A study of the relationships between curriculum and learning in undergraduate medical education

Abstract

Curricula often seem to be based on the views of their planners rather than empirical findings and theoretical models. Partly this is due to an incomplete understanding of the mechanisms that link curriculum and learning. This study looks at that relationship within undergraduate medical education, especially to allow an evaluation of problem-based learning and the Southampton programme, which represent current alternatives to the conventional curriculum. It does so by identifying and analysing the causes and effects of medical students' approaches to studying as indicators of their learning, and by accounting for them in educational and psychological terms. Using a mixed methodology involving interviews, a questionnaire and an inventory, three kinds of learning were identified: restricted, adequate and elaborated. Restricted learning reflects a chaotic cognitive structure leading to poor knowledge-retention and -retrieval. Adequate learning is `deeper', with better retention though long-term retrieval remains poor. Elaborated learning is both deep and abroad, resulting in good retention and the cognitive interconnections doctors need for effective clinical thinking. The conventional medical curriculum and the early years in Southampton only seem able to generate restricted and adequate learning. However, problem-based learning can promote elaborated learning, as can a revision period at the end of Year Three in Southampton when students relate theoretical knowledge to their clinical experiences. Elaborated learning occurs under certain curricular conditions, namely when the learner first has a relevant `assimilative context' followed by specific information and opportunities for what is called `oscillation'. On these criteria, none of the three curricula are entirely satisfactory, though problem-based learning seems almost appropriate. A model is proposed, called `contextual learning', for planning, evaluating and developing curricula in medical education and possibly elsewhere, though its implementation is by no means guaranteed. (D68114/86)

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