School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.
BMC Med Educ. 2017 Dec 1;17(1):238. doi: 10.1186/s12909-017-1076-z.
Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners.
Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples.
Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners' prior ability and learning condition on conceptual knowledge but not on near and far transfer performance.
Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.
健康专业学习者可以通过研究呈现临床问题完整解决方案的工作示例来培养临床推理能力。通过将这些工作示例与基于概念图的其他学习活动相结合，可以提高这些工作示例的学习效果。本研究调查了活动的组合方式，即工作示例研究与概念图完成的结合，还是工作示例研究与概念图研究的结合，更能促进物理治疗学生干预知识的有意义学习。此外，本研究比较了新手和高级学习者对这些学习活动组合的学习效果。
61 名二年级物理治疗专业学生参加了这项研究，研究包括前测阶段、130 分钟的指导学习阶段和四周的自学阶段。在指导和自学学习期间，参与者必须研究三个书面工作示例，这些示例呈现了选择电疗电流治疗运动功能障碍患者的临床推理过程。在每个示例之后，参与者根据他们被随机分配到的学习条件，进行概念图完成或概念图研究。学生在指导学习阶段结束时进行即时后测，在自学阶段结束时进行延迟后测。后测评估了对所学知识领域（概念知识）的原理的理解能力和解决与之前在示例中学习的问题具有相似（即近迁移）或不同（即远迁移）解决推理的新问题的能力。
从事概念图完成的学习者在近迁移（p=0.010）和远迁移（p<0.001）表现上优于从事概念图研究的学习者。学习者先前能力和学习条件对概念知识有显著的交互效应，但对近迁移和远迁移表现没有影响。
对于新手和高级学习者来说，工作示例研究与概念图完成的结合比工作示例研究与概念图研究的结合导致更大的迁移表现。概念图完成可能使学习者更好地了解他们已经学到和尚未学到的内容，从而使他们在随后的示例研究中能够专注于这些方面。
