Summary: a medical student who has just left a faculty in which he has been provided with a predominantly purely biological orientation and in which the only scientific evidence is positivist and the only acceptable methodology is quantitative, one cannot speak no more than a biopsychosocial approach to the clinical process and pretend that he assimilates it without any previous knowledge. Individuals may feel uncomfortable having to modify the perspectives and visions they have held so far and the incorporation of a new piece of information implies that for it to be integrated, in its frame of reference (cognitive map) the subject must be modified, which is not easy and requires appropriate methodological strategies in the medium and long term.
Importance in Medical Education:-
The importance of what the person previously knows to be involved in a learning process is a determining factor for the effectiveness of this (Ausubel, 1968). The learning to be effective must be significant and for this it is required that the new information acquired be linked to concepts that the person already has.
Although learning includes the memorization of facts and names, the knowledge to be retained and above all to be used must be properly processed and integrated with the information that was previously known. Human beings retain information in an organized and related way, in what we call cognitive maps or frames of reference, which is what gives meaning to each piece of information.
Meaningful learning is one that involves the incorporation of substantive knowledge in the cognitive structure of the person. It is opposed to the arbitrary and literal learning in which a mechanical memorization takes place, which does not imply understanding. Disintegrated and isolated information is meaningless and difficult to retain and there are great difficulties in using it for what is generally useless. Teaching to facilitate a learning that is worth having that name, should avoid promoting exclusively the memorization of data that are not understood (not integrated) because, as we have said, true learning has to be meaningful and fit into what which is previously known. Thus, meaningful learning is more efficient and lasting (Novak and Gowin, 1984).
In rote learning, since the conceptual meaning of the material to be learned is not taken into account, it cannot be linked to relevant concepts that the learner already knows. In the same way, new ideas and information can be integrated and retained to the extent that relevant concepts are clear and available in the cognitive structure of the individual and thus serve to anchor new ideas and concepts. The existing concepts act as inclusion of later learning and in this way the extension and extension of knowledge is favored.
The cognitive frame of reference formed by the knowledge of the subject is the one that will be used to give the meaning to the new information that is received. The cognitive structure of the individual not only conditions the processing of information but also their expectations and presumptions determine the perception process: what stimuli are given attention and what information is selected.
The significant learning process occurs as a result of the interaction of the new information and the existing concepts, resulting in a modification of both. The incorporation of a new piece of information implies that for it to be integrated, the frame of reference (cognitive map) of the subject must be modified to allow it to adapt. In summary, the processing and integration of the new information depends on the cognitive map that the subject already possesses, which in turn is modified by the new information.
This integration is not always easy since certain learning poses different tasks for one or another individual from the point of view of the modifications that it requires from its previous frame of reference. These modifications can be only quantitative or qualitative. The required modifications are quantitative when only an addition to the existing knowledge is needed, that this knowledge is nuanced or that the learned ability is perfected for a better use. On other occasions, the modification of the cognitive map that is required is broader and involves a restructuring of existing conceptions or the relationships between them or question existing habits or perspectives.
When the new information involves a broad restructuring of the cognitive map, greater difficulty arises due to the effort involved and because resistance is often generated. We must remember that there is a tendency, when integrating new information, to minimize the inconsistencies between what we already know and what is presented to us. This tendency must be taken into account to counteract it, when a broad restructuring of existing knowledge is appropriate. In this situation, individuals may feel uncomfortable having to modify the perspectives and visions they have held so far. But this change is even more problematic when implicit theories have to be modified, that is, that the subject has not explicitly explained them and is not fully aware of them. The implication of this fact is that we must help people to recognize the theoretical frameworks and presumptions that are conditioning their behavior. We must build experiences that allow participants to observe and reflect on their behavior and identify the underlying reasons for it, to prevent them from taking refuge in the safety and comfort of the established way of thinking.
The need to restructure a person’s cognitive map often occurs when the educational phase is changed and when a new discipline, subject, perspective is introduced. Etc. In these cases, a particularly difficult challenge for the teacher is posed and the strategy to be followed must be carefully planned. For example, to a medical student who has just left a faculty in which he has been provided with a predominantly purely biological orientation and in which the only scientific evidence is positivist and the only acceptable methodology is quantitative; he can talk about a biopsychosocial approach to the clinical process, and pretend that he assimilates it without any previous knowledge.
Meaningful learning is related to another requirement of effective learning: that is active. If the learning process is active, it facilitates that the information is processed in a deeper way and not only is memorized, and that a meaningful integration of the new information is made with the existing knowledge and is not retained as isolated data or facts. But we will insist once again, because sometimes an exclusive emphasis is placed on active methodologies, that the process is active is not enough, another aspect that is closely related to promoting “learning by understanding” is the organization of educational content and its sequence that guarantees that all new information is presented in a way that is understandable in terms of existing knowledge and that is seen as relevant to the needs of the learner.
Meaningful learning is fully relevant to medical education. This importance of the cognitive structure of the subject is clearly studied in the case of the clinical competence of physicians, that is, of their ability to solve (diagnosis and treatment) clinical problems. Although for a period the importance of the concepts and principles was somewhat relegated and they did not receive much attention within the medical education, the so-called mental health skills, in particular the problem-solving skills, were defined as priority objectives of the physician’s training. And of decision making. Later with the arrival of the problem-based learning model, Once again the importance of knowledge and especially of its organization was reiterated in the mind of the doctor to guarantee its clinical competence. It has been proven that effectiveness as a clinician does not depend on any problem-solving ability that will operate outside the content of the area or discipline in question (Norman & Schmidt, 1992). This has been confirmed by studies that have found a clear difference in the structure of knowledge in the memory of expert clinicians with respect to beginners (Schmidt & Rikers 2007). A structure that facilitates the ability to recognize the essential features, the presentation of a patient’s case. These traits are the ones that activate the relevant knowledge structures to analyze the case and make the right decisions.