Albert Scherpbier

Experience-based learning : a model linking the processes and outcomes of medical students' workplace learning

Objective  To develop a model linking the processes and outcomes of workplace learning.

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review #

Review date: Review period January 1992–December 2001. Final analysis July 2004–January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: • Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. • Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than ‘authentic’ experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Patient-oriented learning: a review of the role of the patient in the education of medical students

To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research.

How residents learn: qualitative evidence for the pivotal role of clinical activities

Objectives  Medical councils worldwide have outlined new standards for postgraduate medical education. This means that residency programmes will have to integrate modern educational views into the clinical workplace. Postgraduate medical education is often characterised as a process of learning from experience. However, empirical evidence regarding the learning processes of residents in the clinical workplace is lacking. This qualitative study sought insight into the intricate process of how residents learn in the clinical workplace.

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

Introduction  Problem‐based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non‐integrative curriculum, these disciplines are generally taught in separate courses. Problem‐based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non‐PBL students in perceived and actual levels of knowledge of anatomy.

Students' opinions about their preparation for clinical practice.

Introduction  There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre‐clinical to clinical training causes problems.

Can medical schools rely on clerkships to train students in basic clinical skills

 Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final‐year medical students in 1996 and 1997.

The need for evidence in education

In this article a plea is made to use evidence in education. A remarkable difference in attitude is noted between university staff in their role as scientists in their discipline and in their role as teachers. Whereas evidence is the key to guide scientists in the development of their discipline, evidence on teaching and learning hardly affects their role as teachers. Teaching is, rather, dominated by intuition and tradition. However, particularly in education, intuitions and traditions are not always correct when they are submitted to empirical verification. It even often turns out that our intuitions are not justified or that assumed relations are far more complex. To illustrate the fallacy of our (implicit) intuitions and beliefs, a few of these assumptions are held against the available evidence. Two assumptions related to the learning of students and two assumptions related to the assessment of student achievement are discussed. The illustrations make clear that we do need to use evidence in educatio...In this article a plea is made to use evidence in education. A remarkable difference in attitude is noted between university staff in their role as scientists in their discipline and in their role as teachers. Whereas evidence is the key to guide scientists in the development of their discipline, evidence on teaching and learning hardly affects their role as teachers. Teaching is, rather, dominated by intuition and tradition. However, particularly in education, intuitions and traditions are not always correct when they are submitted to empirical verification. It even often turns out that our intuitions are not justified or that assumed relations are far more complex. To illustrate the fallacy of our (implicit) intuitions and beliefs, a few of these assumptions are held against the available evidence. Two assumptions related to the learning of students and two assumptions related to the assessment of student achievement are discussed. The illustrations make clear that we do need to use evidence in education, just as we do in any other professional area. Being a professional teacher requires more than being an expert in a content area; it also requires familiarity, use, and perhaps production of educational evidence and theory.

‘The research compass’: An introduction to research in medical education: AMEE Guide No. 56

This AMEE Guide offers an introduction to research in medical education. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of transforming ideas and problems into researchable questions, choosing a research approach that is appropriate to the purpose of the study and considering the individual researchers preferences and the contextual possibilities and constraints. The first section of the Guide addresses the rationale for research in medical education and some of the challenges posed by the complexity of the field. Next is a section on how to move from an idea or problem to a research question by placing a concrete idea or problem within a conceptual, theoretical framework. The following sections are structured around an overview model of approaches to medical education research, ‘The research compass’. Core to the model is the conceptual, theoretical framework that is the key to any direction. The compass depicts four main categories of research approaches that can be applied when studying medical education phenomena, ‘Explorative studies’; ‘Experimental studies’; ‘Observational studies’; and ‘Translational studies’. Future AMEE Guides in the research series will address these approaches in more detail.

An evaluation study of the didactic quality of clerkships

Previous qualitative research at the University of Antwerp revealed dissatisfaction amongst medical students about clinical clerkships.