A.H. Aagesen is a medical student, Medical Faculty of the University of Copenhagen, and research assistant, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
R.D. Jensen is assistant professor, Department of Clinical Medicine, University of Aarhus, and medical educational scientist, MidtSim Simulation Center, Aarhus, Denmark.
Acad Med. 2020 Nov;95(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 59th Annual Research in Medical Education Presentations):S37-S43. doi: 10.1097/ACM.0000000000003646.
Teaching technical skills through the use of guided discovery learning (GDL) is an ongoing topic of research. In this approach, learners practice and struggle before receiving formal instruction. This has shown promise in other domains of learning, yet in the realm of procedural skills, clarity is still needed. This study seeks to address these gaps by investigating efficacy and mechanisms relating to application for a GDL approach in teaching basic surgical skills.
In 2018, young surgical trainees (N = 16) undertook a 6-week open surgical course applying the principles of GDL, each lesson beginning with a discovery phase before subsequent instruction and practice. A concurrent triangulation mixed-methods approach was used with direct observation and collection of semistructured interviews using a framework designed from productive failure literature. At the end of the course, all participants took a conceptual knowledge test and a performance-based skills test. Performance on the skills test was rated using global ratings and checklists.
The GDL cohort outperformed the historical cohort on the written exam (F [1,65] = 4.96, P = .029, d = .62), as well as on the summative suturing test (F [1,65] = 6.23, P = .015, d = .68). Furthermore, 3 main themes that highlight the mechanisms and mediators of efficient GDL were: (1) building conceptual knowledge, (2) motivating self-regulated learning, and (3) the type of skill and psychological safety.
GDL can be an efficient approach to teaching procedural skills. Implications for future research and curricular design are discussed.
通过使用引导发现式学习（GDL）来教授技术技能是一个持续的研究主题。在这种方法中，学习者在接受正式指导之前进行练习和挣扎。这在其他学习领域已经显示出了希望，但在程序技能领域，仍然需要明确。本研究旨在通过调查与 GDL 方法在教授基本手术技能中的应用相关的疗效和机制来解决这些差距。
2018 年，年轻的外科受训者（N=16）参加了为期 6 周的开放式外科课程，应用 GDL 的原则，每节课都从发现阶段开始，然后进行后续的指导和练习。采用直接观察和收集半结构化访谈的并行三角交叉混合方法，使用源自生产性失败文献的框架设计。在课程结束时，所有参与者都参加了概念知识测试和基于绩效的技能测试。技能测试的表现使用总体评分和检查表进行评估。
GDL 组在书面考试中的表现优于历史组（F[1,65]=4.96，P=0.029，d=0.62），在总结性缝合测试中的表现也优于历史组（F[1,65]=6.23，P=0.015，d=0.68）。此外，有 3 个主要主题突出了 GDL 的机制和中介因素：（1）建立概念知识，（2）激发自我调节学习，（3）技能类型和心理安全。
GDL 可以成为教授程序技能的有效方法。讨论了对未来研究和课程设计的影响。
