4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93

Abstract

Medical education increasingly stresses that medical students should be prepared to take up multiple roles as a health professional. This requires the integrated acquisition of multiple competences such as clinical reasoning and decision making, communication skills and management skills. To promote such complex learning, instructional design has focused on the use of authentic, real-life learning tasks that students perform in a real or simulated task environment. The four-component instructional design model (4C/ID) model is an instructional design model that starts from the use of such tasks and provides students with a variety of learning tools facilitating the integrated acquisition of knowledge, skills and attitudes. In what follows, we guide the reader on how to implement educational programs based on the 4C/ID model and illustrate this with an example from general practice education. The developed learning environment is in line with the whole-task approach, where a learning domain is considered as a coherent, integrated whole and where teaching progresses from offering relatively simple, but meaningful, authentic whole tasks to more complex tasks. We describe the steps that were taken, from prototype over development to implementation, to build five learning modules (patient with diabetes; the young child with fever; axial skeleton; care for the elderly and physically undefined symptoms) that all focus on the integrated acquisition of the Canadian Medical Education Directives for Specialists roles in general practice. Furthermore, a change cycle for educational innovation is described that encompasses practice-based challenges and pitfalls about the collaboration between different stakeholders (students, developers and teachers) and the transition from traditional, fragmented and classroom-based learning to integrated and blended learning based on sound instructional design principles.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

“…It is also noteworthy that controlling behavior of educators has been consistently reported to impede student learning (Emerson, ; Mor et al, ), and achieve only short‐term compliance (Fryer et al, ; Nuffer et al, ). Thus, autonomy‐supportive health care education is intrinsically valuable by providing students with opportunities to learn from different perspectives (Vandewaetere et al, ; Burch et al, ; Mestdagh et al, ; Rowland and Kumagai, ; Woolley and Fishbach, ), and thereby enhance a greater conceptual understanding of the material (Abdel Meguid and Khalil, ; Christensen et al, ).…”

Medical education should teach heuristics rather than train them away

“…These methods are not new to medical education, but based on our analysis, we attempt to provide a deeper rationale for exactly why they are effective and to specify how they should be used to successfully train physicians and health professionals in clinical decision making. Other approaches (not covered here, but in line with our arguments) include, for instance, the four‐component instructional design model (4C/ID) by van Merriënboer and colleagues …”

Introduction

“…They conclude that there is little evidence for the serial-cue approach, favored by most teachers and recommend a switch to wholecase approaches (Schmidt and Mamede 2015). While cognitive theory does support whole-task instructional techniques (Vandewaetere et al 2014), the description of a whole-case in clinical education is not well elaborated. Evidently a whole-case cannot include a diagnosis and must at least be partly serial.…”