Medical Education

  • Tim DornanEmail author
  • Pim W. Teunissen
Part of the Springer International Handbooks of Education book series (SIHE)


Educating the next generation of doctors is closely linked with caring for patients. Everyone learns to be a doctor in and through practice, and it is a basic professional duty of every doctor to help others learn to be doctors. This chapter defines what attributes of medicine shape its contribution to the wider scholarship of practice-based learning. It identifies tensions: Is medical practice applied science, or is it a practice that is informed by science? Is it just biomedical science that is relevant or do behavioural and social sciences contribute? Can art, music, literature, language study or other fields of study usefully contribute to making doctors? We describe admission to medicine, preparation for practice, practice-based learning, and continued learning in practice in ways that might give useful insights to other walks of life. The conceptual landscape of medical practice-based learning is broadening from one dominated by psychology to one that derives valuable insights from sociocultural theory. Both conceptual orientations have much to say about what many now regard as the central feature of medical education: Identity development. It is not a smooth incremental process so much as one in which transitions along a trajectory of identity development alternate with periods of identity consolidatation. We offer two models developed through our own research that conceptualise medical practice-based learning in its basic and post-basic stages. Medicine’s contribution, we conclude, is to show how the expertise of seasoned professionals can be made accessible to novices in a scholarly way under the conditions of twenty-first-century society.


Workplace learning Practice-based learning Clerkship Residency Transition Identity 


  1. Archer, J. C. (2010). State of the science in health professional education: Effective feedback. Medical Education, 44(1), 101–108. doi: 10.1111/j.1365-2923.2009.03546.x.CrossRefGoogle Scholar
  2. Ashley, P., Rhodes, N., Sari-Kouzel, H., Mukherjee, A., & Dornan, T. (2009). They’ve all got to learn. Medical students’ learning from patients in ambulatory consultations. Medical Teacher, 31, e24–e31.CrossRefGoogle Scholar
  3. Bell, K., Boshuizen, H., Scherpbier, S., & Dornan, T. (2009). When only the real thing will do. Junior medical students’ learning from real patients. Medical Education, 43, 1036–1043.CrossRefGoogle Scholar
  4. Bezemer, J., Kress, G., Cope, A., & Kneebone, R. (2012). Learning in the operating theatre: A Social semiotic perspective. In V. Cook, C. Daly, & M. Newman (Eds.), Social-cultural perspective on work based learning in clinical practice. Abingdon: Radcliffe Medical Press.Google Scholar
  5. Billett, S. (2004a). Learning in the workplace: Reappraisals and reconceptions. In G. Hayward & S. James (Eds.), Skills, knowledge and organisational performance (pp. 149–170). Bristol: Policy Press.Google Scholar
  6. Billett, S. (2004b). Workplace participatory practices: Conceptualising workplaces as learning environments. The Journal of Workplace Learning, 16, 312–324.CrossRefGoogle Scholar
  7. Billett, S. (2006). Constituting the workplace curriculum. Journal of Curriculum Studies, 38, 31–48.CrossRefGoogle Scholar
  8. Bogg, J., Gibbs, T., & Bundred, P. (2001). Training, job demands, and mental health of pre-registration house officers. Medical Education, 35, 590–595.CrossRefGoogle Scholar
  9. Bravata, D. M., Huot, S. J., Abernathy, H. S., & Skeff, K. M. (2003). The development and implementation of a curriculum to improve clinicians’ self-directed learning skills: A pilot project. BMC Medical Education, 3, 7.CrossRefGoogle Scholar
  10. Brown, J., Ryland, I., Shaw, N., & Graham, D. (2009). Working as a newly appointed consultant: A study into the transition from specialist registrar. British Journal of Hospital Medicine (London, England), 70, 410–414.Google Scholar
