How cognitive psychology changed the face of medical education research
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How cognitive psychology changed the face of medical education research Henk G. Schmidt1 · Silvia Mamede1 Received: 12 September 2020 / Accepted: 27 October 2020 / Published online: 26 November 2020 © Springer Nature B.V. 2020
Abstract In this article, the contributions of cognitive psychology to research and development of medical education are assessed. The cognitive psychology of learning consists of activation of prior knowledge while processing new information and elaboration on the resulting new knowledge to facilitate storing in long-term memory. This process is limited by the size of working memory. Six interventions based on cognitive theory that facilitate learning and expertise development are discussed: (1) Fostering self-explanation, (2) elaborative discussion, and (3) distributed practice; (4) help with decreasing cognitive load, (5) promoting retrieval practice, and (6) supporting interleaving practice. These interventions contribute in different measure to various instructional methods in use in medical education: problem-based learning, team-based learning, worked examples, mixed practice, serial-cue presentation, and deliberate reflection. The article concludes that systematic research into the applicability of these ideas to the practice of medical education presently is limited and should be intensified. Keywords Knowledge acquisition · Self-explanation · Elaborative discussion · Distributed practice · Cognitive load · Retrieval practice · Interleaving practice · Medical expertise
Introduction Research into medical education began to attract serious attention with the publication of the Journal of Medical Education (now Academic Medicine) in 1951. Not surprisingly, from its very beginning it has been influenced by what was current in the psychology of learning and instruction and always reflected its ongoing concerns. In the fifties and sixties the language of behaviorism was dominant in the medical education literature. Learning was seen as the result of repetition and reward, with its application to so called ‘learning machines’ (Owen et al. 1965, 1964), to programmed instruction (Lysaught et al. 1964; Weiss and Green 1962), and with its emphasis on ‘behavioral’ objectives (Varagunam 1971). Cognitive-psychology concepts such as ‘memory,’ ‘retention,’ and ‘reasoning’ * Henk G. Schmidt [email protected] 1
Department of Psychology, Erasmus University, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
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started to appear only in the early seventies (Elstein et al. 1972; Klachko and Reid 1975; Levine and Forman 1973), and found an early synthesis in the groundbreaking work of Elstein and colleagues on medical problem solving (Elstein et al. 1978). The purpose of the present article is to assess the role of cognitive psychology in the study of medical education (and by extension health professions education). We will focus here on how cognitive conceptualizations of learning and instruction have assisted in an understanding of knowled
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