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Cory Rohlfsen's avatar

Great read! Medical education is informative here. Leans constructivist in teaching praxis because of context hyper-specificity. Canon is rare. Some rules should never be broken, others are broken daily. A bit wicked because Learners often experience the exception before they experience the rule.

Because of the variability in experiential learning (learner schemata built on a diversity of past experiences), orienting to any new situation is 90% of the teaching task. Hard to advance a learner’s schema if current understanding of the situation is not shared. ‘Remember the last patient we took care of who went straight to liver transplant, well here are 3 reasons this patient’s situation is different.’ Highlighting context is less about cognitive load and more about ecological awareness. Situational cues.

Examples / Non examples only make sense after constructing a schema as a team. Is it efficient? Far from it. It’s hard to build on a learners problem representation without them saying it (openly & honestly) out loud. Situativity takes time.

This is why dialogic teaching strategies are privileged over explicit instruction in clinical education (actual patient care). microskills like pre-brief (to orient) and debrief (to build) are paramount. ‘tell me your last experience admitting a patient with decompensated liver disease’ may be the single most important Q in the clinical teacher’s repertoire. Co-construction of robust schemas is not possible imo without this cognitive apprenticeship.

The implications on the experiential curriculum are therefore profound. The adaptive teacher who recognizes patterns in clinical situations is more likely to have an impact than someone trying to teach to the median or overrepresent the importance of one rule over another. The worst teacher misses the teachable moment, usually because the curriculum in their head didn’t map to the situation in front of them.

But to your point, canon must come first. All of this relies on learners who have learned *most* of the rules. My own privilege / bias rooted from teaching graduate medical trainees.

David Scrimgeour's avatar

The 'counter' argument--I hesitate because what I am about to say doesn't have to conflict with any of your excellent points-- is not that teachers shouldn't teach but that their instruction, being indirect, and conveyed through various symbolic means, requires an engagement with and experience of what the models actually refer to, not other models, 'mental' or otherwise, unless you want to invite some endless regress of representation. This argument, of course, goes back to St Augustine. So then the effectiveness of teaching lies not in pre-organizing input so much as orienting to some object, generally speaking, concrete social practice, the use of the models in expanding students' purchase on the world they will live in. And if that is discovery, so be it.

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