Metacognition in healthcare communication training: a critical analysis of blended second language learning

Datum: 20 november 2018

Locatie: Stadscampus, Barokzaal Grauwzusters - Lange Sint-Annastraat 7 - 2000 Antwerpen (route: UAntwerpen, Stadscampus)

Tijdstip: 14 - 16.30 uur

Promovendus: Christine Fourie

Promotor: Prof Kris Van de Poel

Korte beschrijving: PhD defence Christine Fourie (Linguistics) - Faculty of Arts


The diversity of learning needs among the members of any professional group of second language users is often under-estimated. By blending conventional classroom teaching with online learning, the linguistic needs of learners can seem scattered and beyond the teacher’s ability to address. However, for healthcare professionals, communication training in a second language is crucial, as sound communication between patient and healthcare provider is associated with improved patient health outcomes.

Consequently, my thesis wants to demonstrate how to optimise communication training for healthcare purposes via a blended learning platform by facilitating and supporting learner metacognition. The literature shows that attention spent on metacognition is known to improve learning outcomes independent of learner intelligence. Though often neglected in existing research, this thesis emphasises that metacognition only manifests when learners have the opportunity to exercise both declarative and procedural knowledge, which in a language learning environment translate as awareness of and reflection on learning a language (declarative knowledge) and the skill to implement this knowledge as engagement with learning via interaction (procedural knowledge). Apart from exploring learner metacognition, this thesis also explores the principles underlying the curriculum and syllabus design process as meta-metacognition, where needs analysis and evaluation can be defined as declarative insights that feed into implementation during the pedagogical phases of teaching and learning (procedural knowledge).

The research context of this thesis spans two continents, with the main studies conducted amongst (1) medical students at the University of Stellenbosch, South Africa, and (2) pre-professional nurses studying at Artesis-Plantijn Hogeschool in Antwerp, Belgium. To validate and compare results, data were also obtained from (3) a group of medical professionals in Gothenburg, Sweden, studying Swedish as a second language via an online platform, and (4) first and second year majors of English at the University of Antwerp, Belgium. The core syllabi for the medical as well as nursing training were based on the online modules Medics on the Move and Nursing on the Move, which were developed along the same foundations.

A multi-methods research approach was opted for in order to gain a comprehensive understanding of the metacognitive processes in the different blended learning contexts and the research approach taken was mainly qualitative as the research purpose was to investigate the nature and impact of metacognition in a healthcare community, rather than to test a theory or measure variables. The research designs of enquiry varied slightly between the different phases of the research. Quantitative data were collected via questionnaires containing Likert (type) scale items, for example, in the usability study adopted in a logframe model, as well as by tracking students’ online learning behaviour. Qualitative data were collected by means of transcribed focus group discussions, Facebook posts and open-ended questions and analysed according to the principles of grounded theory.

The results from the data analysis were organised in four parts to address the research question.

The first focal point of the research question is on the foundations of curriculum and syllabus design, where the first foundation entails a process of on-going needs analyses among stakeholders. This in turn should feed into the syllabus, as the next foundation. The syllabus should be functional, while relying on relevant scenarios to support communication. The third foundation refers to the task-based pedagogy underlying the course and realistically reflecting the activities to be undertaken in a healthcare context. Both teacher and learner should each take responsibility for learning during task performance. The fourth foundation then refers to stakeholder evaluations feeding continuously and systematically into the on-going development of the materials and teaching approach. Both the needs analyses and reflections function as declarative insights, which, when implemented, represent procedural knowledge. As the overall regulatory process, curriculum and syllabus design can be coined ‘meta-metacognition’, which will remain pro-active in delivering a relevant and meaningful learning experience. 

The second part of the research focuses on the dynamic nature of learning support that results from the meta-metacognitive processes (needs analyses and evaluation) and the reciprocal relationship between curriculum components and the stakeholders’ input (procedural knowledge).

The third part studies the nature of declarative and procedural knowledge, which stretches over three knowledge fields, namely (1) the self as a learner, (2) the task of learning a new language for healthcare purposes, and (3) strategies to support this learning process. Results indicate that collaborative learning in a social network fosters true peer interaction, while learners at the same time gain confidence in using the second language. Furthermore, the safe environment of the closed group makes it possible for learners to validate aspects of their identities as learners in a second language. Declarative knowledge (reflection) and procedural knowledge (interaction, validation) enable learners to take part in the on-going process of identity formation, which is necessary for their personal wellbeing. Results regarding the nature of language learning indicate that tasks should be interactive, relevant and personalised in order to support learning. Finally, results regarding learning strategies indicate that learning is ultimately an individualised process and that the blended learning approach offers learners a variety of strategies to choose from. The results furthermore indicate that there may be a discrepancy between a learner’s declarative and procedural knowledge, which can point towards unvoiced learner/learning needs.

Finally, based on a systematic review of all the analyses undertaken, this thesis produces a taxonomy of learner metacognition, a model of the meta-metacognitive processes and a set of guidelines to optimise healthcare communication training courses by facilitating meta-metacognition and learner-metacognition. In doing so, I hope to deliver a defensible curriculum and syllabus that can meet the diverse and fluctuating needs of the healthcare learner with a pro-active approach.

KEYWORDS: metacognition, blended learning, communication training, health-literacy, online learning, vocational training, collaborative learning, meta-metacognition

Contact e-mail: