Is clinical experience enjoyed by medical students essentially equivalent to the case-based learning prevalent in many business schools? The portion of a medical education that places a student’s knowledge into practice by working in a real teaching hospital is represented by what Lave and Wenger (1991) identify as Situated Learning. Drawing from early apprenticeship models, Lave and Wenger believe that knowledge needs to be presented in an authentic context, that learning is inherently social and involves building relationships with proficient practitioners. What people learn, see and do is situated in their role as a member of a community. In other words, that learning is a function of doing within a particular context and culture.
The importance of pairing students with practitioners stems from the informal learning that takes place. The student as able to take advantage of the tacit knowledge that comes from years of direct experience and is expressed as part of the process of evaluating and treating actual patients. In other words, students are welcomed as legitimate peripheral participants into a community of practice where they work collaboratively with their faculty to engage in both peer to peer and peer to mentor learning.
Beginning as a legitimate, but peripheral participant, new students start with limited participation in a clinical setting. As their knowledge and skills grow, they move from the periphery to become full members capable of taking on more meaningful roles. In this way, the acquisition of knowledge proceeds at a pace that is in sync with the development of their ability to act. It is through repetition and responsiveness to a myriad of patients with differing conditions, that enables them to eventually become skilled practitioners of their craft.
It is a skill that is developed over time as patterns are repeated and memories are formed similar to the muscle memory developed by athletes who spend multiple hours practicing until a certain motion or action becomes second nature. For the medical student, placement within a working hospital along with the experience acquired by seeing a wide variety of patients, is seen as an integral part of the educational process. Memories are formed not just by placing ideas in context, but also from repeated use in authentic situations. This promotes the development of situation awareness (Endsley, 1995) that is critical for successful decision making.
Compare and contrast this with the education of a business student who is taught using the case method. While a business school professor might be very proficient with the underlying theoretical constructs, they may have no or limited experience in applying those principles in real life situations. In other words, while they may have a wealth of explicit knowledge, they might be limited in the informal knowledge that is needed to develop the situational awareness required to make sound decisions in a real context. In addition, what is lacking is exposure to the social and institutional cues that are helpful for sound decision making within a specific context.
Students may work with each other in study groups, but in the classroom, they are largely on their own as they contribute to class discussion of a case. Ideas are shared, but there is the potential for a large disconnect between the facts of the case and a student’s real-life experiences. Either because the case is built around an example that is no longer relevant, contains the point of view or biases inherent in the case writer, or because the student has not had any exposure to relevant practical experiences. Thus, for many students, it may seem that a business education is more of an academic exercise than a meaningful tool contributing to future professional success. Rather than students perceiving themselves as legitimate peripheral participants, they are more like disconnected observers to a play that was written and is now directed by someone who is disconnected from the matter at hand.
Where the medical student learns by practicing medicine in a functioning hospital with authentic patients with real medical problems, the business student learns by hearing about what others have done and then is given the opportunity to think about the mistakes of others to form an opinion of how they might have done things differently. At the end of their education, medical students become skilled practitioners of medicine. In contrast, business students become adept at the case method, but lack the equivalent clinical experience that would turn them into skilled businesspeople.