Kulasegaram Kulamakan M, Chaudhary Zarah, Woods Nicole, Dore Kelly, Neville Alan, Norman Geoffrey
The Wilson Centre for Health Professions Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Programme for Education Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Med Educ. 2017 Feb;51(2):184-195. doi: 10.1111/medu.13145.
Transfer of basic science aids novices in the development of clinical reasoning. The literature suggests that although transfer is often difficult for novices, it can be optimised by two complementary strategies: (i) focusing learners on conceptual knowledge of basic science or (ii) exposing learners to multiple contexts in which the basic science concepts may apply. The relative efficacy of each strategy as well as the mechanisms that facilitate transfer are unknown. In two sequential experiments, we compared both strategies and explored mechanistic changes in how learners address new transfer problems.
Experiment 1 was a 2 × 3 design in which participants were randomised to learn three physiology concepts with or without emphasis on the conceptual structure of basic science via illustrative analogies and by means of one, two or three contexts during practice (operationalised as organ systems). Transfer of these concepts to explain pathologies in familiar organ systems (near transfer) and unfamiliar organ systems (far transfer) was evaluated during immediate and delayed testing. Experiment 2 examined whether exposure to conceptual analogies and multiple contexts changed how learners classified new problems.
Experiment 1 showed that increasing context variation significantly improved far transfer performance but there was no difference between two and three contexts during practice. Similarly, the increased conceptual analogies led to higher performance for far transfer. Both interventions had independent but additive effects on overall performance. Experiment 2 showed that such analogies and context variation caused learners to shift to using structural characteristics to classify new problems even when there was superficial similarity to previous examples.
Understanding problems based on conceptual structural characteristics is necessary for successful transfer. Transfer of basic science can be optimised by using multiple strategies that collectively emphasise conceptual structure. This means teaching must focus on conserved basic science knowledge and de-emphasise superficial features.
基础科学的迁移有助于新手临床推理能力的发展。文献表明，尽管迁移对新手来说往往很困难，但可以通过两种互补策略进行优化：（i）让学习者专注于基础科学的概念知识，或（ii）让学习者接触基础科学概念可能适用的多种情境。每种策略的相对效果以及促进迁移的机制尚不清楚。在两个连续的实验中，我们比较了这两种策略，并探讨了学习者处理新迁移问题时的机制变化。
实验1采用2×3设计，参与者被随机分配通过说明性类比学习三个生理学概念，学习过程中要么强调基础科学的概念结构，要么不强调，并且在练习期间通过一个、两个或三个情境（具体化为器官系统）来学习。在即时测试和延迟测试中，评估这些概念迁移到熟悉器官系统（近迁移）和不熟悉器官系统（远迁移）以解释病理情况的能力。实验2研究了接触概念类比和多种情境是否改变了学习者对新问题的分类方式。
实验1表明，增加情境变化显著提高了远迁移表现，但练习期间两个情境和三个情境之间没有差异。同样，增加概念类比导致远迁移表现更高。两种干预措施对整体表现有独立但累加的影响。实验2表明，即使与先前示例存在表面相似性，此类类比和情境变化也会使学习者转向使用结构特征对新问题进行分类。
基于概念结构特征理解问题是成功迁移的必要条件。基础科学的迁移可以通过共同强调概念结构的多种策略来优化。这意味着教学必须专注于守恒的基础科学知识，淡化表面特征。
