Clinical epidemiology : an active learning approach

Abstract

For over 10 years, a group of professors at the Facultad de Medicina of the Universidad Autónoma de San Luis Potosi have taken up the challenge of revolutionizing the learning approach to Clinical Epidemiology. On this journey, we have learned a lot, and we have made a lot of mistakes, but we believe we have found a way (a small path) that has lead us to where we are right now: we incorporated critical thinking skills and competencies in the decision-making process, we scrutinize the conventional schemes of evidence-based medicine and traditional clinimetry up to adopting a blended model with an active learning approach by the student. Our intention is to foster the competences in our med students that will permit them to build up clinical expertise and continue their path through the transformation of their skills into a model of adaptive expertise with the years. To become an adaptive medical decision-maker, students must create critical thinking skills and meta-cognitive processes such as reflection and mindfulness, which have to be mentored. Students need to construct the ability to transfer concepts learned in one specific context into new contexts and into novel situations. In this trail to expertise, our students necessarily begin in the analytic mode (System 2 from the two modes of thinking), because the recognition of patterns of symptoms and signs is not yet possible At this point, System 1 from the two modes of thinking, the faster "intuitive" mode, is minimal. Through repetition and learning, students become more experienced to the point where basic patterns become familiar and will elicit System 1-based responses. In order to firmly build their adaptative decision-maker abilities, first students need to establish an explicit acquisition phase, where processes become embedded in their cognitive and behavioral repertoires through learning (often over-learning). In this phase the templates for illness scripts begin to appear. It is in this path, if our students have an unquestioning, passive attitude, using learning by memory with minimal insight, where they will accumulate experience, but may not gain expertise (i.e., they can become experienced non-experts). However, it they do possess insight, and actively engage with the clinical setting, they may progress instead toward proficiency and competence, showing elficient and accurate mastery of concepts to achieve "classic" or "routine" expertise. If we prepare them for this pattern, they will continue with their independent practice, and they will maintain a leaming approach that develops qualities of the adaptive leaming described above.This will lead to the accumulation of experience with the varied presentations of a disease, and together with the capability of adopting innovative approaches toward novel and atypical cases, may progress beyond routine expertise towards adaptive expertise.