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Page 771 – Stanford Medicine X

An approach allowing a practitioner to externalize thoughts for guiding effective and productive learning

Yih-Ming Yang yihming_yang@yahoo.com


In the new millennium, we seem to be lagging behind in creating a groundwork to effectively exercise the process of learning. When Michelangelo envisaged one of the greatest paintings “the creation of Adam,” his brush conveyed a message that a person is endowed with intellect that resides in the brain. As Michelangelo described, the intellect he received empowered him to plan the best and to try all things conceived. This brilliant visual art recognized that “Design Thinking” could be applied inward to enabling people to grow richer in intelligence and in achievement 5 centuries before Generation X and Millennials. Recent advances in neuroscience provide evidence for principles of learning and a direct relationship between brain and learning, and shows how learning changes the physical structure and the functional organization of the brain. The brain is a structure that produces learning naturally, and learning is an active process of acquiring new knowledge constructed from pre-existing knowledge which is used for thinking and problem-solving. Learning is actually the analysis of experiences. “Experiential Learning” architected by John Dewey a century ago, and then “Learning Cycle” constructed by David Kolb a quarter century ago, provided us a groundwork to effectively exercise the process of learning. These offered a “Design Thinking” that empower health care providers to “visualize” and “grasp” their own thinking and reasoning progression to “relish” cerebral exercise experience that lead to effective learning. The fundamentals of the health care provider’s mental process are remarkably similar to the fundamentals of the learning cycle, and can be thought of in four corresponding stages of the learning: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Stages of patient-care activities are comprised of collecting information, assessment and differential, hypothesis, diagnosis, and management with follow up. The above illustrates that intuitive thinking processes allow practitioners to integrate effective learning into professional activities such as patient care. Kolb’s initial description of this learning cycle identified natural learning patterns. Effective learning generally engages some combination of all four of these aspects depending on the learning environment. The natural thought process, along with self-reflection, drives both the stages of the learning cycle and the stages of professional activities: Experience is gained during history taking, physical examination, and data collection; reflective observation is used during the initial assessment and formation of a differential diagnosis; abstract conceptualization yields a working hypothesis and diagnosis; and active experimentation leads to management and follow-up.
Conclusion: By externalizing the internal questions that a healthcare provider asks himself/herself during patient-care activities, the provider intuitively guides himself/herself to reflect and to identify the need to learn, and hence learn effectively and productively with joy and self-satisfaction.

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