10.14601/TUTOR-14725
In the scientific literature there are numerous articles concerning the testing of new models of experiential learning in Medical Education. The experiential learning, indeed, is used as a method of training in continuing education in medicine and in many university courses that are intended for doctors, nurses and other health professionals. We, therefore, designed a literature review to evaluate the existing evidence about the effects of educational models based on experiential learning in university education and continuing training of health and care professionals.
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1971-8551
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Valerio Ferro Allodola
Tutor
The effects of educational models based on experiential learning in Medical Education: an international literature review
Text.Serial.Journal
https://ojs.unito.it/index.php/tutor
14
2014-07-22
2019-07-30
2014-07-22
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1
Valerio Ferro Allodola
2014/07/22
10.14601/TUTOR-14725
23
1971-8551
1
49
The effects of educational models based on experiential learning in Medical Education: an international literature review
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tutor                                                                                                      Vol. 14, N. 1, 2014: 23-49
                                                                                                         DOI: 10.14601/Tutor-14725



           The effects of educational
           models based on experiential
           learning in Medical Education: an
           international literature review
                   Valerio Ferro Allodola
                   Laboratory of Medical Education, University of Florence. E-mail: valerio.ferroallodola@unifi.it

        SUMMARY
        In the scientific literature there are numerous articles concerning the testing of new models of experiential
        learning in Medical Education. The experiential learning, indeed, is used as a method of training in continuing
        education in medicine and in many university courses that are intended for doctors, nurses and other health
        professionals.
        We, therefore, designed a literature review to evaluate the existing evidence about the effects of educa-
        tional models based on experiential learning in university education and continuing training of health and
        care professionals.

        Keywords: experiential learning, learning from experience, change, behavior, practice, reflection, experience

        RIASSUNTO
        A partire dalle teorie di Dewey, la visione dell’educazione e della formazione è cambiata radicalmente, so-
        prattutto per quanto riguarda il processo di insegnamento/apprendimento. Si è passati, infatti, da una visio-
        ne di “trasmissione delle conoscenze” ad un modello in cui il soggetto che apprende ha un ruolo inter-attivo
        nella costruzione della conoscenza.
        Questo nuovo concetto (evolutosi in seguito, soprattutto grazie agli studiosi post-deweyani,) ha molto da
        suggerire alla formazione dei professionisti della salute e della cura.
        Nella letteratura scientifica troviamo numerosi articoli riguardanti la sperimentazione di nuovi modelli di
        apprendimento esperienziale per la formazione (universitaria e continua) nel campo della medicina e della
        salute. L’apprendimento esperienziale, infatti, è utilizzato come metodo formativo in Medical Education e in
        molti corsi universitari e non che si rivolgono a medici, infermieri e altri operatori sanitari.
        Abbiamo, pertanto, ritenuto utile progettare ed effettuare una revisione della letteratura al fine di valutare
        i dati esistenti sugli effetti dei modelli educativi basati sull’apprendimento esperienziale nella formazione -
        universitaria e continua - dei professionisti della salute e della cura.

        Parole chiave: experiential learning, apprendimento dall’esperienza, cambiamento, comportamento, pra-
        tica, riflessione, esperienza




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           © Firenze University Press       ISSN (print) 1971-7296
           http://www.fupress.com/tutor    ISSN (online) 1971-8551
  tutor Volume 14, Numero 1, aprile 2014

                   INTRODUCTION                                              likely that working together in this way creates the
LAVORI ORIGINALI




                   As the conditions of medical practice have been           best environment, for learning that enhances pro-
                   changing in the past 20 years, the possibilities          fessional practice and professional judgment [9].
                   and conceptions of Continuing Medical Education           This review of the literature is the result of a re-
                   (CME) have also changed [1].                              search project started in January 2011 as part of
                   Today’s health care professionals must function in        an internship followed by the writer (part of the
                   complex and changing health care systems, con-            curriculum of the Master program in “Sustainable
                   tinuously refresh and update their knowledge and          development and impact assessment” followed at
                   skills, and frame and solve complex patient and           the Center for lifelong learning and retraining of
                   healthcare problems. Preparing professionals who          personnel in the health service - CEFPAS - Caltanis-
                   possess these capabilities is correspondingly com-        setta, Sicily) at the Department of Psychology at
                   plex [2].                                                 Erasmus University in Rotterdam (Tutor: Dr. Silvia
                   Various programs have been developed to bridge            Mamede MD, PhD) and concluded in May 2012 at
                   the gap between what should be practiced and              the University Florence, Laboratory of Medical Ed-
                   what is actually done, but few have been uniformly        ucation as a research Fellow (Tutor: Prof. Dr. Patri-
                   successful. Passive education, such as conferences        zia de Mennato PhD, director of the Laboratory of
                   or the publication of clinical practice guidelines, has   Medical Education).
                   been shown consistently to be ineffective [3].
                   In recent years, however, has spread a vast litera-       EXPERIENTIAL LEARNING DEFINED
                   ture on the processes of knowledge construction           Many definitions of Experiential Learning can be
                   and the “how” to make visible to students the com-        found. To guide our review we used these defini-
                   plex dynamics of knowledge construction.                  tions, trying to reconstruct the evolution of the
                   This is possible - particularly in the light of recent    construct.
                   studies in the field of Medical Education - through       Dewey [10], who was likely one of the most signif-
                   the promotion of “reflective practice” [4] and the        icant and influential educators of his time, founded
                   ‘”transformative learning” [5] in the training of         an educational movement based, at least in part, on
                   health professionals, especially through the so-          the concept of, “experience plus reflection equals
                   called “narrative approach” [6].                          learning”. This was the foundation of what came
                   From the experience of many U.S. universities since       to be termed “progressive education”, in that it
                   1980 has spread to Europe, the Problem Based              challenged. It is here that the origins of experien-
                   Learning (PBL), ie the problem-based learning,            tial learning can be seen, with Dewey’s recognition
                   which is configured as a specific methodology of          of the importance of experience and reflection in
                   experiential learning [7].                                learning.
                   More active strategies to implement guidelines,           Experiential learning has received considerable
                   such as educational outreach, feedback, reminder          coverage in the recent literature on nurse educa-
                   systems, and continuous quality improvement, offer        tion [11]. The theoretical literature seems to use
                   greater promise and have captured the interest of         the term in two different ways.
                   physicians, health systems, hospitals, managed care       One approach involves the concept of life as a
                   plans, and quality improvement organizations. To          learning process and thus experiential learning is
                   date, however, research on whether these meth-            learning through the process of living, working and
                   ods produce meaningful change in practice patterns        generally relating to the world. This approach to
                   or patient outcomes has yielded mixed results [8].        the concept of experiential learning is best exem-
                   Physicians interact with peers and mentors to frame       plified by Keeton and his associates [12].
                   issues, brainstorm, validate and share information,       The other approach is via humanistic psychology
                   make decisions, and create management protocols,          and emphasises subjective experience, personal
                   all of which contribute to learning in practice. It is    interpretation and the education of the emotions.




