Context matters when striving to promote active and lifelong learning in medical education

Abstract

Where do we stand now? In the 30 years that have passed since The Edinburgh Declaration on Medical Education, we have made tremendous progress in research on fostering ‘self‐directed and independent study’ as propagated in this declaration, of which one prime example is research carried out on problem‐based learning. However, a large portion of medical education happens outside of classrooms, in authentic clinical contexts. Therefore, this article discusses recent developments in research regarding fostering active learning in clinical contexts. Self‐regulated, lifelong learning in medical education Clinical contexts are much more complex and flexible than classrooms, and therefore require a modified approach when fostering active learning. Recent efforts have been increasingly focused on understanding the more complex subject of supporting active learning in clinical contexts. One way of doing this is by using theory regarding self‐regulated learning (SRL), as well as situated learning, workplace affordances, self‐determination theory and achievement goal theory. Combining these different perspectives provides a holistic view of active learning in clinical contexts. Entry to practice, vocational training and continuing professional development Research on SRL in clinical contexts has mostly focused on the undergraduate setting, showing that active learning in clinical contexts requires not only proficiency in metacognition and SRL, but also in reactive, opportunistic learning. These studies have also made us aware of the large influence one's social environment has on SRL, the importance of professional relationships for learners, and the role of identity development in learning in clinical contexts. Additionally, research regarding postgraduate lifelong learning also highlights the importance of learners interacting about learning in clinical contexts, as well as the difficulties that clinical contexts may pose for lifelong learning. However, stimulating self‐regulated learning in undergraduate medical education may also make postgraduate lifelong learning easier for learners in clinical contexts.

Twelve tips for teaching twelve transferable skills

“…While by definition every transferable skill (Table 1) has a degree of transferability on a spectrum from medical to non-medical applications, it is crucial that the clinical relevance is prioritised to ensure appropriate student motivation (Berkhout et al, 2018). Depending on the outcome required, it may be useful to separate the skill from its context (e.g.…”

Expanding the definition of learning: from self to social to system

“…Although many scholars have called for a contextualised approach to SRL, conceptual frameworks are needed to make the elements of the system visible and foreground the multiplicity of their connections. Frameworks such as cultural‐historical activity theory (CHAT), actor‐network theory (ANT), complexity theory and systems engineering, among others, provide lenses to recognise, analyse and optimise the connections and interactions that lead to learning .…”

Medical education: how are we doing?

“…Berkhout et al 3 highlight the skills that learners need to develop in order to become effective lifelong learners. They argue that the key to this is the development and use of selfregulated learning (SRL), defined as 'the modulation of affective, cognitive, and behavioral processes throughout a learning experience to reach a desired level of achievement'.…”

“…Recently, the literature has begun to reflect some of this disquiet. [1][2][3] If an academic assessment of competency is only one of the pieces of information upon which a supervisor relies to make decisions in the real world, 4 why are we so wedded to this learner-centric model? In this issue of Medical Education, the article 'Competencybased education: the discourse of infallibility', by Boyd et al, 5 invites the reader to question this apparent monopoly of CBME on the health education dialogue.…”

“…3 These seem especially suited to vocational training because there are, at this career stage, a limited number of key clinical tasks that can be tracked in a formal supervisory arrangement, and the achievement of independent practice is an observable milestone. These…”