Integrated and Contextual Basic Science Instruction in Preclinical Education: Problem-Based Learning Experience Enriched with Brain/Mind Learning Principles.

The revisiting of learning approaches and models developed on the basis of constructivist theories and the integration of these with the new evidence obtained from neuroscience studies provide a new interdisciplinary perspective and create an infrastructure for education. With the impact of the constructivist approach, learning characteristics and individual differences, real-life coherence, complexity, and contextuality/situativity with contextualized/situated cognition and learning have become more important. Consequently, the focus of learning activities has shifted to integrating related basic, clinical, and sociobehavioral knowledge and cognitive and metacognitive strategies with process-oriented learning and teaching; decision making/problem solving; reflective practice and thinking; and positive motivational, emotional, and sociocultural climate. All these support deeper knowledge and enrich learning experiences (Caine & Caine, 2010, p. 11-32; Caine, Caine, McClintic, & Klimek, 2005, p. 1-14; Durning & Artino, 2011; Fischer, 2009; Mennin, 2007, 2010; Wilkerson, Stevens, & Krasne, 2009; Vermunt & Verloop, 1999). During the last three decades, the major viewpoint in medical education was to bring clinical context to earlier years and increase the integration among the basic, clinical, and social sciences (Norman, 2009; Wilkerson et al., 2009). Accordingly, during the preclinical period, problem-based learning (PBL) and scenario-based learning are widely used, whereas during the clinical training period, task-based learning and work-based learning are preferred. Evaluations of PBL, in general, have provided evidence that this model is effective, but some common problems have also emerged during its application. For example, a meta-analysis conducted with 43 selected articles indicated that students in PBL conditions are better at both remembering the acquired knowledge and applying it (Dochy, Segers, Van den Bossche, & Gijbels, 2003). Nevertheless, research focusing on PBL-related learning processes such as deep and meaningful learning, student motivation and participation, and group dynamics has revealed some problems. The major problems experienced are as follows: converting the method into routine and mechanical steps, inadequate integration or deep processing of knowledge, insufficient individual preparation, and poor group dynamics with unsatisfactory student participation (Antepohl, Domeij, Forsberg, & Ludvigsson, 2003; de Grave, Dolmans, & van der Vleuten, 2001, 2002; Khoo, 2003; Moust, Roebertsen, Savelberg, & de Rijk, 2002). Regarding the PBL tutorial group learning process, one of these studies conducted with 200 first- to third-year medical students investigated students' perceptions of the occurrence of critical incidents and their inhibitory effects on group functioning (de Grave et al., 2002). Among six critical incidents (i.e., lack of elaboration, lack of interaction, unequal participation, lack of cohesion, difficult personalities, and lack of motivation), unequal participation, lack of interaction, and lack of elaboration were the most frequent success inhibitors. According to students' perception, lack of motivation and lack of elaboration were the two prominent inhibitors of learning in the tutorial groups, highlighting the strong impact of motivational influences on tutorial group functioning.The abovementioned problems that emerged during the PBL tutorial group emphasize that studies focusing more on learning process as a whole along with its different components should be conducted. According to complex theory and contextualized cognition and learning theory, a holistic approach is needed for small-group interactive learning processes such as PBL. Therefore, in such studies, not only cognitive and metacognitive but also motivational and sociocultural components should be considered. In this context, the evaluation of PBL learning should include both decision making/problem solving with cognitive and metacognitive components and the learning experience as a socialization process with affective, motivational, and sociocultural components (Ntyonga-Pono, 2006; Vermunt & Vermetten, 2004). …