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                             The effects of educational models based on experiential learning in Medical Education



This approach is best exemplified in the writings          3. forming abstract concepts;
of Kilty [13], Shaffer [14] and Heron [15]. From a         4. testing in new situations.
Freirian [16] and Illichian [17] perspective the focus     Immediate or concrete experiences are the basis
that experiential learning puts on an individual’s ex-     for observation and reflections. These reflections
perience rather than the learning institution’s (and       are assimilated and distilled into abstract concepts
hence the government or state) is highly significant.      from which new implications for action can be
For when the locus of control of what is learnt lies       drawn.
with the individual, then the potential for the chal-      McGill and Warner Weis [21] attempted to provide
lenge of social norms becomes a reality, a “bottom         a definition that incorporated a wide range of inter-
up” rather than a “top down” change agent.                 pretations: ‘‘The process whereby people engage
Apart from these two main themes in the expe-              in direct encounter, then purposefully reflect upon,
riential learning literature, there are also some          validate, transform, give personal meaning to and
‘hybrids’. Kolb [18], for example, combines some           seek to integrate their different ways of knowing.
of the ‘learning through the process of living’ ap-        Experiential learning therefore enables the discov-
proach with ideas from Carl Rogers and Carl Jung           ery of possibilities that may not be evident from
and applies, almost paradoxically, a fairly rigorous       direct experience alone’’.
quantitative approach to researching his theoretical       Burnard [22] summarized experiential learning as:
constructs. Boydel’s [19] theoretical approach also        “learning by doing, which involves reflection and is
seems to stand outside the mainstream humanistic           an active rather than a passive learning process”.
approach and yet does not fit completely into the          Cohen, Boud and Walker [23] developed five prop-
first approach either.                                     ositions concerning experiential learning. They iden-
For Kolb and Fry [20], the experiential learning is        tified that experience is the foundation of and stim-
the process of making meaning from direct experi-          ulus for learning, learners actively learn, in a holistic
ence. He helped to popularize the idea of experi-          way, which is socially and culturally constructed and
ential learning drawing heavily on the work of John        influenced by the socio-emotional context in which
Dewey, Kurt Lewin, and Jean Piaget. His work on            it occurs. The outcome of learning, subsequent to
experiential learning has contributed greatly to ex-       the ideas contained within these propositions and
panding the philosophy of experiential education.          within the four villages, is that experiential learning
The root of this model can be found in very early          has the potential to result in: self growth, ranging
descriptions of educational settings; certainly de-        from the individual to communities, and aspects of
scriptions of teaching by Socrates utilized similar in-    professional, life and academic education.
quiry-based practices. Experiential learning, indeed,      A number of authors in the 1990s began to dis-
is related to -but not synonymous- with experien-          tinguish between levels of depth in reflection [24].
tial education, action learning, adventure learning,       However, they seemed to make the assumption that
free choice learning, cooperative learning, service        “no reflection” is associated with “surface learning”
learning, reflective practice and adult education.         whilst “critical reflection” is associated with “deep
While there are relationships and connections be-          learning”. They do not seem to acknowledge that
tween all these theories of education, importantly         the stage or level of reflection may be associated
they are also separate terms with separate mean-           with the level of exposure to the experience; in es-
ings. In its simplest form, experiential learning is       sence, that there may be an inappropriate time for
learning achieved through the appropriate use of           reflection and an appropriate time. If the two tax-
experience. In other words, experiential learning is       onomies, reflection and experience are combined,
a form of learning by doing. Kolb and Fry’s experi-        then there exists a potential strategy or framework
ential learning model is a continuous spiral process       for experiential learning.
which consists of four basic elements:                     The more significant developments have been in the
1. concrete experience;                                    recognition of the importance of corporate bodies
2. observation and reflection;                             becoming “learning organizations” not just at an in-



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  tutor Volume 14, Numero 1, aprile 2014

                   dividual level [25]. A number of recently published      ed all papers that did not describe research examin-
LAVORI ORIGINALI




                   educational textbooks (both nursing education and        ing the educational models on experiential learning in
                   general education) contain details of experiential       the continuing education of health professionals. This
                   learning approaches based upon Kolb’s original           resulted in the identification of 43 papers.
                   work of the 1980’s [26]. There is thus a consid-         The original search in Educational Resources Informa-
                   erable body of knowledge and experience, which           tion Center (ERIC) identified more than 40 papers but
                   acknowledge the significant learning that occurs as      we have narrowed the field even more and we tried
                   a result of reflection upon experience but little in     to focus our research and we have chosen 4 paper.
                   the way underpinning structure as to how that oc-        The identified papers (n. 47) are shown by type of
                   curs or how as a teacher can facilitate that learning.   study, journal of publication, country of location,
                   Finally, in an attempt to give a definition of experi-   educational level of subjects and profession studied.
                   ential learning, Valkanos and Fragoulis [27] would       As shown, the majority of studies reported were in
                   say that the experiential learning is a process by       medicine and nursing; the largest percentage of pa-
                   which learners are invited to live and conscien-         pers was from the United Kingdom (approximately
                   tiously understand their own reflections, feelings,      44,6%) and USA (approximately 40,4%). Moreover
                   actions and reactions to a particular situation. This    25 of 47 utilized qualitative approaches to address
                   can be achieved either by simply sharing one of          the research question (See Appendix 1- Studies Re-
                   their experiences relating to a cognitive object or      viewed with Abstract for a detailed overview).
                   by participating in the representation of a given sit-
                   uation – real or imaginary – which is introduced
                   by the educator in the form of a fact or incident,       Review procedure
                   etc. and which is offered, so that participants can      A review of the published literature, limited to the
                   understand more deeply all parameters of the situ-       last 27 years, was conducted to include recent up-
                   ation and develop their relevant abilities.              dates on medical and nursing education. This was
                                                                            done by systematically searching appropriate da-
                                                                            tabases using keywords. We also conducted hand
                   METHOD                                                   searches and reviewed bibliographies of identified
                   We conducted a systematic review of the research         papers. The search was limited to English language
                   literature in the area of educational models on ex-      papers published between 1984 and 2011, dealing
                   periential learning in the continuing education of       specifically with medical or health professional ed-
                   health professionals.                                    ucation or practice.
                                                                            To evaluate the premise that experiential learning is
                                                                            essential component of competence in health pro-
                   Selection process                                        fessionals, and therefore capabilities that must be
                   The PubMed and Educational Resources Information         acquired, we developed the following questions:
                   Center (ERIC) databases were searched using the          • What is the nature of experiential learning?
                   following keywords: experiential learning – learning     • What are the areas of medicine in which experi-
                   from experience – change – behavior – practice – re-         ential learning is used?
                   flection – experience.                                   • Can experiential learning be assessed?
                   We also conducted hand searches and reviewed bibli-      • What contextual influences hinder or enable
                   ographies of identified papers. The search was limited       the development of experiential learning?
                   to English language papers published between 1984
                   and 2011, dealing specifically with education models
                   on experiential learning education of health profes-     RESULTS
                   sionals. The original search in PubMed identified more   The results of the review are structured to sum-
                   than 622 papers, commentaries and reviews of the lit-    marize the relevant studies that addressed each of
                   erature. To address our specific interest, we exclud-    these questions in relation to medicine, nursing and



