Authentic learning in anatomy: A primer on pragmatism

摘要

"Education is life itself." —John Dewey (1859-1952) Authentic learning in medical education is an increasingly popular topic. We are seeing more presentations on "authentic learning" at medical education conferences (Harden, 2015; Manninen, 2015) and the presentations are often linked to competency-based education. More commonly, "authentic learning" is used to describe the type of learning that occurs when students get early clinical exposure to the health care environment with meaningful patient contact to enhance their learning (Yardley et al., 2013; Gonzalo et al., 2014). While this medical education buzz phrase may sound foreign, as anatomists "authentic learning" is something we do daily in the teaching and learning activities that occur in our anatomy classrooms and laboratories. In fact, we consider the "patient contact" our students have to be one of the earliest and most intimate educational/clinical exposures they have in medical school. Historically, in many traditional basic science courses including biochemistry, molecular biology, and anatomy, there used to be a palpable separation between "knowing" and "doing" (Resnick, 1987). Students who memorized anatomical facts could pass their examinations, but were often unable to access this knowledge to solve a clinical problem they encountered later during their clinical clerkships. Information acquired in the anatomy laboratory used to be a collection of stored facts. But now, we would argue that modern teaching strives to provide dynamic tools for real-life problem-solving (Bransford et al., 1990; Herrington and Oliver, 2000; Johnson et al., 2012). In general, "authentic learning" is learning that impacts a student's ability to navigate the clinical environment, solve complex problems, and make meaning of their efforts in the context of their personal lives and ethical practices (Lombardi, 2007). Teaching materials and student activities in the "authentic" classroom should be "real life" situations where the content learned and the skills obtained can be applied. The assumption underlying this approach is students will learn what is meaningful to them. Once learning has personal meaning, it is more motivating and more deeply processed (Chang et al., 2010). The concept of "authenticity" in education is not new. In 1866, William Ware, a professor for the School of Architecture at the Massachusetts Institute of Technology, presented an outline for his new course on "Instruction in Building and Architecture." In this course, students designed projects aimed at addressing problems in the local community (Ware, 1866; Shaffer and Resnick, 1999). His major concern was how the traditional curriculum might cut students off "from a knowledge of practical details" necessary to function within their profession (Ware, 1866). Similarly, in his book Experience and Education, education philosopher John Dewey championed the notion that "freedom of observation and judgment exercised on behalf of [practical] purposes … are intrinsically worthwhile" (Dewey, 1938). Following the legacy established by Ware and Dewey, the modern pedagogical concept of "authentic learning" has been articulated by Herrington and Oliver (2000). "Authentic learning" brings together disparate disciplines and perspectives to work toward a common goal—an objective which mirrors the real-world of the active professional navigating their field (Lombardi, 2007; Herrington et al., 2014). Early exposure to "authentic learning" provides an opportunity to address professional identity formation alongside knowledge acquisition, a setting which requires a student to become familiar with the realities of clinical reasoning, where they learn not only content but team-forward behaviors (Yardley et al., 2013). Over the last 10 years, the hours available for anatomical education in United States medical schools have decreased (Drake et al., 2009, 2014). As such, anatomists have been forced to become selective in the material t