Mardian Aram S, Villarroel Lisa, Kemper Lori, Quist Heidi E, Hanson Eric R
Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States.
Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.
Front Med (Lausanne). 2023 Jun 22;10:1197373. doi: 10.3389/fmed.2023.1197373. eCollection 2023.
The United States is undergoing a transformation in the way pain is viewed and treated. This transformation affects pain education, as some degree of disconnect will be expected between what is taught in classroom settings and what learners observe in clinical settings. We term this disconnect "didactic dissonance" and propose a novel process to harness it as a learning tool to further pain education. Based on principles of transformative learning theory, we describe a structured, three-step process beginning with (1) priming learners to recognize didactic dissonance and identify specific examples from their education, followed by (2) encouraging learners to search the primary literature to resolve observed dissonance and reflect on the system factors that created and perpetuated the disconnect, and then (3) providing an opportunity for learner reflection and planning for how they will address similar situations in future practice and teaching environments. Fostering an environment conducive to learning-through modeling the intellectual virtues of curiosity, humility, and creativity-is a critical task for educators when implementing this process. Recognizing challenges faced by educators in both classroom and clinical settings, it may be a more feasible first step to integrate the concept of didactic dissonance into existing curricular elements. For programs able to implement the full three-step process, a discussion guide along with an example of a facilitated discussion have been provided. While proposed in the context of pain education, this transformational approach can be utilized across all topics in medical education to foster autonomous lifelong learning.
美国在疼痛的认知和治疗方式上正在经历一场变革。这种变革影响着疼痛教育，因为在课堂教学内容与学习者在临床环境中的观察之间预计会存在一定程度的脱节。我们将这种脱节称为“教学不和谐”，并提出一种新颖的方法，将其作为一种学习工具来促进疼痛教育。基于变革性学习理论的原则，我们描述了一个结构化的三步过程，首先是（1）引导学习者认识到教学不和谐，并从他们的教育经历中找出具体例子，接着是（2）鼓励学习者查阅原始文献以解决观察到的不和谐，并思考造成和延续这种脱节的系统因素，然后是（3）为学习者提供反思的机会，并规划他们在未来实践和教学环境中如何应对类似情况。在实施这个过程时，营造一个有利于通过培养好奇心、谦逊和创造力等智力美德来学习的环境，对教育工作者来说是一项关键任务。认识到教育工作者在课堂和临床环境中面临的挑战，将教学不和谐的概念融入现有课程元素可能是更可行的第一步。对于能够实施完整三步过程的项目，我们提供了一份讨论指南以及一个引导式讨论的示例。虽然这是在疼痛教育的背景下提出的，但这种变革性方法可用于医学教育的所有主题，以促进自主的终身学习。
