In the fall of 2014, 20.4 million American students were enrolled in higher education. Of these, 28% or 5.8 million students were taking at least some of their courses at a distance and half of those or nearly 3 million students were taking all of them at a distance (Allen, Seaman, Poulin, & Straut, 2016). According to the 2017 New Media Consortium Horizon Report, “online, mobile, and blended learning are foregone conclusions” (Adams Becker et al. 2017, p. 2) reflecting the growing numbers of students seeking more flexible schedules and learning environments. In addition, employers are demanding that higher education teach real-world skills to improve student employability and workplace development (Stavredes, 2011).

Problem solving is of critical importance in many disciplines. In medicine, the clinician's ability to arrive at the correct diagnosis often means the difference between life and death. Despite its importance and a significant amount of research regarding how to improve problem solving, few unambiguous answers have emerged for promoting problem solving learning.

This paper focuses on explaining those gains, both theoretically, and in terms of the qualitative data collected from learners over the past two years. The goal of the paper is to associate those gains with specific characteristics of the DP (Diagnostic Pathfinder, a software learning tool designed to help clinical pathology students improve their ability to solve diagnostic problems) by and meaningfully categorizing and characterizing thousands of comments from students who used the DP in a number of different settings, and to use those comments to illustrate, from the students' perspective, how using the DP accomplished what it did. These ideas will be tied to current theory regarding the teaching and learning of problem solving.

During the past 60 years, we transitioned from a society dominated by industrial workers to one abundant with knowledge workers. Sixty years ago, knowledge was relatively scarce and challenging to acquire. Though libraries did their best to distribute information on paper media, a simple literature search typically involved many hours of combing through card catalogs and lengthy bibliographic print publications such as Index Medicus. Frequently, searches were delayed for weeks when the desired reference was sent out for binding or checked out by another patron. Innovations like Google, PubMed, e-journals and digital repositories changed everything. Now, information is not only available, it is overwhelmingly so. Currently, the challenge is less how to acquire knowledge, and more how to sort through the ever-burgeoning content to find relevant and reliable information.

Though our information paradigm has transformed dramatically, our education system remains largely unchanged. In the National Survey of Student Engagement (NSSE), administered annually at more than 700 colleges and universities, over 60% of college students reported in 2014 that “memorizing facts, ideas, or methods from your courses and readings so you can repeat them pretty much in the same form” was used either “quite a bit” or “very much.”2 In other words, the majority of college students report that their courses emphasize rote memorization. Back when information was scarce, it was necessary for professors to distribute knowledge through lecture, and students to memorize facts and figures to recite on examinations. Now that information is readily accessible, it makes sense that our education system can loosen its grip on methods that promote memorization skills and turn toward helping students cope with information overload by teaching critical thinking skills needed to find reliable information, interpret that information, and apply knowledge to solve problems. These are the complex skills essential to the development of disciplinary expertise.

The Diagnostic Pathfinder has been used for nearly ten years at multiple colleges of veterinary medicine to teach diagnostic problem solving. A number of prior studies show this tool to be effective. Research in medical diagnostic problem solving provides hints, but no unambiguous answers regarding how such a tool should be designed. This in-depth review of the interface discusses each interaction in terms of how that interaction relates to the tool’s success. Nine faculty members who have taught using the Pathfinder during the last decade responded to interview questions regarding the tool. Their responses supported what had already been learned – that there is benefit when learner and instructor use the same process for solving a diagnostic problem, and then compare results, and when students learn in the context of realistic problems. Additionally, instructor responses suggest that the Pathfinder has been effective because it has 1.) enabled precise communication among experts and learners in a field where there is no generally agreed upon format for precisely communicating understandings of interrelationships between mechanisms of disease and clinical laboratory data, and 2.) provided a framework for manipulating data that respects the limitations of human memory and invites a thorough, explicit, and “artistic” rendering of the rationale.