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

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.

What can the same-different task tell us about the development of magnitude representations?

We examined the development of magnitude representations in children (Exp 1: kindergartners, first-, second- and sixth graders, Exp 2: kindergartners, first-, second- and third graders) using a numerical same-different task with symbolic (i.e. digits) and non-symbolic (i.e. arrays of dots) stimuli. We investigated whether judgments in a same-different task with digits are based upon the numerical value or upon the physical similarity of the digits. In addition, we investigated whether the numerical distance effect decreases with increasing age. Finally, we examined whether the performance in this task is related to general mathematics achievement. Our results reveal that a same-different task with digits is not an appropriate task to study magnitude representations, because already late kindergarteners base their responses on the physical similarity instead of the numerical value of the digits. When decisions cannot be made on the basis of physical similarity, a similar numerical distance effect is present over all age groups. This suggests that the magnitude representation is stable from late kindergarten onwards. The size of the numerical distance effect was not related to mathematical achievement. However, children with a poorer mathematics achievement score seemed to have more difficulties to link a symbol with its corresponding magnitude.