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Reference: Van der Vleuten, C. P. M., and E. W. Driessen. “What would happen to education if we take education evidence seriously?.” Perspectives on medical education 3.3 (2014): 222-232.



What would happen to education if we took education evidence seriously?

This perspectives article, published in 2014, offers a brief overview of teaching practices that we should be taking more seriously. Unfortunately, medical education the 21st century has not changed significantly from medical education in the 18th century. Of course, we have new technology, simulation, social media, etc., but a majority of our education is still delivered via lecture and relies on the delivery of content from a teacher to a learner. We need to recognize that learning does not look like this:


Delivery = Learning


Instead, it looks like this:


Delivery + PROCESSING = Learning


With this in mind, the authors take the reader through six areas for which we have strong evidence. They argue that application of this evidence would significantly alter the way that we teach. These areas are:


  • Elaboration
  • Cooperative learning
  • Feedback
  • Mentoring
  • Engagement
  • Learning in a social context



Elaboration is any activity that allows the learner to process information. Examples include discussion, summarizing, restating the information in one’s own words, organizing, ranking, etc. As you may have noticed, elaboration relies on activities that come from the upper sections of Bloom’s taxonomy. Elaboration also likely explains the success of just about any active teaching method including simulation, team-based learning, problem-based learning, and the flipped classroom. Unfortunately, elaboration is hindered by passive consumption.



Cooperative learning

Cooperative learning is exactly as it sounds: learning in a group. We now know that in order to be effective, the groups must allow for quality, individual responsibility, and positive interdependence. Unfortunately, our current arrangement still focuses heavily on the individual learners. Ultimately, cooperative learning leads to a highly desirable outcome: the ability to work with others as a member of a team.



Feedback is one of the most powerful and evidence-based teaching activities. It is essential to the development of expert performance and is a key component of deliberate practice. For feedback to be effective, we must adopt the proper behaviors: ensure that the source is credible, focus feedback on the task, not the individual, and model the desired behaviors to create a culture that values feedback. Still, feedback is dramatically underutilized as an evidence-based teaching habit.




Mentoring is another area within the learning literature that has significant positive evidence. We know from the research that learners in a strong mentoring relationship will experience:


  • Better career preparation success
  • Increased clinical productivity
  • Less burnout


Self-determination theory explains that intrinsic motivation is supported when people experience relatedness, competence, and autonomy. Mentoring relationships improve on each of these factors. Unfortunately, a lack of incentives, limited time with learners, and a lack of mentoring development all undermine the utilization of effective mentoring in medical education.



The study of engagement comes from organizational psychology. Engagement is characterized by high employee satisfaction and can be viewed as the opposite of burnout. Engagement depends on the interaction between demands, personal ability, and resources provided. Employee (or learner) engagement can be fostered by:


  • Promoting autonomy and self-control
  • Increasing social support and coaching
  • Allowing diversity in work tasks
  • Teamwork
  • Interesting challenges


Again, our current educational system does not support the above factors. Boring tasks (lecture, anyone?), lack of social support, and external control are the sine qua non of our education system.



Learning in a social context

As the authors of this article point out, the above factors still view learning from an individual perspective. This particular area of evidence has emerged to explain how individuals learn within a social context. It explains how we learn by observation and imitation followed by active participation. Within medical education, this theory has been applied through the use of novel clinical rotations, i.e. longitudinal integrated clerkships. These experiences allow the learners to participate as a member of a single health care team for an extended period of time. This practice supports the development of relationships with both mentors and patients. The prolonged supervision also allows for improved work-based assessment, more effective feedback, and self-directed learning.


From theory to practice

The authors spend the remainder of the article discussing methods for applying the evidence above to the modern classroom. They highlight how modern technology allows for us to efficiently deliver information to learners without relying on traditional class time. Once this is accomplished, educators can focus on the best methods to help learners. They will have more time to allow for the practices of elaboration, cooperative learning, and feedback. Engagement will also likely improve as learners experience increased autonomy and social support. In sum, the authors paint a very positive picture of how medical education can look. We should take their advice seriously, apply the evidence, and reap the benefits in our modern classrooms.




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