The role of knowledge building in medical education

Doctor of Philosophy, 2007
Zahra A. Punja
Department of Curriculum, Teaching and Learning
University of Toronto


Abstract
This thesis investigated the role of knowledge building pedagogy and technology in medical education. The literature in medical education points to a need for change to better address society’s needs for greater community orientation in medicine and integration of new knowledge media. These goals are reflected in the Canadian Medical Education Framework of the Royal College of Physicians and Surgeons. Knowledge Building is an innovative theoretical framework and pedagogy with emphasis on the engagement of all community members in contributing ideas of value to local communities and society, facilitated by Internet-based knowledge building environments. The goal of this research was to determine the applicability and usefulness of knowledge building across various levels in medical education. Case studies were conducted in four University of Toronto contexts: undergraduate Foundations of Medical Practice Course, Obstetrics/Gynecology Graduate Residency Program, Graduate Family Medicine Residency Program, and Psychiatry Continuing Medical Education Course. An online knowledge building environment, Knowledge Forum, supported the knowledge building work which was conducted over a series of investigations lasting 1 to 16 weeks, with the investigations largely conducted as add-ons to course work. Fifty-seven participants (teachers and students) were engaged in these four contexts; 75% volunteered for the add-on component.
Thirty-six months after the pilot investigations the four professors were interviewed to assess current practices and beliefs. Analyses focus on barriers and challenges in integrating knowledge building principles and technologies into medical education. Discourse analysis revealed expert-dominated discourse—in many ways right-answer-driven and exam-based, and leaving little room for student contributions, constructive engagement with authoritative sources, or self-and group-assessment. Teacher-generated activities, along with a curriculum with large amounts of prescribed information to be learned, made it difficult for students to find time to work creatively with ideas, consult additional sources, or reflect on diagnoses and prescriptions. The belief that knowledge innovation should occur after the acquisition of foundational knowledge, not in parallel, reflected a tension between espoused ideals and “add-on” status for knowledge building pedagogies and technologies. Results are consistent with the literature on change, suggesting that reform will be slow, but propelled by prevailing expectations of change and new knowledge media.