how can experts and novices learn together?
http://www.100md.com
《英国医生杂志》
1 Division of Medical Education, Warwick Medical School, University of Warwick, Coventry CV4 7AL ed.peile@warwick.ac.uk
Rapid responses to this case have been less numerous but perhaps more erudite and thought provoking than we have come to expect from previous interactive case reports.1 Could it be that the rapidest responders' expertise in evidence based medicine, diabetes, and reproductive medicine deterred others from contributing? We know that experts and novices learn in different ways and that experts are not always the best teachers for novices,2 but what about their interaction when working and learning together?
More advanced learners can inhibit contributions from the less expert in schools, and this effect, postulated in medical education, has been observed in learning about evidence based health care.3 Benner comments that "proficient performers are best taught by use of case studies where their ability to grasp the situation is solicited and taxed."2 Medical case based learning is used at disparate levels of expertise, ranging from small group work to grand rounds. The trick is to ensure that learners at different stages can each work at their own level without disrupting the learning of others.
What does this mean for medical educators? Firstly, a skilled group facilitator may be able to hold the ring and balance the learning to ensure that everyone goes away from a learning encounter with something learnt, but they may learn sequentially rather than simultaneously. Novices may learn from seeing how experts develop their reasoning, and experts exposed to the thought processes of the less experienced may reflect on their unconscious expertise.
Much of modern educational thinking about professional learning is founded on Lave and Wenger's notion that learning is "a process of participation in communities of practice, participation that is at first legitimately peripheral but that increases gradually in engagement and complexity."4
BMJ interactive case reports attempt to stimulate the formation of a transient community of practice on the web pages. Gilly Salmon coined the term "cafélattia learning" to describe online communities, such as those with a common professional interest, learning by being intellectually extended by dialogue and challenge from others.5 She has valuable advice for those facilitating e-learning in this context.
Competing interests: None declared.
References
Piccoli GB, Mezza E, Grassi G, Burdese M, Todros T. A 35 year old woman with diabetic nephropathy who wants a baby: case outcome. BMJ 2004;329: 900.
Benner P. From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley, 1984.
Page S, Meerabeau L. Hierarchies of evidence and hierarchies of education: reflections on a multiprofessional education initiative. Learning Health Soc Care 2004;3: 118-28.
Lave J, Wenger E. Situated learning. Legitimate peripheral participation. Cambridge: University of Cambridge Press, 1991.
Salmon G. e-Learning works: learning from the past, present and future. Presentation at World Didac, Zurich, 2002. www.atimod.com/presentations/download/ZURICHSALMON1.htm (accessed 30 Sep 2004).(Ed Peile, professor of me)
Rapid responses to this case have been less numerous but perhaps more erudite and thought provoking than we have come to expect from previous interactive case reports.1 Could it be that the rapidest responders' expertise in evidence based medicine, diabetes, and reproductive medicine deterred others from contributing? We know that experts and novices learn in different ways and that experts are not always the best teachers for novices,2 but what about their interaction when working and learning together?
More advanced learners can inhibit contributions from the less expert in schools, and this effect, postulated in medical education, has been observed in learning about evidence based health care.3 Benner comments that "proficient performers are best taught by use of case studies where their ability to grasp the situation is solicited and taxed."2 Medical case based learning is used at disparate levels of expertise, ranging from small group work to grand rounds. The trick is to ensure that learners at different stages can each work at their own level without disrupting the learning of others.
What does this mean for medical educators? Firstly, a skilled group facilitator may be able to hold the ring and balance the learning to ensure that everyone goes away from a learning encounter with something learnt, but they may learn sequentially rather than simultaneously. Novices may learn from seeing how experts develop their reasoning, and experts exposed to the thought processes of the less experienced may reflect on their unconscious expertise.
Much of modern educational thinking about professional learning is founded on Lave and Wenger's notion that learning is "a process of participation in communities of practice, participation that is at first legitimately peripheral but that increases gradually in engagement and complexity."4
BMJ interactive case reports attempt to stimulate the formation of a transient community of practice on the web pages. Gilly Salmon coined the term "cafélattia learning" to describe online communities, such as those with a common professional interest, learning by being intellectually extended by dialogue and challenge from others.5 She has valuable advice for those facilitating e-learning in this context.
Competing interests: None declared.
References
Piccoli GB, Mezza E, Grassi G, Burdese M, Todros T. A 35 year old woman with diabetic nephropathy who wants a baby: case outcome. BMJ 2004;329: 900.
Benner P. From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley, 1984.
Page S, Meerabeau L. Hierarchies of evidence and hierarchies of education: reflections on a multiprofessional education initiative. Learning Health Soc Care 2004;3: 118-28.
Lave J, Wenger E. Situated learning. Legitimate peripheral participation. Cambridge: University of Cambridge Press, 1991.
Salmon G. e-Learning works: learning from the past, present and future. Presentation at World Didac, Zurich, 2002. www.atimod.com/presentations/download/ZURICHSALMON1.htm (accessed 30 Sep 2004).(Ed Peile, professor of me)