Fernandez Nicolas, Foucault Amélie, Dubé Serge, Robert Diane, Lafond Chantal, Vincent Anne-Marie, Kassis Jeannine, Kazitani Driss, Charlin Bernard
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal.
University of Toronto, ON.
Can Med Educ J. 2016 Oct 18;7(2):e104-e113. eCollection 2016 Oct.
A current challenge in medical education is the steep exposure to the complexity and uncertainty of clinical practice in early clerkship. The gap between pre-clinical courses and the reality of clinical decision-making can be overwhelming for undergraduate students. The Learning-by-Concordance (LbC) approach aims to bridge this gap by embedding complexity and uncertainty by relying on real-life situations and exposure to expert reasoning processes to support learning. LbC provides three forms of support: 1) expert responses that students compare with their own, 2) expert explanations and 3) recognized scholars' key-messages.
Three different LbC inspired learning tools were used by 900 undergraduate medical students in three courses: Concordance-of-Reasoning in a 1-year hematology course; Concordance-of-Perception in a 2nd-year pulmonary physio-pathology course, and; Concordance-of-Professional-Judgment with 3rd-year clerkship students. Thematic analysis was conducted on freely volunteered qualitative comments provided by 404 students.
Absence of a right answer was challenging for 1 year concordance-of-reasoning group; the 2 year visual concordance group found radiology images initially difficult and unnerving and the 3 year concordance-of-judgment group recognized the importance of divergent expert opinion.
Expert panel answers and explanations constitute an example of "cognitive apprenticeship" that could contribute to the development of appropriate professional reasoning processes.
医学教育当前面临的一项挑战是，在临床实习早期，学生要陡然面对临床实践的复杂性和不确定性。对于本科生而言，基础课程与临床决策现实之间的差距可能难以承受。协同学习法（LbC）旨在通过引入复杂性和不确定性来弥合这一差距，具体方式是依托现实生活情境并让学生接触专家的推理过程以辅助学习。LbC提供三种支持形式：1）学生可将自身答案与之比较的专家回复；2）专家解释；3）知名学者的关键信息。
900名本科医学生在三门课程中使用了三种受LbC启发的不同学习工具：在为期一年的血液学课程中使用推理协同法；在二年级肺生理病理学课程中使用感知协同法；在三年级临床实习学生中使用专业判断协同法。对404名学生自愿提供的定性评论进行了主题分析。
对于一年级推理协同组而言，缺乏正确答案颇具挑战性；二年级视觉协同组一开始觉得放射影像很难且令人不安；三年级判断协同组认识到不同专家意见的重要性。
专家小组的答案和解释构成了“认知学徒制”的一个范例，有助于培养恰当的专业推理过程。
