Week 10 – Other Perspectives / Influencers

Summary: This week we discussed the concepts of situated cognition and legitimate peripheral participation.

In reviewing the readings this week, I took the opportunity to reflect on the value of cases and digital simulation in Medical Education.

My learning activity for this course focuses on the use of cases to construct a medical narrative and provide students with an opportunity to apply integrated knowledge in addressing an “authentic” problem. However, Brown, Collens and Duguid’s discussion on Situated Cognition made me realize that no matter how authentically we attempt to recreate a clinical scenario, there are certain elements of the clinical setting that are very challenging to create digitally, including the pace that information is unveiled and peripheral features such as the chaos of a clinical setting, competing demands of multiple tasks, the discourse of other members of the community of practice, and so on. There is also, of course, the fact that digital simulations are less high stakes that actually patient interactions and that digital simulations offer learners the opportunity to have a “re-do”, thus the context and purpose of these interactions is transmuted.

Furthermore, if one of the purposes of learning is enculturation, as discussed in earlier weeks, than an authentic and comprehensive experience is especially important in order for learners to experience both the explicit knowledge that would be captured in a simulation as well as the implicit cultural practices that the case/simulation writers may not be fully aware of and thus incapable of capturing in the simulation. The concern then is that through the use of solely simulation, it’s possible that students can “misconceive entirely what practitioners actually do (Brown et. al., 1989, p. 34).

This is not to say that I now devalue the use of cases and digital simulation as a teaching tool but I think it’s important to realize that even the most robust cases/simulations will be ersatz to some degree, and should be used as a prelude to or complement of authentic clinical practice.

REFERENCES

• Brown, J. S., Collins, A. & Duguid, P.  (1989). Situated Cognition and the Culture of Learning. Educational Researcher, Vol 18(1), 32-42.
• Lave, J., & Wenger, E. (1990). Chapter 1 in Situated Learning: Legitimate Peripheral Participation. Cambridge, UK: Cambridge University Press.