Knowledge development and restructuring in the domain of medicine: The role of theory and practice

How does the knowledge of the medical student, clerk, intern, and registrar develop and how do formal and informal, classroom and experiential learning contribute to this process? These questions were investigated in two experiments, focusing on knowledge restructuring rather than knowledge acquisition. The experiments showed that practical experience plays an important role in knowledge restructuring. The process was, however, not as continuous as was expected. Notably, advanced students appeared to have considerable knowledge about conditions in patients and their environments that can predispose to disease. However, they rarely applied it in clinical reasoning. Contrary to what was found in expert physicians, advanced students' knowledge about enabling conditions seems not yet to be integrated into their other knowledge about diseases.

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