Abandoning the Path of Least Resistance: Struggle in Health Professions Education

A significant challenge when assessing health-professions trainees is that our assessment methods tend to be retrospective. As such, we are missing the ability to assess how adaptive our students will be when they begin practising in the healthcare system. To address these gaps and to advance the science of health professions education, this dissertation draws on theories from psychology and the learning sciences to explore systems of instruction and assessment that develop adaptive expertise and the ability to continue learning in the future. In this dissertation, I investigate the relationship between productive failure and active generation, the flexibility of learning through struggle, and the role of conceptual knowledge formation when designing instruction that prepares students to learn in the future. I designed the studies in this dissertation to achieve the following research aims: 1) to characterize the relationship between productive failure and active generation, 2) to study whether the manipulation of pretesting questions by difficulty can support performance on future learning assessments, 3) to examine the role of prior knowledge when learning through struggle, and 4), to examine the role of conceptual knowledge as a cognitive mechanism when learning through failure. The results from my first study emphasize the crucial role of generation in learning. The results of my second study demonstrate that we can leverage testing using theories of productive failure to support the development of expertise and that the quality of the struggle experienced by the learner depends on the learner's prior knowledge. The results from my third study establish that productive failure allows students to develop conceptual knowledge that facilitates transfer. Collectively, the manuscripts presented here show how learning through struggle relates to conceptual knowledge development and preparation for future learning. These instructional design strategies have the value of accentuating the difference between performance and learning and ensuring that measures of learning are central to assessing learner’s success. Practically, the research lays the groundwork for designing educational interventions and curricula to develop pharmacist trainees who can be adaptive and flexible with their knowledge to solve future, unforeseen problems that will inevitably arise in their practice.Ph.D