Meaningful Learning in Clinical Health Professions Education

Ausubel’s 3 conditions for “meaningful learning” can be remembered with the mnemonic “ASK (Attention, Structure, Knowledge).” This approach to meaningful learning, while incomplete in expressing how newly stored knowledge might be used or applied by the learner, can be extremely helpful in health professions education (HPE) where learners are often overwhelmed by the volume and complexity of information. This approach highlights the learner as the focus of Ausubel’s conditions. Using an instructor’s viewpoint, this post takes a functional approach to Ausubel’s Meaningful Learning Theory with some ties to Cognitive Load Theory (CLT). In doing so, we explore one application of this theory to clinical teaching.

Ausubel insisted that meaningful learning first required the learner’s attention to meaningful learning. This commonly accepted premise for Cognitive Theorists is explored further in information processing theory (IPT) and CLT. IPT conceptualizes a dual-store model for memory where only information that is consciously manipulated by the learner (i.e., working memory) can enter into retrievable long-term memory storage. CLT uses the concept of working memory and research by Sweller, among others, to explain the limitations to the amount of data and duration that working memory can “hold.” Unless information is processed to fit into schemata or anchored and organized, learners are left to rely on rote memorization and the limits of working memory. Therefore, Ausubel maintains that engaging learners to a process of meaningful learning is the first step. CLT suggests that cognitive resources should be managed to optimize learning. In order to minimize extraneous cognitive load and to help learners process information (i.e., germane cognitive load), learners also benefit from instruction that is structured. Ausubel’s strategy of an advance organizer, helps lay an initial organizational framework for new information to fill while providing context. This meaningful structure will help the learner make interconnections with and build upon their already existing relatable knowledge.

Clinical bedside teaching rounds is a strategy in which the team members present findings, evaluate the patient, and discuss care at the patient’s bedside. Challenged by work compression of modern medical education, bedside rounds are rarely practiced. By implementing bedside teaching rounds, the instructor can engage the learner in a mindset for meaningful learning further brought about by the presence of the learner’s patient. However, we must also consider the potential for adding extraneous cognitive load that may occur if the learner is particularly uncomfortable with this style of teaching. Teaching at the patient bedside also maintains a very real context and structure in which instruction can be framed for the learner. Using the patient as an initial organizational framework and the learner’s presentation as a demonstration of baseline knowledge, the instructor can help build up knowledge, fill in schemata, and challenge the learner to pull together interconnecting ideas.