Lisk Kristina, Agur Anne M R, Woods Nicole N
Rehabilitation Sciences Institute, Division of Anatomy, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 1158, Toronto, ON, M5S 1A8, Canada.
The Wilson Centre, University Health Network, Toronto, ON, Canada.
Adv Health Sci Educ Theory Pract. 2017 Dec;22(5):1071-1083. doi: 10.1007/s10459-016-9743-0. Epub 2016 Dec 24.
Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of self-explanation during learning has the potential to promote and support the development of integrated knowledge by encouraging novices to elaborate on the causal relationship between clinical features and basic science mechanisms. To explore the effect of this strategy, we compared diagnostic efficacy of teaching students (n = 71) the clinical features of four musculoskeletal pathologies using either (1) integrated causal basic science descriptions (BaSci group); (2) integrated causal basic science descriptions combined with self-explanation prompts (SE group); (3) basic science mechanisms segregated from the clinical features (SG group). All participants completed a diagnostic accuracy test immediately after learning and 1-week later. The results showed that the BaSci group performed significantly better compared to the SE (p = 0.019) and SG groups (p = 0.004); however, no difference was observed between the SE and SG groups (p = 0.91). We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic conceptual understanding of each disease. These findings suggest that integration strategies need to be carefully structured and applied in ways that support the holistic story created by integrated basic science instruction in order to foster conceptual coherence and to capitalize on the benefits of cognition integration.
多项研究表明，基础科学与临床科学的认知整合有助于新手进行诊断推理；然而，教育工作者如何将这种思维活动模式转化为合理的教学策略，这方面的探索还很有限。在学习过程中使用自我解释，有可能通过鼓励新手详细阐述临床特征与基础科学机制之间的因果关系，来促进和支持综合知识的发展。为了探究这种策略的效果，我们比较了分别采用以下三种方式教授71名学生四种肌肉骨骼疾病临床特征后的诊断效果：（1）整合因果关系的基础科学描述（基础科学组）；（2）整合因果关系的基础科学描述并结合自我解释提示（自我解释组）；（3）将基础科学机制与临床特征分开讲解（分开讲解组）。所有参与者在学习后立即以及1周后都完成了诊断准确性测试。结果显示，基础科学组的表现明显优于自我解释组（p = 0.019）和分开讲解组（p = 0.004）；然而，自我解释组和分开讲解组之间未观察到差异（p = 0.91）。我们推测，自我解释任务的结构可能未能支持对每种疾病形成整体概念性理解。这些发现表明，整合策略需要精心构建并以支持基础科学综合教学所创造的整体情境的方式应用，以促进概念连贯性并利用认知整合的益处。
