Web-Based Pedagogical Agents to Facilitate Critical Thinking

Critical thinking is a desired outcome for higher education. Although critical thinking is described as an essential skill in nursing, not all new registered nurses meet these expectations.  The goal is to provide instruction that creates optimal learning situations.  A variety of strategies have been proposed to facilitate critical thinking (Chan, 2013).  One approach is to have the student use critical thinking skills to solve a problem by providing conditions of instruction to trigger higher order thinking (Lunney, 2013). With the growth of online learning in nursing, various strategies are needed to vigorously involve students in the instruction and encourage critical thinking (Martyn, Terwijn, Kek & Huijser, 2014). 

Animated pedagogical agents are virtual characters that facilitate learning in computer-based or Web-based environments (Veletsianos & Russell, 2014).  They possess the ability to provide personalization and use specific pedagogical methods that may enhance online instruction (Kim & Baylor, 2015). Agents can promote student motivation and engagement and engender affective as well as cognitive responses that may facilitate critical thinking (Frechette & Moreno, 2015). It is assumed that a pedagogical agent provides a social presence that may assist with the learning process. Agents can have both informational usefulness as a knowledgeable teacher, and affective interaction reflected in their social presence (Veletsianos, 2012). Various methods to facilitate critical thinking have been explored with varying results (Kong, Qin, Zhou, Mou & Gao, 2014). 

Purpose: The purpose of this study was to evaluate the effectiveness of a Web-based animated pedagogical agent on critical thinking among nursing students.

Methods: This mixed methods experimental study used a pretest, posttest design with a control group. The convenience sample was comprised of 50 Associate Degree Nursing students in their final semester of the program. Random assignment resulted in 21 students in the control group and 24 students in the pedagogical agent group at the study’s conclusion.

Instruction consisted of a series of three patient case study modules on the following topics: shock, chest trauma, and spinal cord injury. The role of the agent in the modules:  an expert and motivational advisor. A nursing case study depicted a particular patient with a certain diagnosis and relayed a series of assessment data and diagnostic results.  Information was relayed in an unfolding case study format. The student needed to make some determinations and conclusions related to what was happening in the case study and decided upon the interventions for the patient in response to questions being asked. One group completed three nursing case study modules with a pedagogical agent. A second group completed the series of case studies in a course management system without the assistance of the pedagogical agent. Each module consisted of an introduction to the case study and a series of slides with questions.

The agent had animations to relay facial expressions with lip synchronization and hand movement, as appropriate for the learning module. The agents represented both a male and female nurse and were realistic in appearance, rather than a caricature. The agent provides a possible innovative tool for critical thinking through active engagement of students by asking questions and supplying feedback about a series of nursing case studies. The questions and feedback was meant to be similar to the facilitation provided by the clinical instructor discussing the student’s patient.

Both groups were assessed for their critical thinking before and after the modules. Students were asked to “think-aloud” about their response to scenarios in a narrative format. Student scenario responses were coded and analyzed by 2 faculty members using a rating tool and rubric for the presence of cognitive processes, level of critical thinking, and for accuracy of nursing diagnosis, conclusions, and evaluation of patient care. Their critical thinking level was rated as novice, advanced beginner or competent on their responses to nursing scenarios.

Results:

Both groups improved their critical thinking. There was evidence of improvement in critical thinking for both groups. 79% of the treatment (pedagogical agent) group improved their critical thinking level compared to 57% of the control group.

Chi-square analyses for each group revealed a significant difference [p= 0.001 (treatment group) and p=0.01(control group)] for improvement of the critical thinking level and correct conclusions [p=0.01 (treatment group) and p=0.04 (control group)] from pre-think-aloud to post-think-aloud scenarios responses. Only the pedagogical agent group had a significant result (p= 0.03) of their appropriate evaluations. Neither group had a significant result for nursing diagnosis.

Conclusion:

Previous research in critical thinking provides evidence of usefulness of case studies and problem based learning (Lunney, 2013).  This research provided further evidence that nursing case studies facilitated critical thinking for both the web-based pedagogical agent group and the control group. The advantage of a pedagogical agent over a non-pedagogical agent environment showed promise. Previous research with pedagogical agents provides evidence that is consistent with this research. Social agency theory describes the social cues of the agent (the image and voice) that cause the learner to deeply process the content to be learned. Domagk's (2015) research specifically showed that the high appeal of the pedagogical agent’s appearance and voice promoted transfer performance. It would seem that students that need more help with critical thinking ability may benefit more from the use of a pedagogical agent. A pedagogical agent may provide a social presence and verbal responses to motivate students and encourage critical thinking. The cognitive and social effects of the pedagogical agent appear to provide some support for facilitating critical thinking that warrants further study. The pedagogical agent has the ability to deliver a message that can affect the learner’s motivation through both verbal and nonverbal communication thereby providing a social interface. Web-based pedagogical agents provide a potential innovative teaching practice applicable to nurse educators in the academic and professional development settings. Ultimately the nurse improves their practice and patient care by increasing their ability to make decisions based on a process of critical thinking and clinical reasoning.