REASONING AND INSTRUCTION IN MEDICAL CURRICULA

We describe two experiments that examine the knowledge and explanatory processes of students in two medical schools with different modes of instruction. One school had a conventional curriculum with basic scien ce courses taught 1 1/2 years before the clinical training; the other had a problem-based learning curriculum with basic science taught in t he context of clinical problems and general problem-solving strategies involving knowledge elaboration and hypothetico-deductive reasoning. Both before and after being exposed to relevant basic science informat ion, students were asked to provide diagnostic explanations of a clini cal case. In this study, students in the problem-based learning curric ulum reasoned in a manner consistent with the way they were taught, us ing a backward directed pattern of reasoning and extensive elaboration s based on detailed biomedical information. However, these students ha d a greater tendency to commit errors of scientific fact, to generate less coherent explanations, and to use flawed patterns of explanation, such as circular reasoning. These results are viewed as reflecting th e operation of two factors: context and method of instruction. The int eraction between these factors is expressed in terms of the hypothesis that basic science and clinical knowledge constitute two different wo rlds.