SDRME Sponsored Scholarship

The Society of Directors of Research in Medical Education periodically sponsors the preparation of a paper summarizing a review of the literature on a timely topic in medical education. An annual call for invited review proposals is announced and submissions are reviewed by the Invited Review Selection Committee. The following are the citations for the commissioned reviews to date.

Albanese, M. A. & Mitchell, S. Problem-based learning: a review of literature on its outcomes and implementation issues. Academic Medicine, 1993, 68, 52-81.

The effects of problem-based learning (PBL) were examined by conducting a meta-analysis-type review of the English-language international literature from 1972 to 1992. Compared with conventional instruction, PBL, as suggested by the findings, is more nurturing and enjoyable; PBL graduates perform as well, and sometimes better, on clinical examinations and faculty evaluations; and they are more likely to enter family medicine. Further, faculty tend to enjoy teaching using PBL. However, PBL students in a few instances scored lower on basic sciences examinations and viewed themselves as less well prepared in the basic sciences than were their conventionally trained counterparts. PBL graduates tended to engage in backward reasoning rather than the forward reasoning experts engage in, and there appeared to be gaps in their cognitive knowledge base that could affect practice outcomes. The costs of PBL may slow its implementation in schools with class sizes larger than 100. While weaknesses in the criteria used to assess the outcomes of PBL and general weaknesses in study design limit the confidence one can give conclusions drawn from the literature, the authors recommend that caution be exercised in making comprehensive, curriculum-wide conversions to PBL until more is learned about (1) the extent to which faculty should direct students throughout medical training, (2) PBL methods that are less costly, (3) cognitive-processing weaknesses shown by PBL students, and (4) the apparent high resource utilization by PBL graduates.

Irby, D. M. Teaching and learning in ambulatory care settings: a thematic review of the literature. Academic Medicine, 1995, 70, 898-931.

A thematic review was conducted of the 1980-1994 research literature on teaching and learning in ambulatory care settings for both undergraduate and graduate medical education. Included in the review were 101 data-based research articles, along with other articles containing helpful recommendations for improving ambulatory education.

The studies suggest that education in ambulatory care clinics is characterized by variability, unpredictability, immediacy, and lack of continuity. Learners often see a narrow range of patient problems in a single clinic and experience limited continuity of care. Few cases are discussed with attending physicians and even fewer are examined by them. Case discussions are short in duration, involve little teaching, and provide virtually no feedback. Excellent teachers are described as physician role models, effective supervisors, dynamic teachers, and supportive persons. Rather than block rotations, students and residents prefer longitudinal teaching programs, which offer continuity-of-care experiences with patients and preceptors. Although little can be concluded about learning outcomes, the studies indicate that some medical students and residents have deficient skills in interviewing, physical examination, and management of psychosocial issues.

Based on the reviewed studies, the author recommends facilitating learning by increasing continuity-of-patient-care experiences and contact with faculty members, encouraging collaborative and self-directed learning, providing faculty development, and strengthening assessment and feedback procedures. The author also recommends further research to learn about medical specialties other than internal medicine and family medicine, to describe the knowledge and reasoning of both teachers and learners, and to assess the influences of various educational programs on learning and satisfaction.



Regehr, G. & Norman, G. R. Issues in cognitive psychology: implications for professional education. Academic Medicine, 1996, 71, 988-1001.

Education and cognitive psychology have tended to pursue parallel rather than overlapping paths. Yet there is, or should be, considerable common ground, since both have major interests in learning and memory. This paper presents a number of topics in cognitive psychology, summarizes the findings in the field, and explores the implications for teaching and learning.

The organization of long-term memory: The acquisition of expertise in an area can be characterized by the development of idiosyncratic memory structures called semantic networks, which are meaningful sets of connections among abstract concepts and/or specific experiences. Information (such as the assumptions and hypotheses that are necessary to diagnose and manage cases) is retrieved through the activation of these networks. Thus, when teaching, new information must be embedded meaningfully in relevant, previously existing knowledge to ensure that it will be retrievable when necessary.

Influences on storage and retrieval from memory: A wide variety of variables affect the capacity to store and retrieve information from memory, including meaning, the context and manner in which information is learned, and relevant practice in retrieval. Educational strategies must, therefore, be directed at three goals--to enhance meaning, to reduce dependence on context, and to provide repeated relevant practice in retrieving information.

Problem solving and transfer: Much of the development of expertise involves the transition from using general problem-solving routines to using specialized knowledge that reduces the need for classic "problem solving." Two manifestations of this specialized knowledge are the use of analogy and the specialization of general routines in specific domains. To develop these specialized forms of knowledge, the learner must have extensive practice in using relevant problem-solving routines and in identifying the situations in which a particular routine is likely to be useful.

Concept formation: Experts possess both abstract prototypical information about categories and an extensive set of separate, specific examples of categories, which have been obtained through individual experience. Both these sources of information are used in categorization and diagnostic classifications. Thus, it is important for educators to be aware that experience with sample cases is not just an opportunity to apply and practice the rules "at the end of the chapter." Instead, experience with cases provides an alternative method of reasoning that is independent of, but equally useful to, analytical rules.

Decision making: Experts clearly do not use classic formal decision theory, but rather make use of heuristics, or shortcuts, when making decisions. Nonetheless, experts generally make appropriate decisions. This suggests that the shortcuts are useful more often than not. Rather than teaching learners to avoid heuristics, then, it might be more reasonable to help them recognize those relatively infrequent situations where their heuristics are likely to fail.



Xu, G., Hojat, M., Veloski, J.J., & Gonnella, J.S. The changing health care system: A research agenda for medical Education. Evaluation & the Health Professions, 1999, 22, 152-168.

The volatility in the U.S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.