Eitel F, Kanz K G, Hortig E, Tesche A
Chirurgische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, München, Germany.
J Eval Clin Pract. 2000 Aug;6(3):321-33. doi: 10.1046/j.1365-2753.2000.00229.x.
Medicine has evolved toward rationalization since the Enlightenment, favouring quantitative measures. Now, a paradigm shift toward control through formalization can be observed in health care whose structures and processes are subjected to increasing standardization. However, educational reforms and curricula do not yet adequately respond to this shift. The aim of this article is to describe innovative approaches in medical education for adapting to these changes. The study design is a descriptive case report relying on a literature review and on a reform project's evaluation. Concept mapping is used to graphically represent relationships among concepts, i.e. defined terms from educational literature. Definitions of 'concept map', 'guideline' and 'algorithm' are presented. A prototypical algorithm for organizational decision making in the project's instructional design is shown. Evaluation results of intrinsic learning motivation are demonstrated: intrinsic learning motivation depends upon students' perception of their competence exhibiting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational format, called 'evidence-based learning (EBL)' is deduced from these findings and described here. Effects of formalization consist of structuring decision making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formalization such as implementation problems and bureaucracy are discussed. Formalized tools for designing medical education are available. Specific instructional designs influence students' learning motivation. Concept maps are suitable for controlling educational quality, thus enabling the paradigm shift in medical education.
自启蒙运动以来，医学朝着合理化发展，倾向于定量测量。如今，在医疗保健领域可以观察到一种向通过形式化进行控制的范式转变，其结构和流程正日益标准化。然而，教育改革和课程设置尚未充分应对这一转变。本文旨在描述医学教育中适应这些变化的创新方法。研究设计是一份描述性案例报告，依赖于文献综述和一个改革项目的评估。概念图用于以图形方式表示概念之间的关系，即教育文献中定义的术语。给出了“概念图”“指南”和“算法”的定义。展示了该项目教学设计中用于组织决策的原型算法。展示了内在学习动机的评估结果：内在学习动机取决于学生对自身能力的感知，其路径系数在0.42至0.51之间变化。能力感知因学习环境类型而异。从这些发现中推导出一种名为“循证学习（EBL）”的创新教育形式并在此进行描述。形式化的作用包括构建关于不同学习环境实施的决策，或关于最小化教学或学习中的差异。讨论了形式化的意外影响，如实施问题和官僚作风。有用于设计医学教育的形式化工具。特定的教学设计会影响学生的学习动机。概念图适用于控制教育质量，从而推动医学教育的范式转变。
