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Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example
Liam Rourke1, Jessica Leong1, Patricia Chatterly1
1a Department of Medicine , University of Alberta , Edmonton Alberta , Canada.
Teaching and Learning in Medicine
|February 17, 2018
Summary
A review of electrocardiogram (ECG) instruction found that incorporating all four components of Gagne's conditions-based learning theory significantly improved trainee abilities. This challenges the common conclusion that all teaching methods are equally effective.
Area of Science:
- Medical Education
- Learning Theory
- Cardiology Training
Background:
- Comparative-effectiveness reviews in medical education often conclude instructional approaches are equally effective.
- This finding is counterintuitive and limits the advancement of evidence-informed medical education.
- Electrocardiogram (ECG) interpretation is a critical skill in medical practice.
Purpose of the Study:
- To systematically review the comparative-effectiveness literature on ECG interpretation instruction.
- To determine if instructional quality, based on Gagne's conditions-based learning theory, influences learning outcomes.
- To challenge the prevailing conclusion that all instructional methods are equally effective.
Main Methods:
- A conditions-based learning theory framework was used to structure the literature review.
- Searched MEDLINE, EMBASE, ERIC, PsycINFO, and CINAHL for prospective studies on ECG instruction.
- Extracted data on study quality, instructional interventions, and participant knowledge/skill acquisition.
Main Results:
- Twenty-five studies evaluating 47 instructional interventions were synthesized.
- Instructional interventions incorporating all four Gagne components (presenting information, eliciting performance, providing feedback, assessing learning) showed significantly greater improvements (SMD = 2.80) compared to those with fewer components (SMD = 1.44).
- Comparisons of "innovative" versus "traditional" instruction did not yield significant pooled effects (SMD = 0.18).
Conclusions:
- Structuring comparative-effectiveness reviews using a learning theory framework can reveal differences in instructional impact.
- Instructional interventions that fully implement Gagne's conditions-based learning theory are more effective for ECG interpretation skills.
- The study overturns the common conclusion that all instructional approaches are equally effective, highlighting the importance of instructional design.
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