3. Learning Theory
Apply content knowledge, pedagogical, and professional knowledge necessary to carry out teaching responsibilities and for successful performance in the health professions field.
Artifact 3-A
Learning Theory Paper
Reflection
The Learning Theory Paper, from HPTT 801 – Foundations of Health Professions Education, tasked me to select the theory most closely matching my educational approach after gaining a foundational understanding of behaviorism, cognitivism, and constructivism. I felt that cognitivism, and more specifically Bandura’s social cognitive theory, matched my teaching most closely. I was particularly drawn to Reciprocal Determinism, as it draws on a learner’s prior experiences to teach new concepts, which has particular relevance for bedside clinical medicine and therefore represents competency 3a well.
Reciprocal determinism describes personal, behavioral, and environmental factors influencing one another, and its adaptability suits it to clinical teaching. Much of the paper explored enactive versus observational learning, and the value of modeling my approach to clinical decisions in real time so that trainees see the reasoning and not only the decision. Comparing social cognitive theory against behaviorism best represents this competency. Operant conditioning is often not an effective tool in endoscopic skill development; when teaching loop reduction during colonoscopy, an unrecognized loop carries the risk of splenic laceration or colonic perforation. Positive reinforcement still has a role, such as celebrating a successful polypectomy, but modeling remains the more effective strategy. Patient safety therefore plays a large role when choosing a learning theory in the procedural setting.
One of the challenges encountered was committing to a single learning theory when my practice draws from several, especially given the different approach required for procedural versus bedside teaching. I revisited these ideas in my Integration Paper later in the same course, comparing the theory against the curriculum I designed. Following this course, I have been more deliberate in modeling my clinical reasoning aloud for fellows and students, and in integrating reciprocal determinism during bedside rounds.
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Artifact 3-B
Analysis and Application of Learning Theory in Medical Simulation Design
Reflection
The Analysis and Application of Learning Theory in Medical Simulation Design assignment was completed in HPTT 824 – Simulated and Virtual Learning in Health Professions Education. It required me to select a peer-reviewed article on learning theory in simulation, critique one of the theories described, and apply it to my own simulation design. I chose a 2022 review by Herrera-Aliaga and Estrada for its recency at the time, its relevance to how learner needs changed after the COVID-19 pandemic, and its mini-review of types of simulation activities. I selected it to represent competency 3a as it applies the same pedagogical reasoning as my learning theory paper to a different modality.
The paper summarizes theories from Vygotsky, Kolb, Dreyfus and Dreyfus, Posner, Schön, Bandura, and Ericsson. I chose to summarize and critique Ericsson’s work on deliberate practice. Its central idea is the identification of critical events, usually derived from how an established expert developed their skill, to measure an individual’s proficiency. The limitation I raised is that the theory does not explain how some individuals reach proficiency faster through intuition, or acquire technical skills more easily than their peers despite identical practice. Combining Ericsson’s theory with the zones used by the Boston Children’s Simulator Program gave me a framework for simulation design for my medical student learners. The zones group simulation activities by what they train: basic technical skills in zone 0, such as paracentesis on a manikin; clinical competencies in zone 1; and clinical decisions in more complex settings in zone 2.
One of the challenges encountered was adopting a theory whose limitation I had just described, and deciding that deliberate practice remained the most useful frame for procedural teaching despite it. Following this course, I have been applying some of these learning theories in simulation design, especially in the endoscopy ergonomics project I developed later in the semester.
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