의과대학에서 자기주도학습 촉진하기: 교육과정 혁신만으로는 부족할 때(IJSDL, 2011)

의과대학에서 자기주도학습 촉진하기: 교육과정 혁신만으로는 부족할 때(IJSDL, 2011)

FOSTERING SELF-DIRECTED LEARNING IN MEDICAL SCHOOL: WHEN CURRICULAR INNOVATION IS NOT ENOUGH

Janet F. Piskurich

1984년 the Physicians for the Twenty-first Century: Report of the Project Panel on General Professional Education of the Physician and College Preparation for Medicine (Association of American Medical Colleges [AAMC]) 에서도 강조함. 

Advances in scientific information and technology are proliferating at an accelerating pace, requiring that physicians continually acquire new knowledge and skills. In 1984, the Physicians for the Twenty-first Century: Report of the Project Panel on General Professional Education of the Physician and College Preparation for Medicine (Association of American Medical Colleges [AAMC]) emphasized that a medical education should prepare students to learn throughout their professional lives.

1990년 다시 기념비적 보고서가 나옴 (ACME-TRI report)

Again in the 1990’s, a seminal report on assessing medical education change stated, “…Faculty members’ first goal should be to foster their students’ lifelong learning by helping them to develop their learning skills” (AAMC, 1993, p. S33).

LCME 기준에도 평생학습 기술이 포함됨

Standards for medical school accreditation now specify that medical education programs must include opportunities for independent study to foster lifelong learning skills (Liaison Committee on Medical Education [LCME], 2010).

PBL이 도입되었고, Mercer University School of Medicine에서는 25년넘게 PBL에 교육과정의 유일한 기반

One nontraditional pedagogy, problem-based learning, emerged early as a method for development of self-direction and lifelong learning skills in medical students (Neville, 2009). While many medical schools use blended approaches incorporating various aspects of this instructional pedagogy, problem-based learning has been the sole basis of the curriculum at Mercer University School of Medicine for over twenty-five years (Donner & Brickley, 1993).

또 다른 교육과정의 혁신은 임상표현중심 교육과정. 이는 기초의학지식이 특정한 임상사례에만 엮이는 단점을 개선하기 위한 것으로, 진단 스키마가 기초의학과 임상지식의 gap-free integration의 scaffold가 된다. 이러한 스키마가 전문가들이 사용하는 귀납적 진단 추론과정을 더 촉진시켜주며, 전문가와 같은 형태에 더 노출된다.

Another curricular innovation that is being introduced into medical schools to improve diagnostic reasoning skills of medical students as well as their retention and transfer of knowledge is clinical-presentation-based curricula, an attempt to avoid the drawback of having basic science knowledge tied to specific clinical cases (Mandin, Jones, Woloschuk, & Harasym, 1997). In this approach, diagnostic schemes that serve as scaffolds for gap-free integration of basic science and clinical knowledge are provided. These schemes are used to promote more inductive diagnostic reasoning processes as used by experts, and exposure to experts is maximized.

학습자들의 저항은 잘 알려져있다.

Initial resistance of some learners to self-directed learning is well-recognized. The transition can represent an intimidating change in educational approach for individuals without previous self-directed learning experience (Long, 1994). It has been shown that medical students, who have normally excelled in a teacher-centered college environment, value the familiar teacher-directed approach rather than self- directed, independent learning (Ho & Tani, 2007). Resistance by medical students as the responsibility for their learning is shifted from the teacher to the student has also been noted in publications aimed at preparing medical students for problem-based learning (Woods, 1994). In both problem-based and clinical presentation-based curricula, faculty are encouraged to serve as learning facilitators and provide students with opportunities for self-directed learning; however, resistance of learners to accept responsibility for their learning occurs in both programs, especially early in the first year. Since excellent evaluations by their students are essential components of the medical educator portfolios required of faculty for tenure and/or promotion (Fresco & Nasser, 2001; Simpson et al., 2007), faculty are likely to perceive learner resistance as a formidable barrier to teaching-learning transactions that foster self-directed learning.

Methods

Problem-based Learning Curriculum

인터벤션 방식 Intervention.

Essential elements of the problem-based learning curriculum are described above. During the four years spanned by this study, the average class size was 50 medical students. The one-minute paper is an in-class writing activity that takes a minute or less to complete where students respond to a question posed by the instructor (Cross & Angelo, 1988). It enables students to reflect on the instruction and provides instructors with useful anonymous student feedback. The intervention in the problem-based learning curriculum consisted of two one-minute papers, performed at the first session, after group members introduced themselves but before they started the first case. 

• The first question posed was: “Name one thing a good group member does?” Pieces of paper were handed out on which students were asked to write their response. All papers were collected into a bag. The bag was then passed around and students were asked to draw out a paper and read it aloud while the facilitator made a list of the responses. 
• This process was repeated for the second one- minute paper, for which the question posed was: “Name one thing a good faculty learning facilitator does?” 

Reflection by students at this first session was private while each composed their response. Facilitators were encouraged to set aside time during the last formal group session of each week to discuss students’ perceptions of the learning process within the group. To initiate discussion, the facilitator provided the list of responses gathered during the first session. Group members were encouraged to collectively reflect and discuss how the group and learning process was working.

설문 도구 Survey instrument.

Students’ scores and comments from the level-one evaluation survey (Kirkpatrick & Kirkpatrick, 2006) were examined for the six-week “Host Defense” course that occurs early in the curriculum.

Clinical Presentation-based Curriculum

인터벤션 방식 Intervention.

The intervention consisted of a student survey using an audience response system. 

• The survey question, which described team-based learning in layman’s terms for the students, was: “Our next session (based on the self- taught learning module) will be interactive and composed of clinical vignettes with audience response questions that you can use to formatively assess your knowledge. How would you prefer to answer the questions during this session?” 
• The possible responses were: “By consensus of your assigned small group” (consistent with team- based learning) or “Individually” (inconsistent with team-based learning). 

Students’ responses to the survey were collected anonymously, and the collective results were shared with the class. For the year when there was no intervention, the class was not surveyed and students were not given any chance to provide input.

Assessment.

Results

Problem-Based Learning Curriculum

Clinical Presentation-Based Curriculum

Discussion

Since students selected for admission may have been successful in situations dominated by didactic instruction, they may be highly resistant to self-directed learning (Long, 1994; Albers, 2009). Especially during their first year, students may reward faculty who use a directive lecture approach with higher scores on teaching evaluations.

두 가지 인터벤션은 그 교육과정 자체만큼이나 다르지만 둘 다 결과가 좋았다.

The two types of interventions seem almost as different as the curricula themselves, yet both yielded very favorable results.

Simpson, D., Fincher, R.-M. E., Hafler, J. P., Irby, D. M., Rich, B. F., Rosenfeld, G. C. & Viggiano, T. R. (2007). Advancing educators and education by defining the components and evidence associated with educational scholarship. Medical Education, 41, 1002-1009.

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FOSTERING SELF-DIRECTED LEARNING IN MEDICAL SCHOOL: WHEN CURRICULAR INNOVATION IS NOT ENOUGH

Janet F. Piskurich

Medical students are poised to enter a constantly changing field. Although medical school education standards specify inclusion of independent study to foster lifelong learning skills, first-year medical students may pressure faculty to provide necessary knowledge in strict lecture format, especially early in their programs. This paper reports on two different interventions that were used to help support students’ autonomy and their acceptance of self-directed learning during this transitional period in two very different medical school curricula. Medical students’ perceptions of sessions that fostered independent study were improved by interventions that allowed students to provide input into the facilitation or implementation of these sessions.