의학교육에서의 학습자 중심 접근법 (BMJ, 1999)

의학교육에서의 학습자 중심 접근법 (BMJ, 1999)

Learner centred approaches in medical education

John A Spencer, Reg K Jordan

전통적인 교수자 중심 접근법에서 학생 중심 접근법으로의 변화는 학생들이 자신의 배우는 것에 대한 책임이 강조되며, 가르치는 교수자에서 학습의 촉진자로 선생님의 역할 변화를 요구한다.

The pedagogic shift from the traditional teacher centred approach, in which the emphasis is on teachers and what they teach, to a student centred approach, in which the emphasis is on students and what they learn, requires a fundamental change in the role of the educator from that of a didactic teacher to that of a facilitator of learning.3

SDL의 핵심 요소

Box 1—Key elements of self directed learning 

The learner takes the initiative for: 

• Diagnosing learning needs 

• Formulating goals 

• Identifying resources 

• Implementing appropriate activities 

• Evaluating outcomes

성인학습의 원리

Box 2—Principles of adult learning 

Adults are motivated by learning that: 

• Is perceived as relevant 

• Is based on, and builds on, their previous experiences 

• Is participatory and actively involves them 

• Is focused on problems 

• Is designed so that they can take responsibility for their own learning 

• Can be immediately applied in practice 

• Involves cycles of action and reflection 

• Is based on mutual trust and respect

SDL에서 학생은 다음과 같은 것을 한다.

Self directed learning is when students take the initiative for their own learning: 

• diagnosing needs, 
• formulating goals, 
• identifying resources, 
• implementing appropriate activities, and 
• evaluating outcomes. 

The key features of self directed learning (box 1) concord with the principles of adult learning4 (box 2) and the findings of research in cognitive psychology.5

SDL은 능동적 과정이다. 1970년대에 처음 제시된 학습에 대한 심층적 접근법(deep approach)를 권장한다. 심층 학습은, 표면 학습과 반대되는 말로서, 이해를 위한 적극적 탐색을 말한다. 표면 학습은 학생들이 배운 것을 재생산하는 것에 그친다. 학생들이 학습에 대한 접근법은 - 그것이 표면이든 심층이든 - 학습 성과의 질을 결정하는 중요한 요인이다.

Self directed learning is an active process. It encourages the adoption of the deep approach to learning first described in the mid 1970s. Deep learning, as opposed to surface learning, is an active search for understanding. Surface learning merely encourages students to reproduce what has been learnt.6 Research has identified the student’s approach to learning—surface or deep—as the crucial factor in determining the quality of learning outcomes.7

SDL은 의학교육의 연속체에서 가장 효과적인 접근법으로 제시되고 있으며, 특히 이는 학습이 경험을 기반으로 할 때, 그리고 새로운 지식과 이해가 개개인별로 개인과 전문가로서의 맥락에 통합된다.

Self directed learning is suggested as the most efficacious approach for the continuumof medical educa- tion, particularly when learning is based on experi- ence, and new knowledge and understanding can be integrated into the personal and professional context of the individual.8

PBL에 대한 universal한 정의는 없으며, 이러한 개념적 모호함이 그것의 철학과 실제 운영에 모두 존재한다. 예컨대 Problem-based라는 말은 PBL이라는 교육법과 동시에 교육과정의 철학이 무엇인가에 대한 것을 모두 의미한다. 이것은 평가, 연구, 프로그램간 비교에 상당한 영향을 준다. 그러나 PBL은 일반적으로 학생들이 특정 문제에 대한 이슈를 찾고, 기저의 개념과 원칙을 이해해가는 교육 전략을 의미한다. 초점은 항상 "설명이 필요한 현상"을 중심으로 구성되고 기술된 문제에 있다.

There is no universal definition for problem basedlearning, and a “conceptual fog” prevails regardingboth its philosophy and practice—the term is used, forexample, to describe both an educational method anda curricular philosophy.15 This has important implica-tions for evaluation, research, and comparisons of pro-grammes.16 However, problem based learning isgenerally understood to mean an instructional strategyin which students identify issues raised by specificproblems to help develop understanding about under-lying concepts and principles. The focus is usually awritten problem comprising “phenomena that needexplanation.”17 

Development of problem based learning 

PBL의 적용은 새로운 것이 아니며, 1889년에 "multiple working hypotheses"가 등장했다. 교육이론가인 듀이는 학생들에게 실제 삶에서의 문제를 제시하고, 그 문제를 풀기 위한 정보를 찾도록 도와줘야 한다고 했다. 이후에 다른 연구에서 학생들에게 이미 만들어진 문제에 대한 답을 주는 것은 학습에 "명백히 비효과적"이다라는 것을 보여줬다. 1960년대 후반 McMaster는 최초로 PB 의학 교육과정을 선도했으며, Maastricht가 1974년에 그 뒤를 이었다. 150개의 의과대학이 PB curriculum을 사용중이다.

The application of problem based approaches in edu- cation is not new. In 1889 a method known as “multiple working hypotheses” was advocated.20 Dewey, one of the educational theorists of the early part of this century, recommended that students should be presented with real life problems and then helped todiscover the information required to solve them. Later,other workers showed that giving students ready madesolutions for problems was “manifestly ineffective” forlearning.21 In the late 1960s, McMaster medical schoolin Ontario pioneered the first completely problembased medical curriculum, with Maastricht following in1974 as the first in Europe. Around 150 medicalschools worldwide (some 10% of the total) haveadopted problem based curriculums

Maastricht의 PBL 일곱 단계

Box 3—Maastricht “seven jump” sequence for problembased learning 

1 Clarify and agree working definitions and unclear terms and concepts 

2 Define the problems; agree which phenomena need explanation 

3 Analyse the problem(brainstorm) 

4 Arrange possible explanations and working hypotheses 

5 Generate and prioritise learning objectives 

6 Research the learning objectives 

7 Report back, synthesise explanations, and apply newly acquired information to the problem

PBL은 다음과 같이 정의되며 관련 영역은 다음과 같다.

