Learner centred approaches in medical education

Last post, I reviewed an article that described the use of new technology in the anatomy laboratory, and the mixed results that were obtained.  This article referenced the Adult Learning theories of Malcolm Knowles.  I looked into these, and found that he posited his theories in a seminal book, "The Adult Learner: a Neglected Species."

I have put this on my "must-read" list.  However, searching for this source led me to a nice review of learner-centered educational techniques that are used in medical education, published in the British Medical Journal in 1999 by Spencer and Jordan.

This article speaks directly to the challenge that I find myself in: the traditional method of course presentation has presented large quantities of information in an abbreviated, rapid manner, leaving students in a "no-win" situation where they must learn shallowly in order to survive.  In the past, I have personally resisted attempts by my administration and colleagues toward moving away from such techniques, because my experiences as a student in student-centered environments had been fraught with such confusion and uncertainty.  However, realizing that my personal experiences are not authoritative, I attempt to bypass my biases and give student-centered learning another look.

The authors mention--relatively early on--that learner-centered approaches toward education are often poorly implemented and may even take on the form of a mere "veneer," which does nothing but give a new-looking facade to the same old content.  This gives me a slight flicker of hope that there is more to Learner-centered education than the half-hearted course design I had seen in the past.

Self-directed learning appears to be the key, which leads to deeper learning experiences.  The first example that is presented is problem-based learning, which is the technique I have had so little success with in the past.  As they present it, it seems a fine idea: give the students problems to solve, and guide the process of solving so that students will better understand the core material that it is based upon.

It seems a nice system.  However, the list of negatives that have been identified (eg. inefficiency, difficulty implementing in large courses, and poor learning of the basic sciences, et al.) fill me with concern.  The authors conclude the section by mentioning that there is no evidence yet to support the assertion that problem-based education makes better clinicians.

Realizing these limitations, the mixed approach (Guided Discovery Learning) is presented.  Here, the "best of both worlds" are used: a traditional knowledge transfer system is used to assure all learners achieve a common base of information.  Study aids are designed using Learner Centered approaches to help the students use what they have learned immediately, cementing the newly-acquired knowledge and helping learners to see its clinical relevance.

Here is a method that seems to strive for depth of understanding, while realizing the realities of standardized testing and basic science core requirements that must be met.  I recognize that, without consciously doing so, I have been using a mixed approach in my own classes.  However, they have been mostly lecture courses, and so I could perhaps add more study aids to them, particularly when trying to express a clinical correlate.

APA Citation:
Spencer J.A., & Jordan R.K. (1999). Learner centred approaches in medical education. BMJ, 318(7193), 1280-1283.