Recherche et Perspectives Etude descriptive des pratiques d'apprentissage d'étudiants en quatrième année de médecine dans une faculté française et de leurs performances à résoudre un problème

Context: Small group teaching and learning activities become difficult to maintain because of the enhancement of the numerus clausus imposed by the French legislation. Taking into account the context of the summative and normative French standard examination, namely the National Classifying Exanimation (NCE), and before considering diverse educatio- nal strategies compatible with active-based learning principles, we have carried out a prospective study among fourth year medi- cal students, which aimed to describe their learning approaches (in depth as well as superficial), their learning and problem-sol- ving strategies and their problem-solving performances simulated by written clinical-based problems. Material and methods: For a given topic drawn from the NCE program, (e.g. epilepsy), the learning approach was evaluated by the questionnaire of Biggs. Learning and problem-solving strategies were evaluated from two constructed questionnaires according to recent data from the literature. Problem-solving performances were evaluated during a session where students had to solve a written clini- cal-problem related to epilepsy. Results: The in depth learning approach prevails. Meta-cognitive learning strategies are already developed in fourth year. Problem-solving strategies repertory is not used in an eclectic manner. A correlation was observed bet- ween the in depth learning approach, level 3 learning strategies (information categorization strategies) and performances to solve one of the two clinical-based problems. Conclusion: The predominance of the in depth learning approach, the development of meta-cognitive based learning strategies and the acknowledgment of certain limitations in the use of problem-solving strategies make us consider a generalization of self-based learning from didactic referential, tutoring and from medical reasoning training sessions.