An AMEE 2013 plenary presentation by Cees van der Vleuten

1. Taking evidence
seriously: what
would happen to our
training
programmes?
Cees van der Vleuten
Maastricht University
The Netherlands
AMEE Conference 2013,
Prague, 28 August 2013

4. Collegezaal rond 1798

5. Collegezaal rond 1998

6. A parallel attitude?
Evidence-based
Medicine
(EBM)
Best Evidence
Medical Education
(BEME)

7. Instructional formats
Lecture
Reading
Audiovisual presentation
Demonstration
Group discussion
Practice by doing Teach others

8. The Learning Pyramid
Teach others
Lecture
Discussion group
Demonstration
Audiovisual
Reading
Practice by doing
5%
10%
20%
30%
50%
75%
80%
Average
Retention Rate
National Training Laboratories, Bethel, Maine, USA
Teach
others
Lecture
Discussion
group
Demonstration
Audiovisual
Reading
Practice
by
doing

10. Reductionism in education
 Illustrations:
 Education as a
tradition, as a ritual
 Focussed on
information
transmission
 Not stimulating
motivation, excellence,
creativity
 Information-poor grade
culture
 An out-dated learning
model (mastery
learning)

11. Solid evidence in education
 Processing information leads to more
profound learning (elaboration)
Levin, J. R. (1988). Elaboration-based learning strategies: Powerful theory=powerful application. Contemporary Educational Psychology, 13(3), 191-
205.

12. Elaboration
 Contingent on the functioning of our
cognitive system (short-term, long term
memory)
 Can be done in many different ways:
 Discussing
 Explaining others
 Schematizing
 Apply to (transfer) cases
 ………

13.  Processing information leads to more
profound learning (elaboration)
 Working in groups (collaborative learning)
Solid evidence in education

14. Collaborative learning
 Evidence-based conditions:
 Equality in participation
 Individual responsibility
 Mutual positive interdependence
 Simultaneous interaction
Johnson, D.W., Johnson, R.T., & Smith, K. (2007). The state of cooperative learning in
postsecondary and professional settings. Educ Psychol Rev, 19, 15–29.

15.  Processing information leads to more
profound learning (elaboration)
 Working in groups (collaborative learning)
 Feedback works
Solid evidence in education

16. Feedback
 No learning without feedback!
 Contemporary education
provides little feedback
 Summative information-poor
assessment systems
 Limited direct observation in
work-based learning
Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81-112.

17.  Processing information leads to more
profound learning (elaboration)
 Working in groups (collaborative learning)
 Feedback works
 Coaching/mentoring works
Solid evidence in education

18. Coaching/mentoring
 Empirical findings:
 Increased feedback use (feedback is a
dialogue)
 Improved professional development
 Career preparation and success (incl. higher
(clinical) production, higher positions)
 Under-used by those who need it most
Driessen, E. & Overeem, K. (2013) Mentoring. In: Oxford Handbook of Medical Education.

19.  Processing information leads to more
profound learning (elaboration)
 Working in groups (collaborative learning)
 Feedback works
 Coaching/mentoring works
 (Clinical) learner responsibility works
Solid evidence in education

20. Learning in the workplace
 Care for patients is powerful way of
learning
 Increases intrinsic motivation
 (Access to) supervision and feedback is
essential
Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247-273.
Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: a model linking the
processes and outcomes of medical students' workplace learning. Medical education, 41(1), 84-91.
Watling, C., Driessen, E., Vleuten, C. P., Vanstone, M., & Lingard, L. (2013). Beyond individualism:
professional culture and its influence on feedback. Medical education, 47(6), 585-594.

21.  Processing information leads to more
profound learning (elaboration)
 Working in groups (collaborative learning)
 Feedback works
 Coaching/mentoring works
 (Clinical) responsibility works
 Attention to ‘generic’ skills works
Solid evidence in education

22. Generic skills
 Professionalism, communication, teamwork,
leadership…….
 Activating learning environments lead to
superior generic skills
 Success and failure on labour market are
(strongly) associated with these skills
 They require longitudinal attention!
Meng, C. . (2006). Discipline-specific or academic ? Acquisition, role and value of higher education
competencies. (PhD), PhD Dissertation, Universiteit Maastricht, Maastricht.
Schmidt, H.G., & Van der Molen, H.T. (2001). Self-reported competency ratings of graduates of a
problem-based medical curriculum. Academic Medicine, 76, 466-468.
Papadakis, M. A., Hodgson, C. S., Teherani, A., & Kohatsu, N. D. (2004). Unprofessional behavior
in medical school is associated with subsequent disciplinary action by a state medical board.
Academic medicine : journal of the Association of American Medical Colleges, 79(3), 244-249.

23. So, what should we do in education?
 Use elaboration assignments
 Use group or teamwork
 Provide feedback
 Coach and mentor learners
 Introduce early (clinical)
responsibility
 Give ample attention to generic
skills

25. Radical change 1
 We “capture” all information transmission
through IT use (collaboratively in
MedEdWorld?)

28. Illustration

29. Radical change 1
 We “capture” all information transmission
through IT use (collaboratively?)
 Education consists of (free to choose)
assignments fulfilled in groups
 Intensive guidance by teachers
 All assessment is formative and
informative; summative on longitudinal
progression

30. Radical change 2
 Competencies and milestones are
leading for all courses and assessment,
in longitudinal flexible tracks
 Early exposure to patients and health
care
 Tight regulations, demanding on
students, considerable (peer) social
control

32. Conclusions
 Education practice and education
evidence are not aligned
 Effective education focuses on
information processing, not on
information transfer
 Education can be radically different!
 Education for the 21st century? Will
be different

33. “Did you ever feel you’re on the verge of
an incredible breakthrough?”
This Powerpoint can be found at:
www.fdg.unimaas.nl/educ/cees/amee