Final reflection

My inquiry tree has a few branches now.  As I look up towards the top of one of the branches I reflect on the stages of the growth of this tree.  Starting from a seedling, gradually it established a root system and sprouted a few shoots.  It’s really satisfying to see that some of these shoots have steadily grown into reasonably strong branches.

The strongest branch of the tree is my main re-search question: Does an inquiry learning approach lead to improvements in student clinical reasoning skills?  I consider my search for an answer to this question in terms of Carol Kuhlthau’s Information Search Process (ISP).  Kuhlthau’s ISP describes the feelings, thoughts and actions that occur during seven distinct stages in the search process.

Stage 1: Initiation

During this initial stage, I reflected on what I already knew about inquiry learning in my professional context.  It occurred to me that I didn’t know a great deal about the details of different levels of inquiry, but I was familiar with problem based learning and case based learning as approaches used to teach clinical reasoning in medical education settings.  After moving from a medical to a dental school 18 months ago, I had often wondered why PBL or CBL weren’t used as a pedagogical approach in my new workplace.  None of my colleagues could give me a definitive answer.  This lead to me ask myself why PBL and CBL are so common in health professional education.  I suddenly realised that I had always assumed this was ‘the way everyone teaches clinical reasoning’.  But was it?  Why was it used in one health professional education setting and not another?  Why was it used at all?  I felt really uncertain because I realised I had no idea what the arguments for and against using this approach were.

Stage 2: Selection

I decided at this point that before I started suggesting to my colleagues that we incorporate a PBL or CBL approach into our curriculum, that I should probably gather evidence that it is an effective way of developing students’ clinical reasoning skills.  At this point I was fairly optimistic that I would be able to find evidence from several sources that demonstrated that inquiry learning in the form of PBL or CBL was effective.  I mean it must be if so many schools around the world use this approach, right?  A quick search for the terms “problem based learning” and “case based learning” returned literally millions of results.  No problem.  This is totally under control.

Stage 3:  Exploration (otherwise known as “I’m freaking out”)

Then reality hit.  It turns out that getting millions of results for my initial searches isn’t a good thing.  How on earth was I going to choose the best ones?  Maybe my question is terrible.  It’s probably unanswerable.  How on earth have I gotten this far into a Masters degree without using proper Boolean searches?  I remembered learning about Boolean searches during the first semester of my undergraduate degree a million years ago.  But clearly I had become lazy because I never used them anymore.  I was getting millions of results but so many of them weren’t relevant because they didn’t directly answer my question.  And who knew that PBL and CBL could be implemented in so many different ways?  I felt like I was reading one article after another and become more confused instead of more knowledgeable.  At this point I felt overwhelmed and I started to panic, and even considered abandoning my research question and starting again.  But the reality was that I didn’t have enough time to start again.  And besides, I genuinely wanted to know the answer to my question.  Otherwise I would have felt like a fraud when discussing these approaches with colleagues, and I also would have felt a personal sense of failure.  I told myself that I just needed to have a growth mindset and keep going.

Stage 4: Formulation

I can’t remember exactly when I turned a corner.  There was no epiphany, but gradually I found a focus for my re-search.  I was finding a lot of information about PBL and CBL but I realised that what I was really after was “empirical evidence”.  Not just evidence from one or two schools but lots of schools.  My search techniques were getting better so I was able to narrow my searches down substantially and retrieve more relevant results.  Eventually, I managed to find a couple of needles in the haystack – systematic reviews of PBL and CBL approaches in health professional education as well as a book about evidence-based education in the health professions.  I came across some interesting ways that schools had implemented PBL and CBL as part of a wider curriculum strategy.  I also started to ask myself whether there were other forms of inquiry learning that were proving successful in the health professional education context.  I’m not sure I was feeling more confident at this point, but I was certainly feeling more focussed and interested in what I was reading instead of feeling panicked by the volume of information and time constraints.  I also started to enjoy discovering different aspects of tools that I thought I was already fairly familiar with.  I could see multiple benefits to this approach – not only was I discovering an answer to my question, but I was learning a lot of new, useful research skills at the same time.

Stage 5: Collection

As I moved on to the point of deciding what was worthy of my curated collection, my biggest concern was what to leave out.  I wanted my collection to be something that would be helpful to my colleagues who aren’t familiar with inquiry learning approaches, but also to people who are new to health professional education.  Also, if the collection was too big it would be unwieldy and off-putting so I really needed to include the most relevant finds as well as just a taster of the more innovative approaches that I had found.

Stage 6: Presentation

As I synthesised my information into my response I most certainly started to feel relieved and satisfied.  But I couldn’t help feeling a slight tinge of disappointment that a couple of my searches using particular tools hadn’t been completely successful. However, I consoled myself with the fact that I still learned a great deal about these tools and in some instances, could really see the potential of using them in later research.  In the case of social media, I’ve even decided to set up some professional networks that I can tap into from time to time long after this particular project is completed.  So there are positive aspects to everything, including perceived failures.

Stage 7: Assessment

The act of reflecting on this process and assessing my feelings, thoughts and actions at each stage has been quite cathartic!  There were many times when I asked myself whether this was all worth it.  But it most certainly has been worth the effort.  I was reminded of this today when a colleague confided that they were dreading having to spend countless hours writing 13 weeks’ worth of  lectures for a whole new unit next year after spending most of this year writing lectures for a completely different unit.  I realised just how much I have already learned from this process when I heard myself say “No!  Don’t do that!  There is another way for our students to learn.  Let’s meet and we can discuss it.”

Where to from here?

After formulating an answer to my main research question, I now find myself posing further questions about inquiry learning and clinical reasoning.  So I have evidence that inquiry learning approaches such as PBL and CBL do improve students’ clinical reasoning skills.  But why and how are these approaches successful?  What contextual factors contribute to the success or failure of inquiry learning in health professional education?  And given that PBL and CBL can take many forms, are some more successful than others? How will I determine which format would be the best one to use in my professional setting?  Are there certain elements in these approaches that must be included for it to be successful?  And are other elements negotiable?  If so, which ones?  It looks as though my path of inquiry may never end…


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