Open Journal Systems

EDITORIALS

Received: June 1^st 2016

Accepted: June 15^th 2016

Linking learning theory with practice

María Teresa Ávalos-Carranza,^a Eric Amador-Olvera,^a Lydia Zerón-Gutiérrez^a

^aDivisión de Educación Continua, Coordinación de Educación en Salud, Unidad de Educación Investigación y Políticas de Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México

Communication with: Lydia Zerón-Gutiérrez

Email: lydia_zeron@yahoo.com.mx

It is often said that it is easier to learn what is observed and practiced on a daily basis; to the need to effectively link theory with practice considered in the process of teaching and learning, many strategies have been developed to allow this process to be carried out in a more efficiently maner. It is, therefore, very important to recognize that an appropriate teacher/student relationship is essential for students to acquire the skills and abilities required.

Keywords: Continuing medical education; Learning

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Aware that in the process of teaching and learning there are a variety of variables that are determinants, such as teachers, the educational environment, conflict resolution, attitudinal variables that influence the teacher-student relationship, among others, we have proposed to find the strategy to facilitate this process, taking the student herself as its starting point.

Considering that students are active entities in the development of knowledge, and that each processes information according to their own limitations and conceptual scope, the task for us is to identify and present learning strategies to facilitate this task.

Because of the close link between the theoretical elements and implementing them in clinical practice, the experiential and observational strategies take on vital importance for doctors in the process of specialization.

Within the framework of the work developed for the specialization of general practitioners based in the Instituto Mexicano del Seguro Social, care must be supported by a wealth of knowledge that makes sense in the doctor/student’s own conceptualization, and that impacts the care of their patients.

This paper presents the institutional proposal to make that linkage through an educational strategy to promote it. This is to encourage learning procedures that allow students to develop their autonomy and their ability to use techniques themselves to improve their care and teaching and learning processes, and even being competent to try to develop new procedures.

We begin by specifying whether the type of learning that is required is generated by behavioral changes, which would bring us to the Behaviorist theory; or if what is sought is a change in the competency of the doctor/student to respond to a particular situation, in which case we would approach the theory of Cognitivism, based on which, of course, and more transcendentally, an internal change is suggested, i.e. in the framework of meanings.

In learning we have an inclusive approach where practical skills or abilities are developed, new content strategies are adopted, and the student wants to appropriate attitudes, values, ​​and norms that govern their behavior.

Therefore, if we conceptualize learning, we would speak of a cognitive process that consists of knowledge, habits, and styles that are different and unique to each student, and reflected in making personal and individual decisions influenced, of course, by the context.

Each student will take on their own learning style, which will vary according to their age and the level of demand in the learning task. However, this form of learning is modifiable, for as long as the student is confronted with his experience and links with practice, they will discover better ways to learn.

Current trends mention that cognitive conditions are genetically given and developed in interaction with the context of life. That is, what is learned and the education received, becomes experience; so learning processes and experience intertwine to potentiate what one already has, and are strengthened or weakened by stimuli received.

An integrative theory would then assume that change in both behavior and cognitive processing are useful, taking for the purpose two peculiar characteristics of human activity, such as the capacity of self-reflection and ongoing monitoring, which appear to be consistent and that reflect the complexity of knowledge generation.

Knowledge about one’s own learning and strategies to give better academic performance are then linked. This linkage is determined by the relationship between the learner (student) and the observer (teacher) in their environment to teach them.

We focus therefore on what has been termed by some authors metacognition; we are then proposing the educational strategy that responds to the institutional and professional necessity to specialize a doctor.

The "school clinic" as a learning strategy

Learning strategies are integrated sequences of procedures or activities that are chosen for the purpose of facilitating the acquisition, storage, and/or use of information, leading to the development of knowledge.

Strategies, which cannot be implemented outside of thematic and only theoretical disciplines, should facilitate the development of general skills and abilities for students that are necessary for meaningful learning.