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                               The effects of educational models based on experiential learning in Medical Education



          Qualitative                            n = 25                Nursing Standard                       n=1
          Quantitative                           n=2                   Journal of Advanced Nursing            n=4
Type of
          Quasi experimental                     n=1                   Journal of Transcultural Nursing       n=1
study
          Mixed Methods                          n=4                   Journal of Clinical Nursing            n=1
          Reflective paper                       n = 14                Urological Nursing                     n=1
          Literature Review                      n=1                   Journal of continuing education in
                                                                                                              n=1
Journals Medicine                                                      nursing

          Medical Education Online               n=1                   Nurse Educator                         n=3

          British Medical Journal                n=1                   Nursing Ethics                         n=1

          Journal of Allied Health               n=2                   Other

          Archives of Disease in Childhood       n=1                   Clinical Psychology & Psychotherapy    n=1

          Medical Education                      n=3                   Journal of Health Administration
                                                                                                              n=1
                                                                       Education
          American Journal of Pharmaceutical
                                                 n=2                   Action Learning: Research and
          Education                                                                                           n=1
                                                                       Practice
          Patient Education and Counseling       n=1
                                                                       Rural and Remote Health                n=1
          Medical Teacher                        n=2
                                                                       American Educational Research
          Journal of University of Occupational                                                               n=1
                                                n=1                    Association
          and Environmental Health
                                                                       Book                                   n=1
          Canadian Journal Neuroscience
                                                 n=1         Location USA                                     n = 20
          Nursing
          Advanced in Health Science Education n = 1                   UK                                     n = 14

          Journal of Continuing Education in the                       Canada                                 n=3
                                                 n=1
          Health Professions                                           Australia                              n=2
          Dental Update                          n=1                   The Netherlands                        n=2
          Association of periOperative Regis-                          Singapore                              n= 2
                                                 n=1
          tered Nurses                                                 Tasmania                               n=1
          ANNALS Academy of Medicine                                   Belgium                                n=1
                                                 n=1
          Singapore
                                                                       Japan                                  n=1
          Nursing
                                                                       Turkey                                 n=1
          Nursing Education                      n=2
          Nurse Education Today                  n=6                   TOT.                                   n = 47

                                                             Table 1. Summery of 47 reviewed research studies.


other health professional contexts. Several studies          David A. Kolb [28] created his famous model (with
addressed more than one of our questions. For                Fry in 1975) out of four elements: concrete experi-
clarity, we have highlighted the different aspects of        ence, observation and reflection, the formation of
a single study under the relevant questions.                 abstract concepts and testing in new situations. He
                                                             represented these in the famous experiential learn-
                                                             ing circle that involves (1) concrete experience fol-
What is the nature of experiential                           lowed by (2) observation and experience followed
learning?                                                    by (3) forming abstract concepts followed by (4)
Eight studies were found which addressed this                testing in new situations (after Kurt Lewin).
question.                                                    For Kolb, experiential learning is not a molecular



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  tutor Volume 14, Numero 1, aprile 2014

                   education concept but rather is a molar concept         comprehensive plan of learning that allows student
LAVORI ORIGINALI




                   describing the central process of human adaptation      practice time to solve individually and collectively
                   to the social and physical environment.                 problems they may encounter in clinical situations.
                   Learning is the process whereby knowledge is cre-       It combines a variation and extension of the fre-
                   ated through the transformation of experience.          quently used strategy of case study with multiple
                   This definition s several critical aspects of the       cooperative learning strategies, culminating in an
                   learning process as viewed from the experiential        individual reflective writing experience.
                   perspective. First is the emphasis on the process       Bauchner H., Simpson L. and Chessare J. [31] be-
                   of adaptation and learning as opposed to content        lieve that trying to change physician behaviour in
                   or outcomes. Second is that knowledge is a trans-       order to improve quality of care is a critically im-
                   formation process, being continuously created and       portant endeavour for medicine, it reflects current
                   recreated, not an independent entity to be acquired     emphasis on cost, evidence, and patient participa-
                   or transmitted. Third, learning transforms experi-      tion in their care. For many physicians, trying to
                   ence in both its objective and subjective forms. Fi-    practice up to date medicine is an important part
                   nally, to understand learning, we must understand       of their professional life. Unfortunately, there is
                   the nature of knowledge, and vice versa.                limited time for reading, meeting with colleagues,
                   Burnard P. [29] offers an epistemological theory di-    or reviewing their own practice. We must contin-
                   vided into three domains: propositional knowledge,      ue to emphasise creative, efficient, and innovative
                   practical knowledge and experiential knowledge, as      approaches that help physicians change their be-
                   a basis for a theory of experiential learning. After    haviour and improve the quality of health care.
                   a description of the theory, experiential learning is   In this respect, they draw the following
                   redefined and the practical issues relating to the      recommendations:
                   theory are discussed. The paper closes with some        - traditional continuing medical education and pas-
                   thoughts on the problems of research in the field of        sive distribution of information is not effective;
                   experiential knowledge.                                 - continuing medical education that includes in-
                   In the paper of 1987, Barnard studies how the as-           teractive interventions is effective;
                   pects of experiential learning and andragogy may        - creation and promulgation of guidelines does
                   usefully be combined in nurse education. Such a             not impact on patient care;
                   combination needs to take into account certain ba-      - guideline implementation within an organization
                   sic principles such as negotiation, the importance of       can be effective;
                   personal experience and the use of self and peer as-    - clinical paths improve inpatient care;
                   sessment. What must also be borne in mind, how-         - reminders, both patient and physician, improve
                   ever, is that learner nurses and nurse tutors have to       quality of preventive health services;
                   work to a prescribed syllabus of training laid down     - educational outreach is effective, but time con-
                   by the English and Welsh National Boards. This fact         suming and expensive;
                   makes nurse education somewhat different to many        - audit and feedback alone is modestly effective;
                   of the experiential learning training workshops at      - financial incentives can change physician behav-
                   which all of the content may arise out of partici-          ior under certain circumstances;
                   pants needs and wants. Many nurse tutors may en-
                   counter problems in translating workshop experi-        Jarvis P. [32] argues that reflective practice is a fre-
                   ence into practice because of this fact.                quently used but in-frequently defined concept in
                   Glendon K. and Ulrich D.L. [30] that the focus of       nursing. Part of the reason for the lack of defini-
                   education has changed from teaching to learning.        tion lies in the fact that there is no theory of prac-
                   This educational model stresses student outcomes        tice. This paper lays the foundations for a theory
                   that include critical thinking, effective communi-      of practice and paves the way for one useful way in
                   cation, and students’ ability to reflect their own      which the relationship between theory and practice
                   learning. This article describes “unfolding cases,” a   can be understood. It is suggested that thoughtful



