Learning by concordance (LbC) to develop professional reasoning skills: AMEE Guide No. 141

Abstract

Developing effective clinical reasoning is central to health professions education. Learning by concordance (LbC) is an on-line educational strategy that makes learners practice reasoning competency in case-based clinical situations. The questions asked are similar to those professionals ask themselves in their practice and participant answers are compared to those of a reference panel. When participants answer the questions, they receive an automated feedback that is two-fold as they see (1) how the panelists respond and (2) justifications each panelist gives for their answer. This provides rich contextual knowledge about the situation, supplemented by a synthesis summarizing crucial points. As many educators in the health sciences are engaging in introducing innovative approaches, many consider building LbC learning modules. Elaborating, designing and implementing a LbC tool remain a challenge. This AMEE Guide describes the steps and elements to be considered when designing a LbC tool, drawing on examples from distinct health professions: medicine, nursing, physiotherapy, and dentistry. Specifically, the following elements will be discussed: (1) LbC theoretical underpinnings; (2) principles of LbC questioning; (3) goals of the concordance-based activity; (4) nature of reasoning tasks; (5) content/levels of complexity; (6) reference panel; (7) feedback/synthesis messages; (8) on-line learning platforms.

Keywords:

• Learning by concordance
• assessing by concordance
• reasoning
• professional education
• script theory
• tool design
• education in health sciences

Acknowledgements

We wish to thank the following contributors who have provided examples of LbC tools: Jean-Pierre Dumas³, Julie Lecours¹, Anne-Marie Vincent¹, Jeannine Kassis¹, Louis Guertin¹, Robert Gagnon^1–2, Diane Robert¹, Amélie Foucault¹, Stuart Lubarsky⁴, Maxime Ducret⁵.

¹Faculté de médecine, Université de Montréal, Québec, Canada

²Centre de pédagogie appliquée aux sciences de la santé (CPASS), Université de Montréal, Montréal, Québec, Canada

³Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada

⁴Faculty of medecine, McGill University, Québec, Canada

⁵Faculté d’Odontologie de Lyon, Lyon, France

Disclosure statement

Bernard Charlin is the creator of the concepts of SCT and LbC. He sometimes acts as a consultant to private firms or educational institutions that perform training by concordance. The other authors have no conflict of interest to report in relation to the content of this article.

Author contributions

The heart of the article was written by Bernard Charlin. Nicolas Fernandez and Marie-France Deschênes have revised it in depth and provided valuable insights and suggestions. The examples illustrating the article were created by professionals of different disciplines.

Additional information

Notes on contributors

Bernard Charlin

Bernard Charlin, MD, PhD, is Professor in the Department of Surgery at the University of Montreal. He holds a Master degree from Sherbrooke University, a certificate of advanced studies in Education from Harvard University and a PhD in Education from the University of Maastricht. His research field is reasoning in context of uncertainty (theory, acquisition, assessment).

Marie-France Deschênes

Marie-France Deschênes, RN, holds a PhD in Nursing Education from the University of Montreal. Her thesis focuses on the use of e-learning educational strategy based on script concordance to promote undergraduate students’ clinical nursing reasoning. Her themes of interest are clinical reasoning in nursing, the cognitive companionship approach and the use of e-learning environments.

Nicolas Fernandez

Nicolas Fernandez, PhD, is Associate Professor at the Department of Family Medicine and Emergency Medicine of the University of Montreal. Since 2005, he has been involved in multiple research projects and published findings on collaboration and teamwork among medical education professionals. He holds research grants in the field of experiential learning of competencies for the Health Professions. He is Assistant Editor in Chief of Pédagogie Médicale, the French-language journal.