The third wave in health sciences education

Abstract

In 1980, the futurist, Alvin Toffler, published a book, The Third Wave, in which he described human history in terms of 3 waves; the first related to agriculture and accumulation of land mass, with lords and ladies owning vast tracts of land to be farmed by their serfs, the second, the industrial revolution, related to the accumulation of wealth through the efficient production of mass goods, leading to an aristocracy based on finance and resources—the Carnegies, Rockefellers, and Vanderbilts of late nineteenth century America, and, in 1971 still far in the future but now upon us, a third wave based on knowledge. Of course, the computer revolution, and the instant access to the world’s knowledge through Google, exemplifies the third wave. To write this editorial, I perused the table of contents of the next few issues, and discovered something I was only dimly aware of. We are seeing more and more papers related to the ‘‘science of learning’’ in the words of Richard Mayer, experimental research based on cognitive theories of the nature of human learning. Seven of the next 20 papers in the AHSE publication queue are in this tradition. In addition, many of the researchers who have developed this paradigm within mainstream psychology are now publishing a number of papers in health sciences—more on this later. We appear to be experiencing a parallel three wave evolution. I am not referring to the personae—that was covered in an article I wrote a few years ago (Norman 2011). Rather, I see a quiet, but dramatic shift occurring in the research paradigms we employ. The first was dominant when I entered the field. Its roots were in behaviorism, which specifically excluded mental processes from its purview. This ascetic paradigm reduced the world of learning to reinforcement of simple responses to simple stimuli. We created long lists of behavioral objectives, which implicitly reduced the graduating physician to an interminable checklist of behaviours (the resemblance to Competency Based Education is, I’m sure, just coincidental). We tested competence with multiple choice questions, with one right answer (some things don’t change) and ‘‘Patient Management Problems’’, where once again, the dialog between physician and patient was reduced to a long list of items to