                     28
                             The effects of educational models based on experiential learning in Medical Education



practice is often mistaken for reflective practice,        sis so far s the importance of recognizing positive
but that the latter can only exist where practice is       and negative feelings associated with experiences,
not taken for granted and so the outcome of prac-          when engaging in reflection. She also outlines the
tice is more learning from experience. The paper           precursors to effective and non-effective reflection
also maintains that for reflective practice to be          implied by the data. It is suggested that there is no
practiced within the profession it is necessary both       correct model for critical thinking and the author
to have the structures within which it can be en-          highlights the need for further research into effec-
couraged and the theoretical foundation whereby            tive and non-effective outcomes of reflection.
efficient practice need not only be judged in terms        These studies have shown that experiential learning
of ‘value for money’.                                      is a methodology that can help practitioners and
Mander [33] examines the contribution of experi-           health care in the new learning and management of
ence to learning in relation to data collected during      emotions connected to clinical practice.
a study of midwives’ care of relinquishing mothers.        The experiential learning, in fact, gives the subject
The extent to which there is a conflict between            an active role as builder of knowledge, which is also
experiential learning, valued as a component of an-        the result of “exchanges” between him and the sur-
dragogy, and aspirations to being a research-based         rounding environment.
profession is examined. Experience has been shown,         However, emerging terms such as “experiential
by an ongoing research project and the nursing and         learning”, “collaborative learning”, “critical think-
midwifery literature, to be significant as the basis of    ing”, “cooperative learning”, “reflection” and “re-
learning and the resulting practice. This contributes      flection practices” that seem to be often used as
to a healthy learning process only to the extent that      synonyms.
it includes all features of all experience - not just      Despite being aware that all the theoretical and
that of a practical, occupational nature - but also        methodological influence and determine each oth-
the reflective aspects of practical experience, to-        er, we need to systematize and distinguish the var-
gether with the experience of learning from others         ious theories and methodologies, in particular, in
such as researchers and theorists. The limitation of       Medical Education.
experience to the work environment alone, or the
exclusion of any aspect or area of experience, is a
disservice to both the learning itself and to those        What are the areas of medicine in which
for whom care is being provided.                           experiential learning is used?
For Ringsted C. [34] in experiential learning the          Twenty-one studies were found which addressed
learner is highly active in these processes through        this question.
trial and error practice, whereas in the step-by-step      Carpio B.A. and Majumdar B. [36] use experiential
approach the learner takes a more passive role.            learning as an approach to transcultural education
Many errors are characterized in the initial stages        for nursing. Experimental learning is a powerful
of learning and Ringsted states that learning from         methodology for addressing the affective, as well as
error has received increasing attention in skills          the cognitive, domain of learning. The exploration
training. She hopes that clinical training centers         of personal values is an essential first step in devel-
might be places where learners can train in an ex-         oping cultural awareness in order to move learners
periential way, allowing them to make the errors           beyond ethnocentrism through awareness, under-
that are necessary for embedding the skills in the         standing, acceptance, and appreciation of other cul-
long-term memory.                                          tures if learners are to truly adopt a multicultural
Wallace D. [35], finally, describes a continuing eth-      approach to their professional practice.
nographic study of critical thinking, reflection and       D’Eon M. [37] use experiential learning for Inter-
experiential learning in nursing. The author exam-         professional education (IPE), a method to enhance
ines the related theory and explains the terms of          the ability of health professionals to learn to work
reference which underpin the study. Date analy-            together. He examines several approaches to learn-



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  tutor Volume 14, Numero 1, aprile 2014

                   ing that can help IPE fulfill its expectations. The       empathy session in the care-ethics lab is the empha-
LAVORI ORIGINALI




