Slotnick H B
Department of Neuroscience, University of North Dakota School of Medicine, Grand Forks 58203, USA.
Acad Med. 1996 Jan;71(1):28-34. doi: 10.1097/00001888-199601000-00014.
The author proposes a theory of how physicians learn that uses clinical problem solving as its central feature. His theory, which integrates insights from Maslow, Schön, Norman, and others, claims that physicians-in-training and practicing physicians learn largely by deriving insights from clinical experience. These insights allow the learner to solve future problems and thereby address the learner's basic human needs for security, affiliation, and self-esteem. Ensuring that students gain such insights means that the proper roles of the teacher are (1) to select problems for students to solve and offer guidance on how to solve them, and (2) to serve as a role model of how to reflect on the problem, its solution, and the solution's effectiveness. Three principles guide instruction within its framework for learning: (1) learners, whether physicians-in-training or practicing physicians, seek to solve problems they recognize they have; (2) learners want to be involved in their own learning; and (3) instruction must both be time-efficient and also demonstrate the range of ways in which students can apply what they learn. The author concludes by applying the theory to an aspect of undergraduate education and to the general process of continuing medical education.
作者提出了一种关于医生学习方式的理论，该理论以临床问题解决为核心特征。他的理论融合了马斯洛、舍恩、诺曼等人的见解，声称实习医生和执业医生主要通过从临床经验中获取见解来学习。这些见解使学习者能够解决未来的问题，从而满足学习者对安全、归属感和自尊的基本人类需求。确保学生获得这些见解意味着教师的恰当角色是：（1）为学生选择要解决的问题，并就如何解决这些问题提供指导；（2）作为如何反思问题、其解决方案以及解决方案有效性的榜样。有三条原则指导其学习框架内的教学：（1）学习者，无论是实习医生还是执业医生，都试图解决他们意识到自己存在的问题；（2）学习者希望参与到自己的学习中；（3）教学必须既高效，又要展示学生应用所学知识的各种方式。作者通过将该理论应用于本科教育的一个方面以及继续医学教育的一般过程来得出结论。
