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Example 2
Developing a Schema-based Diagram While Teaching
Scenario: The process of generating schema-based diagram (S-BD) can be used to reflect on practice-based knowledge and skills and refocus teaching to improve patient care.
You are an associate residency director for a large community-based Internal Medicine residency program and learned about Schema-based Learning at an educational conference. You decide to try to generate an S-BD to enhance your teaching in the ambulatory setting. You feel that you sometimes focus too much on “scientific information” and not enough on practice-based knowledge and skills.
The illustration below describes how you can promote Patient Care, Medical Knowledge, and Practice-Based Learning and Improvement by using a schema-based diagram to elaborate on the “wisdom of practice”. The learning objectives are that residents will (a) be exposed to methodologies (reflection and schema construction) for assessing their own knowledge and clinical thinking (Practice-Based Learning and Improvement); and (b) acquire new clinical knowledge about patients and its application to clinical decision-making. (Medical Knowledge and Patient Care)
Illustration:
The process of generating a S-BD can help experienced clinicians bring to a conscious level much of the practice-based learning they have gained through experience. In this illustration the associate residency director has had a patient encounter video-taped. She asked that one of the medical educators from the dean’s office view the tape with her. During the viewing of the video, the educator asked her questions about what she was thinking during different segments of the history and physical. At the end of the interview the educator reviewed with her the list of practice-based capabilities and categorical terms that she used in describing her thoughts about the patient encounter. From that list, she selected two of these features to further elaborate. One of the categorical terms she used described the patient as a “poor historian” (click to see historian S-BD or see Attachment 3). The second feature she chose focused on the capability of “enlisting family members to support the patient when needed” (click to see family S-BD or see Attachment 4). She repeated the process of viewing the videotape with a group of residents during a noon conference. She shared with the residents her “discovery” of the two practice-based capabilities that had been highlighted through this reflective process. Together with the residents she generated a SB-D for each. By reflecting on her own practice and making explicit what had previously been tacit or hidden, the associate residency director models reflective practice, teaches residents to value practice-based knowledge and skills and employ those skills in caring for their patients.
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