                   learning process itself needs to be approached from       sis on experience as a basis for ethical reflection.
                   an experiential learning framework cycling through        In the article of Grol R. et al. [41] a description is
                   the four-stage model of planning, doing, observing        given of what ‘implementation’ involves in practice,
                   and reflecting. By using increasingly complex and         the theoretical points of view regarding changes in
                   relevant cases in cooperative groups with an ex-          care practice and how - in general terms - a pro-
                   periential learning process, interprofessional edu-       gramme or project aimed at the introduction of
                   cation can be successful.                                 new working methods or changes in practice could
                   Gaby C. Jacobs [38] developed an action learning          be set up. The effective implementation of guide-
                   programme on empowerment to support practi-               lines, valuable procedures or other innovations, be
                   tioners in the transformation of their current prac-      they new or old, requires a systematic approach
                   tice, in line with the health promotion discourse,        with good preparation and planning. The following
                   using a qualitative case-study approach. In this pa-      steps are important in a systematic approach to
                   per, the process and outcomes of reflection as ex-        implementation:
                   perienced and described by the practitioners in the       – Formulation of a concrete, well-developed and
                   action learning programme, are discussed against              attainable proposal for change in practice, with
                   the background of notions of reflection and reflex-           clear targets.
                   ivity, critical being and critical pedagogy.              – Analysis of the target group and the setting:
                   The study of Hammer D. [39] defines profession-               what are the problems in care provision, and
                   alism in the context of contemporary pharmacy                 what factors are stimulating or hampering the
                   practice, discusses the professional socialization            process of change?
                   process of student pharmacists, and suggests strat-       – Development or selection of a set of strategies
                   egies for preceptors to facilitate the professional-          for change: strategies for both the effective dis-
                   ism of the student pharmacists they precept. There            semination and the effective implementation
                   are numerous techniques to help students develop              and maintenance of change.
                   positive professional behaviors during experien-          – Developing and executing an implementa-
                   tial learning. Preceptors may already be employing            tion plan that contains activities, tasks and a
                   some of these and may have additional ideas that              timetable.
                   have worked at their sites. Some ideas are de-            -– Evaluation and, if necessary, revision of the
                   scribed in detail as state explicit expectations; set         plan: continuous monitoring on the basis of
                   high standards for students; treat students respect-          indicators.
                   fully; frequent, timely, specific feedback to students;   These are brought together in a model. Various
                   evaluation of students’ professional behavior; stu-       theories and ‘approaches related to the effective
                   dent feedback to site and preceptors and, in partic-      implementation of change are integrated into this
                   ular, the role modeling.                                  model.
                   Linus Vanlaere et al. [40] developed an experien-
                   tial learning method to generate empathy in the           Hewson Mariana G. et al. [42] developed and im-
                   care of vulnerable older persons. The care-ethics         plemented a professional development program in-
                   lab ‘sTimul’ originated in 2008 in Flanders with the      volving experiential learning and conceptual change
                   stimulation of ethical reflection in care providers       teaching approaches in the field of complemen-
                   and care providers in training as its main goal. Also     tary and alternative medicine (CAM). The study
                   in 2008, sTimul commenced the organization of             demonstrate that it is possible to increase physi-
                   empathy sessions as an attempt to achieve this goal       cian knowledge and change attitudes towards in-
                   by simulation. The empathy session is a practical         tegrative medicine with an eight-hour intervention
                   and fairly straightforward way of working to pro-         using experiential and conceptual change teaching
                   voke care providers and care providers in training        approaches. The 8-h program consisted of expe-
                   to engage in ethical reflection. Characteristic of the    riential workshops (total of 5 h), in which partici-



                     30
                             The effects of educational models based on experiential learning in Medical Education



pants were actively involved in yoga, massage, Rei-        Kinyon J., Keith C.B., Pistole M.C. [45] describe
ki, T’ai Chi, mindfulness meditation, guided imagery       an interdisciplinary, group experiential learning ap-
relaxation. Specific lectures (total of 3 h) provided      proach used with baccalaureate nursing students
scientific data about the selected CAM modalities.         as group participants and graduate counseling psy-
The evaluation data showed that the program was            chology students as facilitators. This teaching meth-
successful in achieving its aims. The participant phy-     od provides learning to enhance the knowledge and
sicians changed from relative ignorance and nega-          skills of students preparing for both professions.
tive attitudes to having conceptions of CAM that           Because many nursing responsibilities are accom-
were more intelligible, more plausible, and poten-         plished in groups, undergraduate nursing curricula
tially more fruitful. Their attitudes to CAM became        need to prepare students in the skills required to
more positive. The Authors found that the one-day          function effectively in groups.
program had significant impact in an area that is of-      Lian-Kah Ti et al. [46], because simulators provide
ten viewed with suspicion and doubt.                       an effective platform for the learning of clinical mo-
Ikemi A., Masui T. [43] report a study that they           tor skills such as endotracheal intubation -although
conducted in which the effects of participating in         the optimal learning technique remains unidenti-
a seminar on counseling skills were demonstrat-            fied- they hypothesised that, for novices, experi-
ed. The subjects were 11 first and second year             ential learning would improve the learning and re-
medical students who took part in an elective              tention of endotracheal intubation compared with
course in medical humanities, in which counseling          guided learning.
skills, active listening and experimental focusing         Lockhart J.S. and Resick L.K. [47] describe an un-
were taught. The class met for 10 sessions every           dergraduate course in transcultural nursing that
other week, in which students were exposed to              relies heavily on experiential learning activities and
these techniques. On weeks when the class did              local community resources. Student evaluations re-
not meet, students practiced these techniques in           veal both immediate and long-term effects of this
pairs among themselves. At each of these sessions,         course on graduates’ clinical practice.
students filled out a relationship scale and record-       Papai P., Bourbonnais F.F., Chevrier J. [48] use Kolb’s
ed the session into a cassette tape. Furthermore,          experiential learning model as a framework to help
students filled out personality tests at the first         Chinese nurse educators reflect on their practice
and last class. A comparison of the results of the         as clinical teachers. The workshop resulted in the
relationship scale between the first and last ses-         generation of new insights by participants into their
sion showed a significant increase in the students’        role as clinical teachers. Chinese educators wanted
ability for empathy (P less than 0.02) and for un-         to increase their links between the teaching of the-
conditional positive regard (P less than 0.02). Not        ory at the college and the instruction of students in
enough personality tests were handed in at the             the practice setting. The use of a similar approach in
last class to provide a useful comparison. Tapes           future professional development workshops allows
of the sessions are currently being investigated in        presenters to identify nurses’ learning needs regard-
another study using a different measurement. The           ing specific areas of nursing practice and education.
authors discuss the need for such experimental             Phillips R.M., Bonsteel S.H. [49] highlight that Fac-
courses for medical students to overcome the               ulty are challenged to find innovative ways to teach
Cartesian view of seeing others as “objects” and           the skills for evidenced-based practice and informa-
for developing humanistic ways of relating to oth-         tion literacy. Librarians are natural partners with
er persons.                                                nurse educators because of their information liter-
Kidd T. and Kendall S. [44] examine issues of con-         acy expertise. The authors describe the develop-
tention regarding current practices and suggests           ment and implementation of simple research proj-
the application of the experiential theory of learn-       ects in an undergraduate nursing research course
ing (incorporating reflective practice) to advanced        and the collaboration among course faculty, nursing
cardiac life support (ACLS) training.                      students, and the information literacy specialist.



