From Basic Science Knowledge to Clinical Understanding

The aim of the thesis was to expand our understanding of medical students learning of medicine through a longitudinal perspective on the medical curriculum. The development of medical knowledge was illustrated through mapping of two basic science subjects – anatomy and physiology – over the course of the curriculum. Thus, it was analysed in what sense these subject areas function as a knowledge foundation for later clinical studies. Interviews with first and fifth year medical students made up the main source of data used to analyse their experience of learning. A contrasting retention test was also given. The interviews were analysed according to the phenomenographic approach. The first study focused on how medical students learn anatomy. Three categories of description sum up their experience: Learning anatomy as Memorising, as Contextualising and as Experiencing. The second study dealt with anatomy from a clinical perspective. The retrospective view of anatomy yielded four categories: Contextualising, Visualising, Selection and Anatomical Language. In revealing the experience of the students, important content characteristics of the discipline were also found. The third study concerned medical physiology in a clinical setting. Medical students were asked to give an account of a scenario involving basic physiology and biochemistry. Three categories were outlined: A chain of mutually interdependent physiological and biochemical sub-mechanisms, Juxtaposed physiological and biochemical mechanisms and Fragmented physiological and biochemical mechanisms. The fourth study consisted of a contrasting analysis between phenomenographic categories and result on a retention test. Central characteristics of anatomy and physiology as well as medical students’ approaches to learning were revealed. Concepts like memorising, understanding, causality and context feature as important components of the analytical frame of reference in addition to being enriched and clarified by the findings. The thesis adds to the knowledge about medical students learning through its comprehensive account of learning in anatomy and physiology; it adds methodologically to the research area of medical education through the consequent use of phenomenography; and it adds to the field of research on learning in general through its focus on understanding of complex systems. LIST OF PUBLICATIONS I. Wilhelmsson, N. , Dahlgren, L.O. , Hult, H. , Scheja, M. , Lonka, K. , Josephson, A. (2009) The Anatomy of Learning Anatomy, Advances in Health Science Education. Published online 24 of June 2009. DOI 10.1007/s10459-009-91715 II. Wilhelmsson, N. , Dahlgren, L.O. , Hult, H. , Josephson, A. (2010a) On the Anatomy of Understanding. Manuscript accepted for publication in Studies in Higher Education. In Press March 2011. III. Wilhelmsson, N. , Dahlgren, L.O. , Hult, H. , Wirell, S. , Ledin, T. , Josephson, A. (2010b) Lost in the woods – Basic science knowledge transformation amongst PBL and traditional curriculum senior medical students – a phenomenographic study. Submitted manuscript. IV. Wilhelmsson, N. , Bolander Laksov, K. , Dahlgren, L.O. , Hult, H. , Nilsson, G. , Ponzer, S. , Smedman, L. , Josephson, A. (2010c) Retention and long-term understanding of basic science knowledge in medical students – A mixed method approach. Submitted manuscript.