Brighton, United Kingdom
9:00 - 10:30 hrs Session B: Medical Education
Introduction
Normally, medical students have to participate in teaching rounds for long periods of their study, watching expert physicians, asking them questions and practising diagnosis skills. This kind of apprenticeship is an essential part of medical education, but it is time-consuming and lacking in structure. It cannot guarantee that students are exposed to a full range of medical problems, nor are capable of finding appropriate solutions. Computer-based tutoring can supplement medical rounds by teaching a systematic approach to diagnosis, and by presenting unusual or challenging cases. This paper discusses how Gardner’s theory of multiple intelligences, combined with a cognitive apprenticeship approach to teaching, can be applied to the design of a networked tutoring system for teaching medical students the fundamentals of hospital rounds.
This paper outlines a programme of research to investigate the following issues:
* How important are multiple representations of knowledge for medical education?
* How do multiple representations help students to process information according to their own intelligences?
* How can cognitive apprenticeship methods [1] and the theory of multiple intelligences [2] be applied to medical education by engaging students in collaborative learning and peer critique, supporting the cognitive process, reducing cognitive load, engaging students in ‘out of reach’ cognitive activities, and supporting hypothesis testing?
* Can computer-based teaching approaches help students to start apprenticeship earlier?
* How can peer critique encourage students to construct their own knowledge and how can it promote transfer of learning?
* How can these methods allow students to practice, develop their intellectual skill and get the feel of their career? Can it deepen students’ understanding of the domain when they get to practice it? Can it empower students to continue working independently and collaboratively?
* Can network-based systems which implement multiple intelligences theory and cognitive apprenticeship offer the possibility of making the learning situation more flexible for the learners?
Approach
Computer-based instruction can be a powerful aid to learning, but it should be based upon an effective theory and tied to instructional material which supports a constructivist model of learning [3]. I shall briefly describe the potential of intelligent tutoring approaches which combine multiple intelligences theory and cognitive apprenticeship methods to overcome some limitations of clinical teaching. The theory of multiple intelligences proposed by Gardner [2] claims that human beings possess at least seven types of mental functioning or intelligence. He categorised these intelligences as linguistic, logical-mathematical, spatial, musical, bodily-kinesthetic, interpersonal and intrapersonal. But the education system tends to encourage linguistic and mathematical/logical intelligence while neglecting the other forms.
The cognitive apprenticeship method of learning was proposed by Collins, Brown and Newman in 1989. It is based on a learning by doing approach. Central to this approach is the assumption that students can learn cognitive tasks in a similar way to crafts learned from watching an expert in their field, by asking questions and gradually practising the task [1]. Cognitive apprenticeship provides authentic context for learning and encourages deep understanding of the knowledge by engaging students in practice through activity and social interaction.
System Design
The proposed networked intelligent tutoring system will teach medical students hospital rounds or rotation. The system will be based on a learning by doing approach. It will adapt to learners with diverse learning styles and will act as a cognitive tool that enhances learning in medicine. Multiple intelligences theory will be used as a general framework and as a checklist and a cognitive apprenticeship approach will be used as a method of instruction. The system will be accessible from the Internet via Netscape Navigator.
To ensure that it will cover different learners’ intelligences, the system will trace students while they are working and keep two student profiles. The first profile records the student’s preferred ways of processing information. It will be used to advise students on the appropriate paths through the learning material to follow according to their intelligences. The second profile captures the student's performance. It will provide students with intelligent help on demand. A student can compare his or her approach and performance with that of an expert, and can ask the expert about what to do next, or can ask the expert to critique his or her answer.
The teaching material will include text, images, sounds and video clips. Students can progress through the program in linear or nonlinear format at their own pace. The system will be designed using the Java programming language, and Hypertext Markup Language (HTML). It will be divided into three main sections: activity, tutorial and library.
Discussion
In brief, the main objective of our research is to create a learner-centred medical learning environment that can be run and distributed over the Internet. The system will act as a cognitive tool that enhances learning in medicine. It will encourage collaborative learning and peer critique. Students will be able to assess and evaluate their own work and the work of others, they will be encouraged to use the criticism, suggestions by the system or other students and to learn from other problem solving strategies.
The system will support cognitive processes such as memory and metacognition. It will support students’ memory through an online medical library, which gives students supplementary information about the topic. It will support metacognition by encouraging reflection and peer critique. The system will reduce the time needed for carrying out diagnostic testing. Learners can get immediate diagnostic test results for the simulated cases, so maintaining their involvement in the task and reducing the need for them to carry over information from one session to another. It will engage medical students in ‘out of reach’ cognitive activities, by providing learners with cases that are unlikely to occur in normal hospital rounds. It will also provide the learners with a safe simulation environment in which to practice diagnosis at their own pace.
The learners will be encouraged to apply all their intelligences through all the learning sessions. In the activity section, the learners will apply their linguistic and interpersonal intelligences in taking patient histories. Secondly, they will use their musical, interpersonal and bodily ability for examining the simulated patient using audio auscultation techniques. They may also use their bodily, interpersonal and visual ability for examining the patient using inspection. Thirdly, they will use their spatial, logical and interpersonal intelligence for analysis and interpretation of the laboratory and radiological data that they request. Fourthly, they will use their logical and intrapersonal abilities while they are examining and diagnosing the patient. Finally, they may use their logical, interpersonal, and linguistic intelligences when they are assigning and explaining the treatment process for their patient. Nevertheless, if students prefer to work by implementing their own preferred intelligences, the system will advise them on following the appropriate path. But, it will also encourage them to apply their other skills that are not so well developed and that are needed for the medical domain. In summary, the learners will have the choice either to choose multiple representations of knowledge while they are working or to follow their own preferred method of processing information.
References
[1] A. Collins, J. S. Brown and S. E. Newman. Cognitive Apprenticeship: Teaching the Craft of Reading, Writing, and Mathematics. In L. B. Resnick, Knowing and learning: Essays in Honour of Robert Glaser, pages 453-494, Lawrence Erlbaum, Hillsdale, NJ, 1989.
[2] H. Gardner. Frames of Minds: The Theory of Multiple Intelligences. Basic Books, New York, 1983.
[3] D. Laurillard. Rethinking University Teaching: A Framework for the Effective Use of Educational Technology. Routledge, London, 1993.
[-] A. Towle. Critical Thinking: the Future of Undergraduate Medical Education. Report by King’s Centre in collaboration with St. Bartholomew’s Hospital Medical College. Kings Fund Centre Publication, London, 1991.