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                   In an attempt to excite baccalaureate nursing stu-       ticipants to visit, critically observe, discuss and re-
LAVORI ORIGINALI




                   dents about nursing research, a traditional, lec-        port on the various components of the cold chain
                   ture-style nursing research course was transformed       process.
                   into an experiential, interactive course [50]. Atti-     Finally, White K.R. [56] address the issue of how a
                   tudes toward research were compared between              balance of experiential and didactic learning is es-
                   students who received the lecture course and             sential to develop managers and leaders for early
                   those who participated in the experiential course.       and mid-career positions in the healthcare adminis-
                   Students in the experiential course exhibited sig-       tration profession. His article suggests pedagogical
                   nificantly more positive attitudes toward nursing        methods that enhance experiential learning. It also
                   research than students in the traditional lecture        recognizes the need for a renewed focus on diverse
                   course.                                                  experiential learning opportunities, management
                   Sewchuk D.H. [51] developes a “perioperative             and preceptor development programs, and gradu-
                   nursing course” that uses Kolb’s experiential learn-     ate program partnerships.
                   ing theory and learning cycle as a framework to
                   provide nurses new to the OR with a solid knowl-
                   edge base with which to further their practice. This     Can experiential learning be assessed?
                   framework can be used to leverage learning style,        Fourteen studies were found which addressed this
                   promote critical thinking, and encourage active          question.
                   learning.                                                The study of Aukes Leo C. et al. [57] test the ex-
                   The models of reflective practice and experiential       pectation that enhanced experiential learning is an
                   learning, described within the article of Simpson K,     effective educational method that encourages per-
                   Freeman R. [52], provide the dental practitioner         sonal reflection in medical students. Using a pre
                   and his/her team with realistic methods by which         post-test follow-up design, the level of the personal
                   they can improve their skills and working atmo-          reflection ability of an exposure group of first-year
                   sphere, and also reduce occupational stress.             medical students participating in a new enhanced
                   Smith L.M., Emmett H.E., Woods M. [53] highlight         experiential learning program was compared to
                   that the intent to improve the health status of the      that of a control group of second- and third-year
                   population served through community practice             medical students participating in a standard prob-
                   nursing interventions, guided by primary health          lem-based learning program. Personal reflection
                   care principles, is common to all clinical placements.   was assessed using the Groningen Reflection Abili-
                   A curriculum designed to standardize community           ty Scale (GRAS). Students’ growth in reflection was
                   health practice experience and theory may not ad-        analyzed with multilevel analysis.
                   dress students’ learning needs in any of the prac-       After one year, first-year medical students in the
                   tice areas. These challenges have been addressed         exposure group achieved a level of personal reflec-
                   in their study, trough an experiential learning ap-      tion comparable to that reached by students of the
                   proach that focuses on the needs of the learner.         control group in their third year. This difference in
                   Vesper J. et al. [54] explore the effects of experi-     growth of reflection was statistically significant (p
                   ential learning in pre-hospital emergency care by        < .001), with a small effect size (effect size = 0.18).
                   nursing students on placement with the Northern          The reflection growth curve of the control group
                   Ireland Ambulance Service.                               declined slightly in the third year as a function of
                   Vidar Melby [55] refer to The World Health Orga-         study time. The conclusion of the study is that en-
                   nization that developed a weeklong experiential          hanced experiential learning has a positive effect
                   learning event for participants so they could gain       on the personal reflection ability of undergraduate
                   experience in how temperature-sensitive products         medical students.
                   are handled, stored, and distributed throughout          Bligh J. and Parsell G. [58] highlight as the acquisi-
                   the length of the distribution supply chain system.      tion of the necessary knowledge, skills and attitudes
                   This experiential learning method has enabled par-       required for effective interprofessional behavior is



                     32
                            The effects of educational models based on experiential learning in Medical Education



conditional upon a large number of variables, over        compared and contrasted with definitions in the
many of which practitioners may have little control.      literature and implications for nurse education are
Planned educational and organizational strategies,        identified.
research and evaluation are needed to answer the          When students were interviewed, they tended to
considerable number of questions and issues raised        define experiential learning much more in terms of
by the report.                                            clinical work than did the tutors. This difference of
The University of Maryland School of Pharmacy             perception highlights, perhaps, the need for tutors
has systematically implemented professionalism            and students to work closely together in discuss-
assessment to establish expectations in experien-         ing educational approaches to teaching and learning
tial learning and to create a mechanism for holding       nursing.
students accountable for professionalism. Cynthia         In another article, Burnard [62] has advocated Expe-
J. Boyle [59] describe their philosophic approach         riential learning methods for teaching interpersonal
to the development and implementation of these            skills in nursing courses. Tutors and lecturers are
explicit criteria and also review the outcomes of         often teaching larger groups of students on Proj-
applying these criteria.                                  ect 2000 courses and this may lead to difficulties in
In 2001, 3 professionalism criteria were developed        using experiential learning methods. The paper of-
and applied to required intermediate and advanced         fers two types of structure for using such methods
pharmacy practice experiences (APPEs). Students           based on the notion of student-facilitation. The pa-
were expected to achieve 100% acceptable ratings          per also highlights the need for experiential learning
to pass the rotations. The criteria were subse-           groups to be evaluated effectively and the learning
quently enhanced and by 2005 applied to all experi-       that takes place in them to be linked to the clinical
ential courses. Most students exhibited profession-       nursing arena.
al behavior; however, 9 students did not meet the         Coker P. [63] examined the effects of participation
established criteria. Strategies used in remediation      in a 1-week, experiential, hands-on learning pro-
and further professional development are discussed        gram on the critical thinking and clinical reasoning
in the article. The use of professionalism criteria       skills of occupational therapy students. A quasi-ex-
has promoted a culture of professionalism through-        perimental, nonrandomized pre- and post-test de-
out the School.                                           sign was used with a sample of 25 students. The
For Burnard P. [60] the experiential learning has         students had completed three semesters of didactic
been as a means of helping students to learn about        lecture coursework in a master’s level OT educa-
aspects of nursing. His paper reports an analysis         tional program prior to participation in a hands-on
of two language styles identified during a research       therapy program for children with hemiplegic ce-
project that explored nurse tutors’ and students’         rebral palsy. Changes in critical thinking and clinical
perceptions of experiential learning. twelve nurse        reasoning skills were evaluated using the following
tutors and 12 student nurses were interviewed             dependent measures: Self-Assessment of Clinical
and the transcripts were analysed using a modified        Reflection and Reasoning (SACRR) and the Califor-
grounded theory approach. The aspect of the find-         nia Critical Thinking Skills Test (CCTST). Changes
ings reported in the study is that of the emergence       in pretest and posttest scores on the SACRR and
of two ‘language styles’ used by some of the writers      the CCTST were statistically significant (p>0.05)
and practitioners in the field of experiential learn-     following completion of the experiential learning
ing. It is suggested that those language styles may       program. This study supports the use of hands-on
form a ‘culture isogloss’ or barrier between tutors       learning to develop clinical reasoning and critical
and students.                                             thinking skills in healthcare students, who face ever
In another study, Burnard P. [61] interviewed 12          more diverse patient populations upon entry-level
nurse tutors in depth about the way that they de-         practice. Further qualitative and quantitative inves-
fined experiential learning and experiential learn-       tigations are needed to support the results of this
ing methods. In the paper, those definitions are          study and determine which components of experi-