The student must be in contact with various elements that will facilitate the development of metacognition and thus the possibility of linking the theoretical aspects spread in the classroom space, with features that their attending care with any patient should have. 

Thus we have a doctor/teacher who establishes a relationship with the doctor/student from observation to analysis of what happens during a medical consultation in an environment called "clinic", which in turn serves as "school" (which from its root implies a space where you learn).

The scope of applicability of such elaborate medical knowledge includes all activity carried out in patient care, as this has its origin in the occupational context in which the student develops.

For this proposal, the competency to develop conceptual, clinical, and executive skills in the management of various diseases by the medical/student, with the detailed analysis of the methods and techniques of exploration, obtaining subjective and objective data, to strengthen the clinical-diagnostic and therapeutic skills for better patient care, has been defined as the terminal objective of this form of learning, or learning strategy.

Specifically they should be competent in:

• Integrating clinical data obtained from adequate anamnesis.
• Acquiring the ability to perform an appropriate physical examination.
• Developing the ability to select the most appropriate diagnostic aids for each case.
• Developing the necessary competency for diagnostic accuracy.
• Developing competency to create appropriate treatment plans for the patient.
• Establishing proper doctor-patient relationships.

These skills are closely linked to reflective learning, which will be strengthened in doing, observing the doctor/teacher, and that will also allow the development of the following generic skills and attributes:

• Proposing solutions to problems based on established methods, critical, analytical, and investigative thinking on medical information.
• Following up on knowledge processes with a constructive attitude, consistent with the knowledge and skills one needs to acquire.
• Developing effective communication skills in professional medical practice.
• Applying professional and bioethical values to medical practice issues.

This way of learning through experiential observation will allow the doctor/student, with the guidance of the doctor/teacher, to find out what are the features to their own work, and to identify which of these features should be used in every situation for the best results.

It has been shown that one learns more effectively when observing what is done, that is, if the doctor/teacher provides care to a patient while the doctor/student observes, learning opportunities develop that lead to meaningful learning.

This way of doing has the advantage of keeping a doctor/teacher always close to their own work as a doctor, to the preservation of their own clinical abilities and skills, and to the medical/student that will develop or perfect them.

Now, we see that not only observation leads the doctor/student towards achieving what they specifically intend to do, nor will they control the learning, so the doctor/student must also attend to patients under the supervision of their doctor/teacher, then investing observation.

Now it is the doctor/teacher who will observe the doctor/student in his duties, to identify their weaknesses and strengths, and will lead the learning to the implementation of effective techniques that facilitate meaningful learning.

Just as a student of surgery acquires the skills needed for their daily work in the operating room, observing and acting under the supervision of their teachers, so the doctor/student of the Family Medicine specialty will do in the clinic.

Each physician/student has a different way of learning to learn, and this identification made by the physician/teacher has the advantage of guiding the teaching-learning itself without neglecting those aspects of culture that determine learning in a student with a wealth of experience, along their own performance as a clinician.

At this point it is not intended to promote unlearning, but to optimize what one has learned, self-reflectively and observantly, which leads us back to metacognition, and to achieve it one must identify how what is observed is modified by the doctor/teacher’s very observation.

We can say that learning cannot be a mere accumulation of information, but the integrity of new knowledge with old, the reorganization and redefinition of the latter and learned experience.

It is thought that this integration, reorganization, and redefinition of knowledge should affect both "knowing something about something" (conceptual schemes), and "knowing what to do with something" (knowledge of procedures) and "knowing when to do it" (knowledge about the conditions in which to use what is known). 

Thus, the Learning Strategy is a process by which the cognitive and procedural skills are chosen, coordinated, and implemented in the relationship between meaningful learning and learning to learn, highlighting the importance of the relationship of thought with experience, i.e., metacognition.

The doctor/student in learning situations applies the solution to a set problem such as a disease, by providing patient care, and it is the interaction with the patient themselves that generates learning resources, and interaction with their doctor/professor will generate knowledge.

