Relevant independent study after workplace events: Extending the cognitive apprenticeship
Martin V. Pusic, Columbia University, United States
Columbia University . Awarded
This research presents empirical evidence in support of a model of medical student learning in actual clinical workplace settings. For learning from patient encounters, the medical student learns from face-to-face interactions with both patients and expert practitioners. We explore whether it is advantageous for the students to extend their learning from each patient encounter by independently accessing relevant, structured learning resources.
In the first of three studies, we determined the self-reported learning needs of medical students after patient encounters by interviewing 40 medical students and 17 faculty preceptors (126 interviews in total). We found that their learning needs centered on gaining competency, with the Knowledge competency (knowing something) being represented most frequently (56%) followed by Interpersonal Communication Skills (27%) and Patient Care Skills (knowing how to do something) in 18%. Three educators rated the Knowledge competency learning needs as being either "very" or "completely" amenable to independent study in 70% of cases.
In the second study, 92 medical students, after seeing a patient with one of two index conditions, logged into a computer that randomly assigned them to complete either a relevant knowledge competency computer tutorial (coupled condition) or a non-relevant tutorial ( separate condition). They completed pre- and post-test knowledge tests made up of questions about each index condition. We compared the post-test scores for each group, adjusting for pre-test scores and score on the post-test for the non-viewed tutorial topic, using ANCOVA. Z-scores were significantly higher in the coupled condition (1.07 (±SD 0.70) vs 0.52 (1.1); F=5.0; p=0.03). This finding suggests that independent learning from a computer tutorial is advantaged by completion in conjunction with a relevant patient.
In the third study, 43 medical students completed a randomized cross-over study. After encountering a patient with one of the same two index conditions, they logged into a computer that randomly assigned them to either an immediate relevant computer tutorial or to the delayed completion of the tutorial >24 hrs later. The students then did the procedure a second time (crossed design) seeing the other type of patient and the opposite timing of presentation. All students did the same pre- and post-tests on both conditions. Analysis was a within subjects ANCOVA. Post-test scores did not significantly differ whether the tutorial was presented Immediately (z-score 0.43; SD 0.67) or in a Delayed fashion (0.55; SD 0.71). An ANCOVA model that also included order of presentation and pre-test scores did not show an effect for timing (F=0.17, p=NS).
The findings of the three studies are interpreted in the light of existing teaching and learning models in both medical settings and other workplaces. Based on the findings, we present an augmented teaching and learning framework that takes best advantage of the opportunities triggered by learner encounters with patients.
Pusic, M.V. Relevant independent study after workplace events: Extending the cognitive apprenticeship. Ph.D. thesis, Columbia University.
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