Promoting Students' Sense of Coherence in Medical Education Using Transformative Learning Activities

Objective: Transformative learning theory offers medical educators a particularly relevant insight into student learning. Transformative learning involves critically reflecting on assumptions and actions using empirical research methods and participating in a continuing discourse to validate the best reflective judgement and act according to new insights. The purpose of this paper is to investigate medical students' experiences with transformative learning activities and empirically and theoretically explain how these activities contribute to their understanding of the interplay between theoretical knowledge and professional practice, thereby creating a sense of coherence in medical education.

Methods: This paper analyzes the data from interviews with 40 medical students derived from a qualitative longitudinal research project in Norway from 2012 through 2018.

Results: Students characterize linking theoretical knowledge with professional practice, experiencing authentic placement situations with real patients, and discussing and critically reflecting on cases and professional practice with experienced doctors as learning activities that transformed their understanding of professional practice. These transformative learning activities influenced students' perceptions of educational content and demands as being comprehensible, manageable, and meaningful, which are the core components of "sensing coherence" in professional education. Moreover, experiencing a lack of knowledge in either case-based learning on campus or when meeting patients in clinical placements motivates students to pursue further theoretical studies.

Conclusion: Medical education includes rich opportunities to use transformative learning activities both on campus and at clinical placement sites, but it is not given that these types of learning activities are present in the teaching offered at all the various learning sites; thus, enhanced awareness of why and how to promote transformative learning is required among medical educators.