By Jan D. Carline, PhD, director of Educational Evaluation and professor, Biomedical Informatics and Medical Education, University of Washington School of Medicine
Clinical Teaching Based on Principles of Cognitive Apprenticeship: Views of Experienced Clinical Teachers
Renée E. Stalmeijer, PhD, Diana H.J.M. Dolmans, PhD, Hetty A.M. Snellen-Balendong, MD, Marijke van Santen-Hoeufft, MD, Ineke H.A.P. Wolfhagen, PhD, and Albert J.J.A. Scherpbier, MD, PhD
About Cognitive Apprenticeship
Informal models of apprenticeship in clinical training have long been present in medical education. The more formal identification of its components and expert practices are more recent. The essay by Collins, Brown, and Newman in 1989 was a major step in applying cognitive science research to developing an ideal model of effective apprenticeship. Stalmeijer and colleagues have attempted to develop a similar model as applied to clinical medicine and through extensive interviews with clinicians to identify the appropriateness and usefulness of this model in understanding teaching in the clinical setting. The model has three major phases: initial modeling and establishment of a safe learning environment; coaching; and finally engaging the learner in self-directed learning.
In an iterative fashion, the authors worked with a group of experienced clinical teachers at Maastricht University to determine if the model of cognitive apprenticeship fits actual educational practice. Although all aspects of the model were recognized as important to teaching clinical skills, a number of factors played into how completely the model was fulfilled. Longer clerkships, more senior and motivated students, more experience in teaching, and a stronger interest in teaching all played into a more complete use of all facets of the model. The authors conclude that a longitudinal clerkship design coupled with a team approach to teaching and learning would improve clinical education.
- Does the apprenticeship model fit your own experience with effective clinical teaching?
- One finding was that skill and comfort in teaching came only with experience. What would be the preferred scheduling of attendings with students to ensure optimal teaching as well as skill development of the teachers?
- While motivation of students affected learning, interest of faculty in teaching was also related to success in employing the full apprenticeship model. Should interest in teaching be a requirement for placement of students with faculty?
- The authors suggest that students be prepared prior to clerkships to be assertive, effective communicators and to have personal educational objectives for clinical experiences to enhance their learning in the clinical setting? Is this a reasonable task? How might it be done before the student has any real knowledge of the clinical setting?
Collins A, Brown JD, Newman SE. Cognitive apprenticeship: Teaching the crafts of reading, writing, and mathematics. In: Resnick LB, ed. Knowing, Learning and Instruction: Essays in Honor of Robert Glaser. Hillsdale, NJ; Lawrence Erlbaum Associates, Inc.; 1989: 453-494.
Bleakley A. Broadening conceptions of learning in medical education: the message from teamworking. Med Educ. 2006;40:150-157.