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  tutor Volume 14, Numero 1, aprile 2014

                   ential learning programs are essential for develop-       ation of work-based learning within a post registra-
LAVORI ORIGINALI




                   ing clinical reasoning and critical thinking skills in    tion community health nursing degree programme.
                   future allied health professionals.                       Work-based learning is primarily concerned with
                     D’Amour R. and Guimond P. [64] report on an             the process of learning and with encouraging the
                   evaluation of work-based learning within a post-reg-      individual to be explicit about how and what they
                   istration community health nursing degree pro-            learn so that their experiential learning may be as-
                   gramme. The purpose of their article is to describe       sessed and accredited. The methodology of Illumi-
                   the process utilized to develop, implement, and           native Evaluation was adopted, with case studies
                   evaluate a workshop on Creutzfeldt-Jacob disease          (n=6) used as the means of exploring in depth the
                   (CJD) for nurses and other health care providers.         different perspectives of the major stakeholders
                   Kolb’s experiential teaching/learning model was           (that is, the students, their workplace supervisors
                   used as a framework for this workshop. A work-            and their academic supervisors). The data com-
                   book was developed to complement the partici-             prised documentation, participant and nonpartic-
                   pants’ learning. Fifteen health care providers from       ipant observation, interviews and focus groups.
                   the Alzheimer Society of Canada’s Dementia Net-           What emerged through the course of inquiry was
                   work agreed to participate in this educational proj-      a gap between the educational philosophy of work-
                   ect. The results indicated that the participants had      based learning and the way in which work-based
                   limited knowledge about CJD. They felt ill prepared       learning was delivered within the department con-
                   and uncomfortable in providing quality care to this       cerned. Work-based learning provides educators
                   patient population. The workshop generated new            with an opportunity to debate openly fundamental
                   insights and knowledge about the disease and the          issues about the nature of educational practice; in
                   needs of the patients and their families. Participants    particular, about the role of the supervisor in fa-
                   exchanged ideas for tailored interventions. An ex-        cilitating students’ learning. As the evaluation high-
                   periential teaching/learning model is a highly effec-     lights, if this debate does not occur, existing educa-
                   tive approach to increase knowledge and skills, as        tional practice remains unchanged and the potential
                   well as fostering reflective practice.                    benefits to students of this new educational philos-
                   Delany C. and Watkin D. [65] describe and exam-           ophy are not realized. Furthermore, it is by engag-
                   ine the effect of a three hour per week, six week         ing in a reflective process in relation to their own
                   critical reflection program, grounded in knowledge        experience that educators can begin to understand
                   paradigms of postmodernism, reflexivity and crit-         how to facilitate that process in others.
                   ical theory, on third year undergraduate physio-          Hogg D. C. and Morgan P.J. [67] have gathered
                   therapy students’ experience of their first clinical      students’ opinions of the simulator learning expe-
                   placements. The theoretical basis of the program          riences and to study and analyze their comments
                   provides a potential bridge with which to link and        regarding the nature of the learning.
                   broaden the established framework of clinical rea-        All fourth-year medical students were invited to
                   soning theories. Within the program, students’            participate in a simulator session during their an-
                   critical reflection discourse focused on notions of       esthesia rotation. A satisfaction survey was admin-
                   power, hierarchies, connecting with others and re-        istered and the qualitative data were analyzed. A
                   lationships. Their feedback about the effects of the      total of 145 students completed the questionnaire
                   program highlighted themes of validation and shar-        (100% return rate). Most students (88%) reported
                   ing; a break in clinical performance and a broadening     the session to be a positive learning experience that
                   of their spheres of knowledge. These themes reso-         provided opportunities for applying their knowl-
                   nated with students’ overall experiences of learning      edge in a realistic environment. Some students in-
                   in clinical placements and provide some evidence          dicated a lack of comfort in the environment but
                   for the inclusion of critical reflection as a valid and   this did not appear to inhibit performance. Student
                   worthwhile component of early clinical education.         comments highlighted the value of the learning
                   Dewar B. J. and Walker E. [66] report on an evalu-        experience and provided insights into the nature



                     34
                             The effects of educational models based on experiential learning in Medical Education



of the learning. The computer-controlled patient           course intervention was evaluated as an add-on to
simulator offers new and challenging opportunities         a psychotherapy inpatient programme. In a diagnos-
for medical students to apply their knowledge and          tically mixed inpatient sample, participation in ropes
practice working through an Anesthesia case with-          course exposures seemed to be related with better
out endangering patient safety.                            long-term outcomes on personality variables - trait
Evaluation of the effectiveness of the Urinary In-         anxiety and self-efficacy - but not regarding depres-
continence Scales to measure change after student          sive symptoms and state anxiety. Interventions that
participation in a disability-incontinence experien-       draw upon experience and group action might be a
tial learning activity was the focus of the pilot study    valuable addition to talking psychotherapy.
of Karlowicz K.A. [68]. A comparison between
pretest and posttest scores showed a significant in-
crease in Belief and Practice subscale scores after        What contextual influences hinder or
participation in the experience. However, positive         enable the development of experiential
correlations between the variables measured could          learning?
not be established.                                        Four studies were found which addressed this
Lian-Kah Ti et al. [69] present 2 pilot projects in        question.
which the efficacy of experiential learning with sim-      Acosta V. M. [71] offers a perspective on why cul-
ulation is demonstrated. In the first project, groups      turally integrated behaviors are important for al-
of 4 to 6 fourth-year medical students were ex-            lied health education and suggestions of methods
posed to common crisis scenarios. Each student             to facilitate such behaviors. Literature and theory
took turns to individually handle the situation (in        are used to support cultural integration in allied
the hot seat), while the rest of the group watched         health curricula. Examples of learning experiences
“live” via video-link. A group debrief was done after      from students in cross-cultural environments and
the completion of all scenarios and learning points        reflections on those experiences further elucidate
were d. A test was conducted shortly after, and the        facilitation methods.
student who managed the same scenario in the hot           Barrett K. [72] shows a framework for health ed-
seat earlier was compared to the rest of the group         ucation based on experiential learning and critical
with respect to crisis recognition, management and         inquiry was developed and applied to a Spring 1990
diagnosis. In the second project, 36 fourth-year           basic health education class for college students
medical students were assigned to learn endotra-           called “Patterns of Healthful Living.” Students were
cheal intubation through a directed or experiential        asked to consider contemporary health problems
method. Students were recalled after 3 months and          and how these affected their own lives and the lives
tested on 4 major categories: preparation, tech-           of others.
nique, success and ventilation. Students in the hot        Green A.J. [73] develops an enquiry from the prem-
seat tended to perform better (72% vs. 64%), and           ise that there is potential for students to learn effec-
were more likely to be the highest scoring student         tively in experiential teaching sessions. The authors
within their group; although this did not reach sta-       experience of teaching in mental health gave focus
tistical significance. For the intubation study, stu-      to the question as to whether nurse teachers con-
dents in the experiential group had a higher suc-          sider, and then use, a particular experiential learning
cess rate at 3 months (78% vs. 41%). Experiential          framework when facilitating experiential teaching
teaching methods with simulation result in better          methods. The enquiry was an individual case study
learning of crisis management and endotracheal             of one nurse teacher, and the data were collected
intubation.                                                through non-participant observation and focussed,
In the study of Wolf M. and Mehl K. [70] the princi-       non-directive interviewing. The philosophical per-
ples of experiential learning, outdoor ropes courses       spective and methodology was phenomenological
are a means for the facilitation of personal growth        with the data analysed using phenomenological
and promotion of individual coping skills. A ropes         guidelines. This was used as it concentrated on