Problem based learning can be seen as “a systematic attempt to apply findings of cognitive psychology to educational practice.”17 Relevant areas include: 

• activation of prior knowledge (a major determinant of what can be learnt); 
• learning in context (enhancing transfer of knowledge); 
• elaboration of knowledge (enhancing subsequent retrieval); and 
• fostering of competence by an inquisitive style of learning.22 

PBL은 임상추론의 발달과 관련이 깊으며, 소위 (환자의 프로토타입)이라 할 수 있는 illness script를 습득하는 과정이다. 그러나 PBL을 통해서 generic problem solving이 향상된다는 근거는 없다.

Problem based learning fits with what is known about the development of clinical reasoning and the process by which so called “illness scripts”— cognitive structures describing the features of “proto­ typical” patients—are acquired.23 There is no evidence, however, that generic problem solving skills are enhanced through problem based learning.

PBL의 장점

Box 4—Advantages of problembased learning 

• Promotes deep, rather than surface, learning 

• Enhances and retains self directed skills 

• Learning environment is more stimulating 

• Promotes interaction between students and staff 

• Promotes collaboration between disciplines—for example, basic and clinical scientists 

• More enjoyable for students and teachers 

• Promotes retention of knowledge 

• Improves motivation

PBL의 장점은 위와 같으나 다른 교육과정 혁신의 장점과 뚜렷히 구분되지는 않는다. 그러나 Maudsley는 PBL이 유래없는 검증으로부터 살아남았음을 강조하였다. 그러나 단점이 없는 것은 아니며 시작시 드는 비용과 유지에 드는 비용, 스테프들의 시간 투자, 학생과 스테프의 스트레스 증가, 상대적 비효율성, (기초)과학의 축소, 사이즈가 크거나 열정적이지 않을 때 지식 습득의 어려움 등이 있다. Finucane 등은 장점과 단점을 균형있게 고려해야 한다고 했으며, 그러나 아직 PBL교육과정을 거친 학생이 장기적으로 더 낫다는 근거가 부족하다.

Some of these benefits may be indiscernible fromthose related to other concurrent curricular innovations. Maudsley, however, considers problem based learning to have survived unprecedented scrutiny.15 Several dis- advantages have also been identified including the costs for starting up and maintenance,27 excessive demands on staff time,29 increased stress on both students and staff,27 relative inefficiency,25 reduced sciences,26 and acquisition of knowledge of basic implementation difficulties when class sizes are large or where there is a broad lack of enthusiasm for the approach.25 Finucane and colleagues provide a balanced consideration of the advantages and disad- vantages of adopting a curriculum for problem based learning.28 There is as yet no evidence that graduates of problem based programmes make better—or worse— doctors in the long term.

혼합 접근법의 좋은 예시는 guided discovery learning이라 불리는 Newcastle과 Dundee에서 찾아볼 수 있다. 

The better examples of this mixed approach, such as that adopted by Newcastle and Dundee,30 may be described as a form of guided discovery learning. The key features are learning how to learn through the process of discovery and the exploration of knowledge, coupled with the responsibility of the learner to master the content needed for understanding (box 5).

Box 5—Key features of guided discovery learning 

• A context and frame for student learning through the provision of learning outcomes 

• Learners have responsibility for exploration of content necessary for understanding through self directed learning 

• Study guides are used to facilitate and guide self directed learning 

• Understanding is reinforced through application in problemoriented, task based, and work related experiences

여기서 학습가이드는 학생들의 학습을 도와주기 위한 수단이다. 이 학습가이드는 교수들이 자기주도학습을 도와주는 도구이기도 하다. 학생을 가이드하는 동시에 스스로의 학습을 관리하도록 적극적 참여를 하게 하는 도구이다. 

In this context a study guide is an aid designed to assist students with their learning. The study guide is the main tool by which staff support self directed study—guiding the learners while at the same time ensuring active involvement in the management of their own learning.31 

좋은 학습 가이드의 요건

A good study guide 

• indicates what should be learned by specifying learning outcomes, 
• helps students to set their own objectives and plan their learning, 
• identifies appropriate learning resources and advises on their use, and 
• provides opportunities for students to assess their own competence. 

학습가이드의 적절한 활용으로 의사소통을 향상시킬 수 있으며, 과도한 교수-학생 접촉을 줄여줄 수도 있다. 

Properly used, study guides improve communication and can provide guidance like a good tutor but without the need for excessive staff-student contact. Interactive electronic versions of study guides on the world wide web have also been developed, usu- ally in the form of notes.32

교수개발에 대한 함의

This has major implications in terms of staff development, with the recognition that changing a curriculum and keeping it going are unlikely to be effective if teachers are not able to take on new roles. Such development needs to take place at all levels from the institutional to the individual.35 Barriers include the perennial problems of conflict with service provision and the “research first” culture that prevails in most medical schools, and the underresourcing of faculty development.

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BMJ. 1999 May 8;318(7193):1280-3.

Learner centred approaches in medical education.

Spencer JA1, Jordan RK.

Author information

• 1Medical Education, Faculty of Medicine, University of Newcastle, Newcastle upon Tyne NE2 4HH.

PMID:

 

10231266

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC1115656

 

Free PMC Article