Journal Title
Title of Journal: Perspect Med Educ
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Abbravation: Perspectives on Medical Education
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Publisher
Bohn Stafleu van Loghum
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Authors: C P M van der Vleuten E W Driessen
Publish Date: 2014/06/13
Volume: 3, Issue: 3, Pages: 222-232
Abstract
Educational practice and educational research are not aligned with each other Current educational practice heavily relies on information transmission or content delivery to learners Yet evidence shows that delivery is only a minor part of learning To illustrate the directions we might take to find better educational strategies six areas of educational evidence are briefly reviewed The flipped classroom idea is proposed to shift our expenditure and focus in education All information delivery could be web distributed thus creating more time for other more expensive educational strategies to support the learner In research our focus should shift from comparing one curriculum to the other to research that explains why things work in education and under which conditions This may generate ideas for creative designers to develop new educational strategies These best practices should be shared and further researched At the same time attention should be paid to implementation and the realization that teachers learn in a way very similar to the people they teach If we take the evidence seriously our educational practice will look quite different to the way it does nowEducation in the twentyfirst century is not that different from education in the eighteenth century Most education relies heavily on teachers transmitting information to learners In sharp contrast the practice of medicine in the twenty first century is quite different from medicine in the eighteenth century Medicine has evolved substantially through research and the application of research findings into practice Naturally education has modernized as well Studentcentred education programmes such as for example problembased learning have also evolved considerably Although these newer approaches receive quite some attention in the scientific media and our education conferences we would argue that most schools of medicine or other health sciences programmes in university still rely heavily on the lecture as the most dominant form of instruction In our common conception of learning we assume that information delivery particularly when stemming from an expert leads to good learning With all the evidence on education as we have it this view on education is rather naive Our central argument is that learning is not so much a matter of information delivery but of information processing Good education provides strategies to facilitate this processing of information Naturally information delivery is part of learning yet only a very limited part A lot of the processing we simply leave to the learner We do not really support that part of the learning processIn our view education would look very different if we were to take the education evidence seriously Is that because we have vast evidence that one approach say problembased learning works tremendously better than other approaches There is some evidence for this but it is not the kind of evidence we should be looking for These are questions that are too big to be able to properly answer scientifically One might also ask about the effectiveness of two health care systems health care systems are also too complex to be compared meaningfully This is not to say that it is not possible to assemble data on such large comparisons Naturally such data have been assembled around problembased learning reasonably showing its effectiveness 1 but there are major methodological problems in these comparisons and it does not answer why problembased learning works 3 We need evidence on the building blocks of the larger educational system preferably also explaining why things work under which conditions 4 Evidence in education is therefore more than insights from empirical evidence stemming from educational research and other related domains It also includes theories that are based on empirical evidence Theories provide explanations why things may work in educationThis paper will take a collection of areas where we have solid evidence on how learning is facilitated Each of these areas could be a complete review paper deserving publication in its own right Here we only sketch the area just to show in which direction education might be moving We will finally discuss a strategy with which these directions could be achieved We deliberately do not discuss evidence on assessment a topic on which we more regularly publish We refer to other publications summarizing that area of the literature 5Cognitive science has been a revolution to psychology 6 with massive implications for education and learning It studies how our memory works and how we store and retrieve information in longterm memory We will only focus on one element specifically relevant to serve as a contrast to information transmission Cognitive psychology tells us that learning is facilitated when the learner processes the information Learning is not so much a matter of consuming information but of active processing of the information by the learner The term elaboration is used to describe this phenomenon 7 8 Elaboration can be done in many various ways Any activity that allows learners to use the information is useful There are infinite strategies to promote elaboration For example elaboration is facilitated by discussing with others by schematizing by summarizing by verbalizing it in one’s own words or by applying the information to another situation or problem Elaboration is hindered when the learner passively consumes the information In purely traditional lecturebased systems most elaboration on learning content will not take place in the lecture theatre but elsewhere In all probability most elaboration will occur when the learner needs to prepare for the exam at the end of the course The learner will elaborate by him or herself We do not offer special support for this for example certain education strategies that would help the learner to elaborate on learning content In conclusion working with information is very important for understanding and learning the information We should devise educational strategies to promote elaboration as much as possibleThere is a wealth of evidence showing that learning in cooperation with others is much more effective than learning alone 9 We also know the conditions under which learning with others is most productive These conditions include equality in participation members carrying individual responsibility tasks that require mutual positive interdependence and finally simultaneous interactions promoting cooperative learning 9 Learning in groups has some disadvantages as well and comes at a ‘cost’ When certain conditions are met the benefits outweigh the costs and cooperative learning is very effective In most traditional educational systems we highly rely on the individual learner By not using cooperative learning in some form we are not making education as effective as it could actually be Moreover in later professional life virtually all work is teambased Working in cooperation with others will therefore not only lead to more effective education it may also represent a desirable learning outcome the ability to work with othersIt almost seems like a platitude but feedback works 10 There is hardly anything that is more powerful to learning than feedback We also understand the conditions under which feedback is most effective 10 11 12 These include among others the credibility of the source the focus of attention task oriented rather than person oriented and the feedback culture in the environment Another very effective strategy is to create a dialogue around feedback a dialogue in which followup on the feedback is promoted and where help and support is being provided 13
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