  11. Burks, D. J., & Kobus, A. M. (2012). The legacy of altruism in health care: The promotion of empathy, prosociality and humanism. Medical Education, 46(3), 317–325. doi: 10.1111/j.1365-2923.2011.04159.x.CrossRefGoogle Scholar
  12. Cervero, R. M. (2003). Place matters in physician practice and learning. Journal of Continuing Education in the Health Professions, 23(Suppl 1), S10–S18.CrossRefGoogle Scholar
  13. Cheetham, G., & Chivers, G. (2005). Professions, competence and informal learning. Cheltenham: Edward Elgar.Google Scholar
  14. Cooke, M., Irby, D. M., & O’Brien, B. C. (2010). Educating physicians: A call for reform of medical school and residency. Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass.Google Scholar
  15. De Feijter, J. M., De Grave, W. S., Dornan, T., Koopmans, R. P., & Scherpbier, A. J. J. A. (2011). Students’ perceptions of patient safety during the transition from undergraduate to postgraduate training: An activity theory analysis. Advances in Health Sciences Education: Theory and Practice, 16(3), 347–358. doi: 10.1007/s10459-010-9266-z.CrossRefGoogle Scholar
  16. Dornan, T. (2005). Osler, Flexner, apprenticeship, and the new medical education. Journal of the Royal Society of Medicine, 98, 91–95.CrossRefGoogle Scholar
  17. Dornan, T., Hadfield, J., Brown, M., Boshuizen, H., & Scherpbier, A. (2005). How can medical students learn in a self-directed way in the clinical environment? Design-based research. Medical Education, 39, 356–364.CrossRefGoogle Scholar
  18. Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students’ workplace learning. Medical Education, 41, 84–91.CrossRefGoogle Scholar
  19. Dornan, T., Muijtjens, A., Graham, J., Scherpbier, A., & Boshuizen, H. P. A. (2012). Manchester Clinical Placement Index (MCPI). Conditions for medical students’ learning in hospital and community placements. Advances in Health Sciences Education: Theory and Practice, 17, 703–716. doi: 10.1007/s10459-011-9344-x.CrossRefGoogle Scholar
  20. Dornan, T., Tan, N., Boshuizen, H., Gick, R., Isba, R., Mann, K., Scherpbier, A., et al. (2014). Experience based learning (eXBL). How and what do medical students learn in clerkships? Experience based learning (ExBL). Advances in Health Sciences Education (in press).Google Scholar
  21. Engestrom, Y., & Miettinen, R. (1999). Introduction. In Y. Engestrom, R. Miettinen, & R. Punamaki (Eds.), Perspectives on activity theory (pp. 1–16). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  22. Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26, 247–273.CrossRefGoogle Scholar
  23. Flexner, A. (1910). Medical education in the United States and Canada: A report to the Carnegie Foundation for the advancement of teaching. New York: Carnegie Foundation.Google Scholar
  24. Frank, J. R., & Danoff, D. (2007). The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. Medical Teacher, 29(7), 642–647. doi: 10.1080/01421590701746983.CrossRefGoogle Scholar
  25. Gaufberg, E. H., Batalden, M., Sands, R., & Bell, S. K. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections. Academic Medicine, 85, 1709–1716.CrossRefGoogle Scholar
  26. General Medical Council. (2006). Good medical practice. London: General Medical Council.Google Scholar
  27. Griffith, C. H., & Wilson, J. F. (2001). The loss of student idealism in the 3rd-year clinical clerkships. Evaluation & the Health Professions, 24(1), 61–71. doi: 10.1177/01632780122034795.CrossRefGoogle Scholar
  28. Guba, E. G., & Lincoln, Y. S. (2000). Paradigmatic controversies, contradictions, and emerging influences. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 191–215). Thousand Oaks: Sage Publications.Google Scholar
  29. Hannon, F. B. (2000). A national medical education needs’ assessment of interns and the development of an intern education and training programme. Medical Education, 34, 275–284.Google Scholar
