Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Med Educ. 2011 Jan;45(1):60-8. doi: 10.1111/j.1365-2923.2010.03757.x.
Pedagogical practices reflect theoretical perspectives and beliefs that people hold about learning. Perspectives on learning are important because they influence almost all decisions about curriculum, teaching and assessment. Since Flexner's 1910 report on medical education, significant changes in perspective have been evident. Yet calls for major reform of medical education may require a broader conceptualisation of the educational process.
Medical education has emerged as a complex transformative process of socialisation into the culture and profession of medicine. Theory and research, in medical education and other fields, have contributed important understanding. Learning theories arising from behaviourist, cognitivist, humanist and social learning traditions have guided improvements in curriculum design and instruction, understanding of memory, expertise and clinical decision making, and self-directed learning approaches. Although these remain useful, additional perspectives which recognise the complexity of education that effectively fosters the development of knowledge, skills and professional identity are needed.
Socio-cultural learning theories, particularly situated learning, and communities of practice offer a useful theoretical perspective. They view learning as intimately tied to context and occurring through participation and active engagement in the activities of the community. Legitimate peripheral participation describes learners' entry into the community. As learners gain skill, they assume more responsibility and move more centrally. The community, and the people and artefacts within it, are all resources for learning. Learning is both collective and individual. Social cognitive theory offers a complementary perspective on individual learning. Situated learning allows the incorporation of other learning perspectives and includes workplace learning and experiential learning. Viewing medical education through the lens of situated learning suggests teaching and learning approaches that maximise participation and build on community processes to enhance both collective and individual learning.
教学实践反映了人们对学习的理论观点和信念。学习观点很重要，因为它们几乎影响到课程、教学和评估的所有决策。自弗莱克斯纳 1910 年关于医学教育的报告以来，人们的观点已经发生了重大变化。然而，呼吁对医学教育进行重大改革可能需要更广泛地理解教育过程。
医学教育已经成为一个复杂的社会化过程，使学生融入医学文化和专业。医学教育和其他领域的理论和研究为人们提供了重要的理解。源自行为主义、认知主义、人本主义和社会学习传统的学习理论指导了课程设计和教学、对记忆、专长和临床决策的理解以及自主学习方法的改进。尽管这些仍然有用，但需要额外的观点来认识到有效的教育的复杂性，这种教育能够有效地促进知识、技能和专业身份的发展。
社会文化学习理论，特别是情境学习和实践共同体，提供了一个有用的理论视角。它们将学习视为与背景密切相关的过程，通过参与和积极参与社区的活动来实现。合法的边缘参与描述了学习者进入社区的过程。随着学习者获得技能，他们承担更多的责任并更深入地参与其中。社区以及其中的人和人工制品都是学习的资源。学习既是集体的也是个人的。社会认知理论提供了个体学习的互补视角。情境学习允许纳入其他学习观点，并包括工作场所学习和体验式学习。通过情境学习的视角来看待医学教育，可以提出最大限度地参与和利用社区过程的教学和学习方法，以提高集体和个人学习。
