The knowing-doing gap in medical education

Tags: design

Related The knowing doing gap in design thinking, 

Applying the Knowing-Doing Gap to Medical Education

Harvard Business Review. (1999). The Smart-Talk Trap. [online] Available at: https://hbr.org/1999/05/the-smart-talk-trap  [Accessed 21 Oct. 2023].

The knowing-doing gap is the difference between knowing what to do and actually doing it. The above article argues that talk can be a substitute for action, especially when it is smart, critical, and complex. It also suggests five strategies to avoid the smart-talk trap and turn knowledge into action.

Here are some ways to apply these strategies to medical education, specifically in the context of GP tutors teaching medical students:

• Have tutors who know and do the work. GP tutors should be role models for their students, demonstrating clinical skills, communication skills, and ethical principles in practice. They should also be involved in curriculum design, assessment, and feedback, ensuring that the learning outcomes are aligned with the needs of the patients and the health system.

• Have a bias for plain language and simple concepts. GP tutors should avoid using jargon, acronyms, or technical terms that may confuse or intimidate their students. They should explain medical concepts in simple and clear ways, using examples, metaphors, analogies, or visual aids (see Concept mapping). They should also encourage their students to use plain language when communicating with patients, colleagues, and other health professionals.

• Frame questions by asking "how" not just "why." GP tutors should foster a culture of inquiry and problem-solving among their students, rather than a culture of criticism and blame. They should ask their students "how" questions that challenge them to apply their knowledge, skills, and attitudes to real-life scenarios. For example, "How would you diagnose this patient?" "How would you manage this condition?" "How would you communicate this information to the patient?" They should also help their students to find solutions to the problems they encounter, rather than just pointing out the flaws or errors.

• Have strong mechanisms that close the loop. GP tutors should provide timely and constructive feedback to their students, both verbally and in writing. They should also monitor their students' progress and performance, using various methods such as portfolios, logbooks, audits, or exams. They should ensure that their students act on the feedback they receive, by setting goals, making plans, and reflecting on their learning outcomes.

• Believe that experience is the best teacher. GP tutors should create opportunities for their students to learn by doing, rather than by listening or reading. They should expose their students to a variety of clinical settings, cases, and situations, where they can practice their skills, interact with patients, and work with other health professionals. They should also encourage their students to learn from their own experiences, as well as from the experiences of others, by sharing stories, insights, and lessons learned.

Here is an example of how a GP tutor could apply these strategies to their teaching:

A GP tutor is teaching a group of medical students about diabetes. The tutor begins by asking the students "why" questions, such as "What is diabetes?" and "What are the different types of diabetes?" The students answer the questions correctly, demonstrating that they have the necessary knowledge.

However, the tutor knows that simply knowing about diabetes is not enough. The students need to be able to apply their knowledge to real-life situations. So, the tutor switches to asking "how" questions. For example, "How would you diagnose a patient with diabetes?" "How would you manage a patient with type 1 diabetes?" "How would you communicate this information to a patient's family?"

The students struggle to answer these questions at first. But the tutor is patient and supportive, and they eventually come up with some good solutions. The tutor also shares their own experiences and insights with the students, helping them to learn from the experiences of others.

By the end of the session, the students have a deeper understanding of diabetes and how to manage it. They have also learned how to apply their knowledge to real-life situations. This is just one example of how GP tutors can use the knowing-doing gap framework to improve their teaching.

Related educational theories and pedagogy 

• Constructivism: A learning theory that emphasizes the active role of learners in constructing their own knowledge, based on their prior experiences, social interactions, and problem-solving skills. Constructivism is related to the knowing-doing gap because it suggests that learners need to apply their knowledge to real-world situations, rather than just memorizing facts or following instructions.

• Experiential learning: A learning theory that proposes that learning occurs through reflection on doing, rather than just passive observation or theoretical instruction. Experiential learning is related to the knowing-doing gap because it involves learning by doing, and by reflecting on the outcomes and feedback of one’s actions.

• Social cognitive theory: A learning theory that explains how people learn from observing others, and how they regulate their own behavior based on self-efficacy, goals, and outcomes. Social cognitive theory is related to the knowing-doing gap because it emphasizes the role of modeling, feedback, and self-regulation in learning and behavior change.

• Transformative learning: A learning theory that describes how learners can change their perspectives, assumptions, and beliefs through critical reflection, dialogue, and action. Transformative learning is related to the knowing-doing gap because it challenges learners to question their existing knowledge and practice, and to take action based on their new insights.

Reference

Harvard Business Review. (1999). The Smart-Talk Trap. [online] Available at: https://hbr.org/1999/05/the-smart-talk-trap  [Accessed 21 Oct. 2023].