  30. Helmers, K. F., Danoff, D., Steinert, Y., Leyton, M., & Young, S. N. (1997). Stress and depressed mood in medical students, law students, and graduate students at McGill University. Academic Medicine, 72, 708–714.CrossRefGoogle Scholar
  31. Helmich, E., & Dornan, T. (2012). Do you really want to be a doctor? The highs and lows of identity development. Medical Education, 46(2), 132–134. doi: 10.1111/j.1365-2923.2011.04189.x.CrossRefGoogle Scholar
  32. Jarvis-Selinger, S., Pratt, D., & Regehr, G. (2012). Is competency-based medical education enough? Adding identity formation to the conversation about physician development. Academic Medicine, 87(9), 1185–1190.CrossRefGoogle Scholar
  33. Jha, V., Setna, Z., & Roberts, T. (2012). Assessment in natural settings in obstetrics and gynaecology; insights from a guided learning perspective. In V. Cook, C. Daly, & M. Newman (Eds.), Learning in clinical settings: Insights from social-cultural perspectives. Abingdon: Radcliffe Medical Press.Google Scholar
  34. Jolly, B. (1998). Historical and theoretical background. In B. Jolly & L. Rees (Eds.), Medical education in the new millennium. Oxford: Oxford Medical Publications.Google Scholar
  35. Kim, B. (2001). Social constructivism. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Georgia: Department of Educational Psychology and Instructional Technology, University of Georgia.Google Scholar
  36. Kuper, A., & D’Eon, M. (2011). Rethinking the basis of medical knowledge. Medical Education, 45, 36–43.CrossRefGoogle Scholar
  37. Lave, J., & Wenger, E. (1991). Situated learning. Legitimate peripheral participation. Situated learning. Legitimate peripheral participation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  38. Lempp, H., Cochrane, M., Seabrook, M., & Rees, J. (2004). Impact of educational preparation on medical students in transition from final year to PRHO year: A qualitative evaluation of final-year training following the introduction of a new Year 5 curriculum in a London medical school. Medical Teacher, 26, 276–278.CrossRefGoogle Scholar
  39. Ludmerer, K. M. (2011). Abraham Flexner and medical education. Perspectives in Biology and Medicine, 54(1), 8–16. doi: 10.1353/pbm.2011.0009.CrossRefGoogle Scholar
  40. Lyon, P. (2004). A model of teaching and learning in the operating theatre. Medical Education, 38, 1278–1287.CrossRefGoogle Scholar
  41. Lyons, A., & Petrucelli, R. (1987). Medicine. An illustrated history. New York: Abrams.Google Scholar
  42. MacLeod, A. (2011). Caring, competence and professional identities in medical education. Advances in Health Sciences Education: Theory and Practice, 16, 375–394.CrossRefGoogle Scholar
  43. Mann, K., Dornan, T., & Teunissen, P. W. (2011). Perspectives on learning. In Medical education, theory and practice (pp. 11–38). Edinburgh: Churchill-Livingstone.Google Scholar
  44. McConnell, M. M., & Eva, K. W. (2012). The role of emotion in the learning and transfer of clinical skills and knowledge. Academic Medicine: Journal of the Association of American Medical Colleges, 87(10), 1–7. doi: 10.1097/ACM.0b013e3182675af2.CrossRefGoogle Scholar
  45. McLachlan, E., King, N., Wenger, E., & Dornan, T. (2012). Phenomenological analysis of patients’ experiences of medical student teaching encounters. Medical Education, 46(10), 963–973.CrossRefGoogle Scholar
  46. Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44(1), 40–49. doi: 10.1111/j.1365-2923.2009.03440.x.CrossRefGoogle Scholar
  47. Moore, D., Green, J., Jay, S., Leist, J., & Maitland, F. (1994). Creating a paradigm for CME: Seizing opportunities within the health care revolution. The Journal of Continuing Education in the Health Professions, 14, 4–31.CrossRefGoogle Scholar
