I agree with Jim Freeman's comments on this thread, and suggest that a case/problem-based-learning approach achieves the suggested integration of critical appraised information while patterning professional behavior including developing a life-long habit of self-directed learning. Following McMaster's example, UBC's undergraduate medical education program was redesigned some time ago as a PBL experience from the student's very first day of class onward. It spans the aspects of knowledge listed by Dr. Freeman. Also important in context of his concern about the focus ("learning facts to pass tests") is UBC's selection process for medical school applicants and its grading scheme for PBL tutorials (essentially, marking students along defined criteria on 3 attributes: preparation, professionalism, and participation in effective group learning).
My interest in this is applying that pedagogical knowledge to the education of hospital epidemiologists and infection control professionals, among other allied health professionals concerned with quality of care. I learned much from some of the medical school's leadership during their work to redesign UBC's undergraduate medical curriculum, and in that contact was directed to a particularly informative publication by Dolmans et al.
PARADIGM Database Search, 2006/12/06:
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Dolmans DHJM, Snellen-Balendong H, Wolfhagen IHAP, et al.
Seven principles of effective case design for a problem-based
curriculum
MEDICAL TEACHER 1997;19(3):185-9
Review (22 references) explores the nature of what makes a
teaching case effective. Quality of cases appears to be a most
important factor in effective problem-based learning. Seven
principles (illustrated and discussed) are that a PBL case
should: (1) adapt well to activate students' prior knowledge; (2)
contain cues that stimulate students to elaborate; (3) present in
a context relevant to future professional practice; (4) encourage
integration of basic science and clinical practice knowledge; (5)
stimulate student generation of their own learning issues and
literature searches; (6) enhance interest in the subject matter;
and (7) match one or more faculty objectives.
----- Copyright Applied Epidemiology -----
Whether PBL and teaching critical appraisal in this manner will make a difference in future clinical practices remains something of a leap of faith. There are some interesting evaluation studies, but also many unanswered questions. On a personal level, it raises some real challenges when students aren't prepared to be self-directed learners but certainly makes the teaching more interesting and satisfying.
Best wishes,
David.
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David Birnbaum, PhD, MPH
Adjunct Professor
School of Nursing
University of British Columbia
Principal, Applied Epidemiology
British Columbia, Canada
