation in articleCrossrefGoogle Scholar

  • Wirtz, M. (2006). Methoden zur Bestimmung der Beurteilerübereinstimmung [Methods for determining interrater agreement]. In F. Petermann, M. Eid (Eds.), Handbuch der Psychologie: Psychologische Diagnostik (pp. 369–382). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Wittwer, J., Nückles, M., Landmann, N., Renkl, A. (2010). Can tutors be supported in giving effective explanations? Journal of Educational Psychology, 102, 74–89. doi 10.1037/a0016727 First citation in articleCrossrefGoogle Scholar

  • Wittwer, J., Renkl, A. (2008). Why instructional explanations often do not work: A framework for understanding the effectiveness of instructional explanations. Educational Psychologist, 43, 49–64. doi 10.1037/a0016727 First citation in articleCrossrefGoogle Scholar