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.
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 Gagnon1–2, 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.