Supporting collaboration with technology: does shared cognition lead to co-regulation in medicine?

The theoretical distinctions between metacognition, self-regulation and self-regulated learning are often blurred which makes the definition of co-regulation in group learning situations even more difficult. We have started to explore co-regulation in the context of decision making in simulated emergencies where medical teams work together to manage patient cases. Our earlier work has described the relationship between collaborative decision-making in this context as well as discourse patterns that emerge in a simulated medical emergency (Lu & Lajoie, 2008). This paper examines the interactions that occur during this simulation that reflect the relationship between co-regulation and medical decision-making. There are two collaborative learning conditions, a traditional situation where the instructor facilitates collaboration by using a whiteboard to document the group's construction of a medical argument (the traditional whiteboard condition, TW). The second condition uses technology to facilitate the collaboration, where individuals use laptops and an interactive whiteboard (IW) where they can interact with the problem list as it is being created. Our assumption was that the IW would facilitate communication beyond the teacher-student, to include student-student both within and between the various subgroups. The IW group could document their medical arguments by using a structured template for constructing, annotating and sharing arguments. We found that participants in the IW condition differed from the TW condition in that they engaged in more adaptive decision-making behavior early on in the intervention. Similar overall levels of metacognitive activity were found in both conditions but the pattern and timing of metacognitive categories varied. Specifically, the IW group engaged in more planning and orienting than the TW group at the outset of the problem. Early engagement and co-regulation occurred in the IW group which led to shared understandings and subsequently to effective patient management in latter sessions (11.5% vs. 3.6% in TW). Technology supported greater metacognitive activity overall (44% vs 29% in the non supported group). Furthermore, technology facilitated greater planning (23% vs. 10%) and orienting (10% vs 1%) early in the medical problem solving activity. We refer to specific indicators in the discourse that help operationalize the concept of co-regulation.