Missing "the little things that make you human": medical students' experiences of digital teaching and learning


Recent decades have seen a significant global scale-up in the training of doctors with an increased pressure on training resources. This thesis began with a question about how scalable digital materials could be designed to support medical students’ learning of clinical reasoning - the process of making informed judgements about the likely causes and best action to be taken when faced with a clinical problem. My initial research was underpinned by an assumption that it would be possible to design digital tools that students would find as motivating as face-to-face encounters. However, my early empirical work using design research raised doubts about that and caused me to take a step back and examine medical students’ digital learning engagement more generally.
In this thesis, I ask the question: why, and in what ways, is digital learning engagement different from face-to-face learning engagement? I test a hypothesis about digital learning engagement that is derived from Silvan Tomkins’ Script Theory, using a series of repertory grid interviews with clinical medical students. I have taken an ontological position on the human mind, arguing that it is an embodied entity that actively scans the environment looking for meaning, and in which learning is driven by curiosity but motivated by the affective response of interest-excitement. Although Tomkins provides my main theoretical framework, I have triangulated his ideas with George Kelly’s Personal Construct Psychology, partly to add extra metaphorical depth, but also because Kelly’s theory offers a logic of enquiry and a method that I did not find in Tomkins. I also draw on Alexander Bain’s ontological description of the embodied mind, but update this with more contemporary ideas about perception and curiosity.
My script theoretical hypothesis was not supported by the empirical data, because it was based on a false assumption that students’ engagement with digital learning was superficial. However, several important findings emerged. Medical students, on the whole, appreciate the convenience and safety of digital learning but do not actually enjoy it. Students experience digital learning as lonely and perceptually poor, and they explicitly link this to difficulty in sustaining attention. I contextualise these findings within the idea of the embodied, curious, affect-susceptible mind, and argue that a sense of place is important for learning, as is the real presence of others. Learning in three-dimensional “real” worlds allows students to derive meanings from place and person that support the affective response of interest-excitement. This, in turn, supports sustained attention.
I argue that when considering learning media, we should distinguish between the efficient and the human, identifying the contexts in which the efficiency gains of digital media outweigh the de-humanising nature of digital learning, and continuing to value the human attributes of face-to-face teaching and learning.

Keywords: repertory grid method
medical student
affective response to learning
Advisor: Winters, N
Geniets, A