It's Not All in Your Head: Viewing Graduate Medical Education Through the Lens of Situated Cognition

摘要

Consider the last time you sat down to begin a complex activity, such as writing a scientific article or crafting a persuasive letter to a colleague. When you started did you have, in your head, an exact outline of what you wanted to say and then transferred those ideas, verbatim, to your word-processing software? Or did you have a general idea of the topics you wanted to cover and, as you began writing, saw your text emerge as you typed and interacted with the software? In other words, did your final written document go directly from your brain to the virtual paper or did that text materialize as you wrote, revised what you wrote, and copied and pasted different sections of your text? If you are like me, the latter is a more accurate description of how complex activities, such as writing, occur in practice. Now think about your last patient encounter, and ask yourself this same question: did you know ahead of time exactly what you wanted to say and do in the encounter, or did those details emerge in the context of the doctor-patient interaction? Although there is limited empirical evidence, I would argue that similar to writing and other complex human activities, most clinical encounters are dynamic events that emerge as doctors and patients interact in a clinical environment. The processes described above can be explained by different theories of human learning. The fairly straightforward notion of taking a fully formed idea in one's head and transferring it to the virtual paper is closely related to an information processing description of how humans think and learn. In contrast, the description of a dynamic interaction between a whole person and his environment is closely linked to a quite different theory of how humans think and learn: situated cognition. The purpose of this editorial is to (1) describe situated cognition and contrast it to more traditional information processing theories, and (2) consider how situated cognition theory can be applied to teaching, learning, and research in graduate medical education (GME).;Situated Cognition Versus Information Processing Theory (table) View larger version (34K) TableInformation Processing Theory Versus Situated Cognition Theory;Learning From a Situated Perspective To understand learning, sitcog theorists always consider 2 components: the person and the context. From this perspective, knowledge and intelligence are conceptualized as the interaction between the person and the context, and consequently, sitcog theorists place equal emphasis on the person and environment.2 Knowledge is conceptualized as being located in the actions of individuals or groups of individuals and evolves as we work our way through new situations. In real-world situations knowledge is not solely contained within a single individual or group of individuals. Instead, knowledge is distributed throughout the environment in people, computers, books, and other tools or instruments.2 Additionally, “each individual's goals, values, and beliefs interact with these distributed sources of information, so that each person's experience in the situation is unique.”2(p46);Implications for Teaching and Research in GME The primary instructional implication of a sitcog perspective is that all learning should be situated in authentic contexts. Contexts are truly “authentic” if they share some of the important aspects of real-world problems, including being ill structured, having complex goals, and containing collaborative activities among learners and practitioners in society.2 Problem-based learning environments, such as those used in some medical schools, are examples of sitcog theory in practice. Moreover, almost all clinical teaching takes place in an authentic environment, within clinics, hospitals, and medical centers. In these settings an apprenticeship model of teaching and learning is an instructional exemplar of a sitcog perspective.6 Problem-based learning activities and apprenticeships give trainees the op