Comparison of factual and action knowledge in year 5 and year 6 medical students

Dear Sir

According to Bloom's taxonomy (Bloom 1956), it is usual to distinguish several levels in the cognitive domain of knowledge. In this classification, a graduation is made between factual knowledge representing a basic level, action knowledge (procedural or conditional) implicated in the data synthesis relating to an intermediate level and strategies for problem-solving corresponding to the highest level.

Our objective was to compare factual and action knowledge evolution in year 5 (n = 116) and year 6 (n = 112) medical students attending a problem based-learning course.

We used two series of 10 short-answer questions (SAQ) to evaluate factual knowledge and a test consisting in writing the solutions of clinically simulated problems to evaluate action knowledge (Wass 2001). Two year 4 learning objectives were randomly selected (thoracic pain and acute ischemia of the leg). Theoretical learning sessions were identical for year 5 and year 6 students.

The internal reliability was satisfactory for the simulated problems (0.6 and 0.7, Cronback coefficient) but not for the SAQ (0.46 and 0.54). Year 5 and year 6 students had low but similar scores for SAQ (first objective: 43.6 ± 11.9 vs. 46.6 ± 12.6; second objective: 33.3 ± 13 vs. 36 ± 13.6; p > 0.05, student's test). Year 6 students showed higher performances to solve problems for the two objectives (first objective: 46.7 ± 10.3 vs 39.6 ± 10.7; second objective: 56.7 ± 9.5 vs 50.3 ± 10.5; p < 0.001 student's test).

These results suggest that during the last years of medical studies, in the absence of any repetition of theoretical learning, although factual knowledge is steady, there is an increase in the ability of data synthesis. Further studies have to be conducted to identify whether this kind of evolution of knowledge could be related to the sole maturation of students reasoning capacities or to teaching methods.

Dr Pierre Pottier

Medecine Interne Chu Nantes

Place Alexis Ricordeau

Nantes, 44

France.

Email: [email protected]

Pistorius MA, Barrier JH, Connault J, Leborgne C, Planchon B, Rogez JM