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Achieving Excellence in Medical Education by Associate Professor Richard B. Gunderman MD, PhD, MPH

By Associate Professor Richard B. Gunderman MD, PhD, MPH (auth.)

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They believed that information cannot be properly understood apart from the social situations in which it is embedded. There is no such thing as decontextualized information or skills. Instead, what we know and what we can do are powerfully influenced by culture. Constructivism takes its name from the view that knowledge is not really discovered at all, but rather constructed by human beings. What we know is the product of two highly interrelated factors, the nature of the known and the nature of the knower, which can never be completely disentangled from each other.

In some cases, the pattern is visible only to the expert. The expert knows what is most important in a particular picture, and focuses right away on those features, whether it be a constellation of signs and symptoms or a collection of experimental results. It is not only that the expert knows the answers, but the expert knows what questions to ask. An expert radiologist knows how to interrogate a CT scan to extract the relevant information effectively and efficiently. To the expert’s eye, some features are simply more interesting—that is, they offer a higher cognitive yield—than others.

Why would information be retrieved? In some cases, such as a phone number, it is simply retrieved to be recited and then filed away again. In other cases, however, it is retrieved to be used in solving a new problem. Generally speaking, information will be available to a greater degree in problem solving when it has been retrieved to solve problems in the past. Hence tests that ask learners not only to recall information but to use it to solve problems of the sort they will encounter in real clinical practice generally offer a greater learning opportunity.

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