Methodology

• Location of a clinic where the activity of the Medical Unit Headquarters of the Course will be held, during the days of the week that are required to cover the students’ rotation.
• In addition to the professor of the course, there will be two doctor/students doing the activity, who attend four patients, giving the possibility to rotate six doctor/students per shift.
• Allocation of patients by the Clinical Department Head of the Medical Unit Headquarters according to their care needs, considering follow-up in some cases.
• Medical consultation with a duration of 15 minutes.
• First-time consultations that will receive follow-up
• Subsequent consultations with research in the clinical record and follow-up.
• Written informed consent with patient signature for filming their visit for further analysis.
• Printed medical note from each patient for analysis in the clinical record review workshop. 
• Notewritten by the doctor/student with diagnostic and therapeutic position based on the clinical conceptual skills, which considers what is implemented in consultation and in the current medical literature; at least half a page per patient for delivery in the next academic session in the classroom.
• Note written by the doctor/teacher with diagnostic and therapeutic position based on the conceptual clinical skills observed during the visit and current medical literature; at least half a page per patient to be discussed in the next academic session in the classroom.
• Application of the assessment card designed for this purpose.
• Comments on the learning by the doctor/teacher and doctor/students, in group after the activity.

There is research showing that selective focus in the student improves with age, and knowledge based on mnemonic processes is favored, so the doctor/teacher should use these as a teaching technique during this metacognitive strategy.

From the results obtained, the doctor/teacher has the opportunity to implement useful study and learning indicators to develop within their own specialty, the design and development of curricula that move beyond tradition, knowing if there is a relationship between the doctor/student’s academic performance, and the deepening of knowledge and their actions in the clinic.

It should be identified whether or not there is any relationship between the motivation for study and the use of metacognitive strategies in learning and problem-solving. This way one can respond to the demands of this formation revealed by health care indicators.

Conclusion

This learning strategy enables the implementation of different types of learning, such as:

• Dispositional and support strategies. These strategies are those that put the process in motion and help sustain the effort through:
• Affective-emotional and self-management strategies: motivational processes, proper attitudes, self-concept-self-esteem, feelings of competence, relaxation, anxiety management, stress reduction.
• Context control strategies: creating appropriate environmental conditions, control of space, time, material.
• Information search, collection, and selection strategies.

The doctor/student must learn what are the sources of information and how to access them to use them. They must learn mechanisms and criteria for selecting relevant information and critical reading.

• Information use and processing strategies
• Attentional strategies aimed at controlling attention and focus on the task.
• Information coding, processing, and organizing strategies: processes of information personalization, to integrate it better into cognitive structure, through tactics such as underlining, title, summary, outline, concept maps, summary tables.
• Storage and repetition strategies, short- and long-term memory and retention processes, through tactics such as copying, repetition, mnemonics, establishing meaningful connections.
• Personalization and creativity strategies: critical thinking, reprocessing of information, creative personal proposals.
• Information recovery strategies: memory and recovery processes, through tactics like memory exercises, information recovery following the route of concepts
• Communication and information use strategies: effectively use information for academic tasks and everyday life, through tactics such as reporting, making synthesis of learning, test simulations, self-questioning, application and transfer exercises.
• Metacognitive, regulation, and control strategies. These relate to knowledge, evaluation, and control of the various cognitive strategies and processes, according to the specific objectives and depending on the context through:
• Knowledge: of the person themselves, of available strategies, the skills and limitations, the objectives of the task, and the context of application.
• Control of:
  
  
  • Planning: work, study, tests, etc.
  • Evaluation and regulation: verification and evaluation of one’s own performance, checking homework, correction of errors and distractions, renewal of effort, rectifications, self-reinforcement, development of a sense of self-efficacy.

Our interest in finding an improvement in the results of specialization is guided by educational psycho-pedagogical guidance to facilitate the heuristic development of a range of educational alternatives.

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