When did learning become a science experiment?

Philosophiae Naturalis Principia Mathematica

In 1687, Isaac Newton published his Principia, or Mathematical Principles of Natural Philosophy. It became one of the most influential works in the history of science, guiding for the next three centuries the way we would describe the motion of the universe and everything in it. And he did it with a few formulas: three laws of motion and one law of universal gravitation. Simple. Beautiful. Perfectly applicable in a vaccuum. If only everything in our daily experiences could be described with such expository efficiency. Unfotunately, the conditions of a vaccuum are not conducive to maintaining life. Alas! We must, as living creatures, contend with living in the outside world: a much more comlicated environment where moving objects, though still submitting to the laws of motion, are also pushed and pulled by a massive number of other forces - friction, wind, magnetism - that quickly confuse muddle our predictions of where things will end up and the path they will take in arriving. How confusing.

Caveat Lector

I am not a physicist or a mathematician; not a teacher or a doctor (yet). I am, however, a student. And I have been for quite a while now. The job of a student is really quite simple: to learn, learn, and learn some more. And just like motion, learning is not random. The world of cognitive psychology has taught us a number of principles that underlie the learning process, and that can lead to predicable, reproducible results, at least within the highly controlled environment of scientific research. And although students often find their capacity to learn, like everything else in the natural world, to be affected by a number of forces - time, interest, relationships, carpal tunnel syndrome - I will now attempt to boldly argue that there is at least one universal truth at play in medical learning even when the whole picture gets muddled by outside forces. Now hear this: acquisition does not imply integration.

Chaos in the Classroom: Regehr vs. Norman

What is chaos theory? I'll be honest, I have no idea. It has something to do with the complexity engendered by innumerable interacting relationships that shape one another in systems. It makes the outcome really difficult - maybe even impossible - to predict. It's a physics thing that most people aren't anywhere near capable of understanding. But let's play along for the sake of conversation and join in the dialogue with a couple of experts in the field of medical education research who have engaged in a mental experiment comparing chaos theory to the learning process - and who have disagreed about its applicability. Here's the (highly simplified) capsule:

Regehr: We should shift our focus in medical education research from the search for proof of a single generalizable principle toward a better understanding of the sorts of problems that can emerge in learning environments, and to how we may better describe the complexity of those environments.

Norman: If we wanted to describe the complexities of the learning environment, we would have to use all the computational power in the world, which would be a waste of time anyway because it's more important to focus on what we can learn about how individuals learn and how we can make this learning more efficient.

The focus here, whether at a system or at an individual level, is on description of the phenomena at play, with the presumed end result being to increase our capacity to design more effective educational interventions. Medical students - inexperienced as we are - are not subatomic particles, and the application of theoretical physics to the sphere of medical education is a quantum leap. In the reality of a profession where test score does not imply performance, learning can be described only in a qualitative manner. To apply physical theories intended for quantitative description is to ignore the elemental structure of medical practice in which medical education is embedded.

The Search for Truth in a Complicated World

Learning is complex at an individual level. Place that individual within the context of a classroom, a ward, a hospital, and a greater system of professionnal practice, and the forces, both internal and external, generated by a multitude of interacting relationships and responsibilites becomes so variable and difficult to describe that the likelihood that any one individual will efficiently learn any single piece of knowlege becomes computationally impossible to predict. Research into efficient teaching and learning strategies can help individuals to acquire details, even approaches, but cannot serve to force an individual to integrate this information into a system of practice. The essence of medical learning is integration of knowlege through experience. And although it may be impossible to simply and accurately describe the effect of this system on the individual, this does not imply that we cannot improve educational processes. Which brings me back to the search for truth.

There's a distinction to be made between a functional truth and an absolute truth. Newton's laws of motion are functionally true. General relativity may more accurately describe the truth of how subatomic particles interact, but we still rely largely on Newton's laws because, for all intents and purposes, they work quite well on a practical level for most computational questions. Now, please forgive the irony here: although there may exist absolute truths about the efficiency of educational systems, we would be better served my relying on what we can learn about the learning process at an individual level so that we can apply practical interventions that are likely to prime the individual to learn within an already established system of practice. After all, physicians function as individuals within teams, institutions, and health systems. We must maximize our individual learning to establish our own system of practice. In a era where best practices have become a moving target, the medical student who learns to learn more efficiently with become the better physician.



Sarah.