  48. Morcke, A., Dornan, T., & Eika, B. (2013). Competence and outcome based education. An exploration of its origins, theoretical basis, and empirical evidence. Advances in Health Sciences Education: Theory and Practice, 18, 851–863.Google Scholar
  49. Nicholson, N. (1984). A theory of work role transitions. Administrative Science Quarterly, 29, 172–191.CrossRefGoogle Scholar
  50. Norcini, J. J., Blank, L. L., Arnold, G. K., & Kimball, H. R. (1995). The mini-CEX (Clinical evaluation exercise): A preliminary investigation. Annals of Internal Medicine, 123, 795–799.CrossRefGoogle Scholar
  51. Norman, G., Dore, K., & Grierson, L. (2012). The minimal relationship between simulation fidelity and transfer of learning. Medical Education, 46(7), 636–647. doi: 10.1111/j.1365-2923.2012.04243.x.CrossRefGoogle Scholar
  52. O’Neill, P. A., Willis, S. C., & Jones, A. (2002). A model of how students link problem-based learning with clinical experience through “elaboration”. Academic Medicine, 77, 552–561.CrossRefGoogle Scholar
  53. Petersdorf, R. G. (1994). Medical curriculum, training, and the continuum of medical education. Journal of the Royal Society of Medicine, 87(Suppl 2), 47–49.Google Scholar
  54. Reber, A. S. (1993). Implicit learning and tacit knowledge: An essay in the cognitive unconscious. Oxford: Oxford University Press.Google Scholar
  55. Roth, W. M., & Lee, Y. J. (2007). “Vygotsky’s Neglected Legacy”: Cultural-historical activity theory. Review of Educational Research, 77(2), 186–232.CrossRefGoogle Scholar
  56. Scheele, F., Teunissen, P., Van, L. S., Heineman, E., Fluit, L., Mulder, H., Meininger, A., et al. (2008). Introducing competency-based postgraduate medical education in the Netherlands. Medical Teacher, 30, 248–253.CrossRefGoogle Scholar
  57. Schmidt, H. G., & Rikers, R. M. (2007). How expertise develops in medicine: Knowledge encapsulation and illness script formation. Medical Education, 41, 1133–1139.Google Scholar
  58. Schmidt, H. G., Rotgans, J. I., & Yew, E. H. J. (2011). The process of problem-based learning: What works and why. Medical Education, 45(8), 792–806. doi: 10.1111/j.1365-2923.2011.04035.x.CrossRefGoogle Scholar
  59. Sfard, A. (1998). On two metaphors for learning and the dangers of choosing just one. Educational Researcher, 27, 4–13.CrossRefGoogle Scholar
  60. Shah, P., Smithies, A., Dexter, H., Snowden, N., & Dornan, T. (2014). How do residents learn through work? Case study in rheumatology (in preparation).Google Scholar
  61. Sheehan, D., Wilkinson, T., & Billett, S. (2005). Interns’ participation and learning in clinical environments in a New Zealand hospital. Academic Medicine, 80, 302–308.CrossRefGoogle Scholar
  62. Singh, M., Rhodes, L. R., & Dornan, T. (2014). Boundaries and bridges: Access to undergraduate learning in minor specialties (in preparation).Google Scholar
  63. Siu, E., & Reiter, H. I. (2009). Overview: What’s worked and what hasn't as a guide towards predictive admissions tool development. Advances in Health Sciences Education: Theory and Practice, 14(5), 759–775. doi: 10.1007/s10459-009-9160-8.CrossRefGoogle Scholar
  64. Stanley, A. G., Williams, B., & Gallen, D. (2005). A novel foundation-year-two post in academic medicine. Journal of the Royal Society of Medicine, 98, 10–13.CrossRefGoogle Scholar
  65. Steven, K., Wenger, E., Boshuizen, H., Scherpbier, A., & Dornan, T. (2014). How clerkship student learn from real patients in workplaces. Academic Medicine (in press).Google Scholar
  66. Sutton, A., Tan, N., & Dornan, T. (2011). Morality and philosophy of medicine and education. In T. Dornan, K. Mann, A. Scherpbier, & J. Spencer (Eds.), Medical education. Theory and practice (pp. 3–16). Edinburgh: Churchill Livingstone.Google Scholar
  67. Testerman, J. K., Morton, K. R., Loo, L. K., Worthley, J. S., & Lamberton, H. H. (1996). The natural history of cynicism in physicians. Academic Medicine, 71(10 Suppl), S43–S45.CrossRefGoogle Scholar
  68. Teunissen, P. W., & Dornan, T. (2008). Lifelong learning at work. BMJ, 336, 667–669.CrossRefGoogle Scholar
