Learning in Context
An effective professional program prepares students for the conditions they will meet in practice by making the challenges they face in graduate education mirror those they will encounter in professional life (Barrows, 1986; Baskett & Marsick, 1992; Boyer, 1990; Cavanaugh, 1993; Harris, 1993; Hmelo-Silver & Barrows, 2006; Jennet & Pearson, 1992; McParland, Noble & Livingston, 2004; Merrill, 2007; Norman & Schmidt, 1992; Schön, 1987, 1995; Slotnick, 1996). This entails re-orienting professional education to focus on practical applications of knowledge in anticipation of the realities of practice (Barr & Tagg, 1995; Benson & Lewis, 1994; Boyer, 1990; Fox, 1994; Gold, 1993; Macallan, Kent, Holmes, Farmer & McCrorie, 2009; Peterson, 1985, 1987; Peterson et al., 1997; Rice, 1991). Studies in cognitive psychology reveal that expertise - pragmatic knowledge, or "knowing how" - is a form of knowledge acquired through practical experience (Curry & Makoul, 1996; Farnham-Diggory, 1994; Jarvis, 1992; Lewicki, Hill, & Czyzewska, 1992; Regehr & Norman, 1996; Rubinstein & Firstenberg, 1987; Willingham, Nissen, & Bullemer, 1989; Zeitz & Spoehr, 1989). This is because "learning in a clinical context causes the information that is being acquired to be organized or structured in the mind in ways that are useful to clinical tasks" (Barrows, 1985, p. 4). Further, contextual learning as the basis of clinical education fosters not only technical skill, but provides:
[the] opportunity to use higher order, more clinically relevant reasoning skills in applying this information to situations that resemble future professional tasks in ways that will reinforce the usefulness and likely recall of this important information in both the contexts and the cognitive processes used in later clinical work. (Barrows, 1986, p. 24)
Thus, the successful use of scientific knowledge in the actual clinical context is more likely if that the information has been learned in conjunction with work with patients (Barrows, 1985, 1986; Chang, Cook, Maguire, Shakun, Yakimets, & Warnock, 1995; Jarvis, 1992; Jennett & Pearson, 1992; Regehr & Norman, 1996). As pointed out by Barrows, "the cues that appear while working in the task situation will stimulate retrieval of the appropriate information through memory associations" (1985, p. 4). Many professional schools, particularly medical schools, have instituted curricular changes that facilitate learning clinical skills in a clinical context (Chang et al., 1995; Des Marchais & Vu, 1996; Kaufman, Mennin, Waterman, Duban, Hansbarger, Silverblatt et al., 1989; Norman & Schmidt, 1992; Taylor & Miflin, 2008). Most notable of the curriculum reforms is the New Pathway Program at Harvard Medical School, which incorporates an experiential approach to the study of medicine. The curriculum facilitates the development of physicians who practice "science-in-action" by exposing students to practical clinical experience from the first day (Barrows, 1986; Moore et al., 1990; Moore, Block, Style, & Mitchell, 1994; Rice, 1991; Tosteson, Adelstein, & Carver, 1994). Meta-analyses and literature reviews show the superior performance of students on knowledge application measures, when trained in context using problem-based curricula (viz., Colliver, 2000; Dochy, Segers, Van den Bossche, & Gijbels, 2003; Hmelo-Silver, Duncan, & Chinn, 2007; Tan, 2005).