Reasoning and Instruction in Medical Curricula
Abstract
We describe two experiments that examine the knowledge and explanatory processes of students in two medical schools with different modes of instruction. One school had a conventional curriculum with basic science courses taught 1 '/2 years before the clinical training; the other had a problem-based learning curriculum with basic science taught in the context of clinical problems and general problem-solving strategies involving knowledge elaboration and hypothetico-deductive reasoning. Both before and after being exposed to relevant basic science information, students were asked to provide diagnostic explanations of a clinical case. In this study, students in the problem-based learning curriculum reasoned in a manner consistent with the way they were taught, using a backward directed pattern of reasoning and extensive elaborations based on detailed biomedical information. However; these students had a greater tendency to commit errors of scientific fact, to generate less coherent explanations, and to use flawed patterns of explanation, such as circular reasoning. These results are viewed as reflecting the operation of two factors: context and method of instruction. The interaction between these factors is expressed in terms of the hypothesis that basic science and clinical knowledge constitute two different worlds.
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Although PBL students generated more elaborate explanations, they had less coherent explanations and more errors.
“Although PBL students generated more elaborate explanations, they had less coherent explanations and more errors.”
From Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching (2006) · cites this paper as Patel, Groen, and Norman (1993)
Teaching basic science within a clinical context may have the disadvantage that once basic science knowledge is contextualized, it is difficult to separate it from the particular clinical problems into which it has been integrated.
“In the medical domain, Patel, Groen, and Norman (1993) showed that teaching basic science within a clinical context may have the disadvantage that once basic science knowledge is contextualized, it is difficult to separate it from the particular clinical problems into which it has been integrated.”
From Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching (2006) · cites this paper as Patel, Groen, and Norman (1993)
Students trained in a PBL curriculum failed to separate basic science knowledge from the specific clinical knowledge associated with particular patients.
“They showed that students trained in a PBL curriculum failed to separate basic science knowledge from the specific clinical knowledge associated with particular patients.”
From Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching (2006) · cites this paper as Patel, Groen, and Norman (1993)
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- Authors
- Patel, V. L., Groen, G. J., & Norman, G. R.
- Affiliations
- Arizona State University (US)
- McGill University (CA)
- McMaster University (CA)
- ORCID
- Patel, Vimla L.
- Venue
- Cognition and Instruction
- Publisher
- Informa UK Limited
- Published
- 1993-06
- Volume
- 10
- Issue
- 4
- Pages
- 335-378
- ISSN
- 0737-0008 (ISSN-L)
- 1532-690X
- OpenAlex
- W2003209623
- Cited by
- 97
- References
- 41
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 4 · 2013: 6 · 2012: 6
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cognition and Instruction (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Education › Problem and Project Based Learning
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- problem-based learning, medical education, hypothetico-deductive reasoning, diagnostic reasoning, circular reasoning, medical students
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