  69. Teunissen, P., & Westerman, M. (2011a). Opportunity or threat; ambiguity in the consequences of transitions in medical education. Medical Education, 45, 51–59.CrossRefGoogle Scholar
  70. Teunissen, P. W., & Westerman, M. (2011b). Junior doctors caught in the clash: The transition from learning to working explored. Medical Education, 45(10), 968–970. doi: 10.1111/j.1365-2923.2011.04052.x.CrossRefGoogle Scholar
  71. Teunissen, P. W., Boor, K., Scherpbier, A. J., Van der Vleuten, C. P., Diemen-Steenvoorde, J. A., Van Luijk, S. J., & Scheele, F. (2007a). Attending doctors’ perspectives on how residents learn. Medical Education, 41, 1050–1058.CrossRefGoogle Scholar
  72. Teunissen, P. W., Scheele, F., Scherpbier, A. J., Van der Vleuten, C. P., Boor, K., Van Luijk, S. J., & Diemen-Steenvoorde, J. A. (2007b). How residents learn: Qualitative evidence for the pivotal role of clinical activities. Medical Education, 41, 763–770.CrossRefGoogle Scholar
  73. Teunissen, P. W., Stapel, D. A., Van der Vleuten, C. P. M., Scherpbier, A., Boor, K., & Scheele, F. (2009). Who wants feedback? An investigation of the variables influencing residents’ feedback-seeking behavior in relation to night shifts. Academic Medicine, 84, 910–917.CrossRefGoogle Scholar
  74. Van der Vleuten, C. P. M., Schuwirth, L. W. T., Driessen, E. W., Dijkstra, J., Tigelaar, D., Baartman, L. K. J., & Van Tartwijk, J. (2012). A model for programmatic assessment fit for purpose. Medical Teacher, 34(3), 205–214.CrossRefGoogle Scholar
  75. Wallenburg, I., Helderman, J., de Bont, A., Scheele, F., & Meurs, P. (2012). Negotiating authority: A comparative study of reform in medical training regimes. Journal of Health Politics, Policy and Law, 37(3), 439–467. doi: 10.1215/03616878-.CrossRefGoogle Scholar
  76. Watling, C., Driessen, E., Van der Vleuten, C. P. M., & Lingard, L. (2012). Learning from clinical work: The roles of learning cues and credibility judgements. Medical Education, 46(2), 192–200. doi: 10.1111/j.1365-2923.2011.04126.x.CrossRefGoogle Scholar
  77. Wearne, S., Dornan, T., Teunissen, P., & Skinner, T. (2012). Family physicians as supervisors in postgraduate clinical education. An integrative review. Medical Education, 46, 1161–1173.CrossRefGoogle Scholar
  78. Wenger, E. (1998). Communities of practice. Learning, meaning and identity. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  79. Wertsch, J. V., Del Rio, P., & Alvarez, A. (1995). Sociocultural studies of mind. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  80. Westerman, M., Teunissen, P. W., Van der Vleuten, C. P. M., Scherpbier, A. J. J. A., Siegert, C. E. H., Van der Lee, N., & Scheele, F. (2010). Understanding the transition from resident to attending physician: A transdisciplinary, qualitative study. Academic Medicine, 85(12), 1914–1919. doi: 10.1097/ACM.0b013e3181fa2913.CrossRefGoogle Scholar
  81. White, C. B. (2007). Smoothing out transitions: How pedagogy influences medical students’ achievement of self-regulated learning goals. Advances in Health Sciences Education: Theory and Practice, 12, 279–297.CrossRefGoogle Scholar
  82. White, J. A., & Anderson, P. (1995). Learning by internal medicine residents: Differences and similarities of perceptions by residents and faculty. Journal of General Internal Medicine, 10, 126–132.CrossRefGoogle Scholar
  83. Yardley, S., Teunissen, P. W., & Dornan, T. (2012). Experiential learning: AMEE guide no. 63. Medical Teacher, 34(2), e102–e115. doi: 10.3109/0142159X.2012.650741.CrossRefGoogle Scholar

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© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of Educational Development and ResearchMaastricht UniversityMaastrichtThe Netherlands
  2. 2.Department of Obstetrics and GynaecologyVU University Medical CentreAmsterdamThe Netherlands

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