Experiential learning is a powerful learning tool in clinical medicine. For registrar training, it is by far the most important learning methodology employed. For undergraduate students, it is widely understood by teachers as essential, though often not explicitly recognised for what it is. It is frequently labeled “practice” or “seeing patients” when in fact it is one of the most powerful drivers of new learning – the accumulation of new knowledge – we know. To call it practice is to miss its importance completely.
About Experiential Learning
Modified from Atherton JS (2005) Learning and Teaching: Experiential Learning [On-line] UK: Available: http://www.learningandteaching.info/learning/experience.htm Accessed: 4 February 2009
Experiential learning is primarily significant in its emphasis on personal involvement and personal acquisition of knowledge and skills through relevant experiences. CR Rogers differentiates between cognitive (meaningless) and experiential (significant) learning.
Kolb conceptualises the experiential learning process as a cycle, modified here to illustrate the learning which takes place when a student works with a patient. Of critical importance is the need for the three stages which follow the initial experience, namely (1) the need to think, read and reflect, (2) the cognitive engagement which underlies the incorporation of the knowledge, concepts and patterns of association which arise out of this into a developing schema, and (3) the application of this enhanced concept map to further patients, setting up a continuous cycle and feed-forward loop.
Common problems with experiential learning as seen in clinical students
Unfortunately the true experiential learning value of seeing patients is frequently just not realized (in the sense of achieved) in practice because students follow the first or second pathway below. In the case of weaker undergraduate students, this is due to either laziness or to a complete failure to differentiate the process of seeing a patient and the process of learning and generalizing from the experience. In the case of the registrar, it is usually because of work load and time pressure, coupled with a lack of a good habit of reading, assimilation and reflection.
Path 1. The patient is seen, committed directly to paper, and presented (either as a written case report or verbally). No true learning takes place.
Path 2. The patient is seen, committed directly to paper, and presented (either as a written case report or verbally). The student may “read up” about the disease and parrots this information on request. This and/or pearls of wisdom imparted by the tutor during the presentation are committed to paper and memorised. Some superficial learning takes place but again the true value of experiential learning, as a form of active learning, is not realized.
Path 3. In contrast, the true value of experiential learning is realized when the patient is seen, the experience subjected to reflection, thoughtful enquiry (including further reading), the abstract principles extracted and committed to memory, and even more so when the results of this cognitive process is now transferred to subsequent patient experiences in a feed-forward process.
The clinical portfolio of learning is central to our third, fourth and fifth year courses in medicine as it is designed to promote this third path, that of true experiential and active learning.
The student who may present the patient but fails to use the student as a learning opportunity
The student who may present the patient but does no more than memorise bare facts associated with it, sometimes taken from a book or even volunteered by the tutor
The student who uses the case material effectively
Adapted from Jarvis as quoted in http://www.infed.org/biblio/b-explrn.htm