Maturation of knowledge transfer and clinical reasoning throughout the medical curriculum

Since 2000, the Faculty of Medicine at the University of Liege has introduced Problem-Based Learning (PBL) in the curriculum of medical studies (7 years). This contextualized learning raises the issue oc capacity of knowledge transfer and generalization, and maturation of clinical reasoning, troughout the curriculum. Two tests were administered to 108 students (year three to six) and to reference panel. The selected topic was endocrinology. We adapted the script concordance test (i.e., the SCT, see http://cme.umontreal.ca/tcs/) with 60 questions asking for evaluation of the impact of a new information, in a context (short clinical scenario) that was written similar versus different of the original learning context. A True/False test was used to assess factual knowledge. Progress throughout the curriculum was associated with increase in clinical reasoning performance together with a decrease in factual knowledge scores. Early capacity of knowledge transfer was observed, with no difference between the 4 years studied. Overall, the SCT score obtained out of the original context were unexpectedly higher than in such a context. We hypothesize that a new information may result in greater activation of reasoning in a new and realistic context than in a known and possibly factitious context.