                                                                                                              35
  tutor Volume 14, Numero 1, aprile 2014

                   the nurse teachers understanding of experiential          the implications of the power nexus created when
LAVORI ORIGINALI




                   learning as a phenomenon. The results concluded           teachers research students, and issues relating to
                   that the nurse teacher had a clear understanding of       the use of a phenomenological methodology in a
                   experiential learning and aspects of her interpreta-      longitudinal study.
                   tion manifested themselves within the classroom as
                   part of experiential teaching. When compared with
                   the literature there were commonalties with the           DISCUSSION
                   meaning of experiential learning held by the nurse        In this section, we discuss the current state of
                   teacher studied. The focus of this paper is to report     research in this area. We summarize the findings
                   briefly on the enquiry, and then offer a detailed crit-   briefly and relate the literature to existing models
                   ical description and evaluation of the methodologi-       of experiential learning. We also highlight the as-
                   cal approach used.                                        sumptions and relationships that are not yet sup-
                   Green A.J. and Holloway DG. [74] provide a re-            ported by research evidence. Lastly, we offer im-
                   port of the usage of a phenomenological research          plications for research and for educational practice.
                   methodology to investigate the influence on clin-
                   ical practice of pre-and post-registration nurse
                   education which makes explicit use of experiential        Current state of the research
                   teaching and learning approaches. The primary aim         The research literature on the effectiveness of
                   of the research was to explore the use of a phe-          strategies to foster experiential learning is still in
                   nomenological research methodology to examine             development. We identified 49 studies, the major-
                   the students’ understanding of experiential teach-        ity of which were qualitative. Comparison groups
                   ing and learning, The claims made for the use of          were sometimes included. At the time of our re-
                   experiential teaching and learning approaches in          view, no randomized controlled studies were iden-
                   both pre-and post-registration nurse courses and          tified. However, many of the studies employed
                   how clinical practice is influenced by the experi-        carefully conceptualized, theoretically-based quali-
                   ential learning elements of pre-and post-registra-        tative methods and analytic approaches.
                   tion nurse education were also examined. The first        The methods employed were appropriate to the
                   stage of the enquiry involved focused nondirective        research questions and led to reasonable estimates
                   interviews with members of BSc Nursing Stud-              of study quality and findings. Qualitative inquiry
                   ies and MSc Mental Health Branch programmes.              also informs understanding of theoretical perspec-
                   Both programmes claim to make use of experien-            tives and models which best seem to inform expe-
                   tial teaching and learning. Previous experiences of       riential learning in medical education. Comparative
                   experiential teaching and learning were probed,           research approaches can be more appropriately
                   student interpretations differentiated, and the           utilized once these common understandings have
                   relationship between course-based learning us-            been developed.
                   ing experiential approaches and the implications          That said, the review revealed several carefully de-
                   for its influence on practice were examined. The          veloped instruments and analytic approaches for
                   second stage of the enquiry has followed up the           measuring experiential learning. Where these were
                   initial findings, exploring the students’ experience      developed for a specific study, their construction
                   of experiential approaches on their courses both          and validation were clearly described, with an ap-
                   in the classroom and in work-based learning situa-        propriate methodologies, mainly with a qualitative
                   tions. The findings are presented and discussed in        research approach and case studies. These instru-
                   the context of other studies from both nurse and          ments can provide a useful steppingstone to further
                   higher education, Throughout the paper method-            study of experiential learning in medicine.
                   ological concerns arising are discussed. The paper        The experiential learning, as evidenced by papers
                   concludes with the identification of methodolog-          identified, is used in various fields of medicine:
                   ical problems arising from the research strategy:         for example, trans-cultural nursing education, in-



                     36
                              The effects of educational models based on experiential learning in Medical Education



ter-professional education, transformation of cur-          on it, creating new meanings and new professional
rent practices, empathy in the care of vulnerable           practices.
older persons, complementary alternative med-               A key point that emerges from studies identified for
icines, counseling skills, cardiology, to teach the         this review of the literature concerne the personal
skills for evidenced-based practice and information         epistemology as an array of professional shift. To
literacy in pre-hospital emergency care, to develop         change its practices, that is, you need to work on
managers and leaders for early and mid-career po-           dismantling and restructuring of their own beliefs,
sitions in the healthcare administration profession.        attitudes, values​​, languages​​, and in a few words on
We can say that experiential learning is seen as a          our own systems of social-cognitive construction of
methodology that encourages reflection and pro-             reality (social representations).
motes the construction of new shared professional           The next step in the process of building new knowl-
knowledge.                                                  edge involves the “socialization” of these in a “com-
From the studies analyzed, then, emerges as the             munity of practice” [75]. Here, in fact, the experi-
experiential learning is seen as a practice that can        ential learning can play a decisive role, if it manages
be experienced not only in the training of doctors,         to turn a negotiation, exchange and restructuring of
nurses, educators, but also managers and other              the “personal knowledge” of each individual practi-
professionals working in teams.                             tioner who is part of a “learning community”.
                                                            Because an experiential teaching / learning model is
                                                            a highly effective approach to increase knowledge
Summary of our findings                                     and skills, as well as fostering reflective practice, it
This literature review allows us to identify certain        is necessary to keep experimenting with new mod-
influential variables that can form the foundation          els of experiential learning assessment, which can
for future studies. It also reveals the gaps in the ex-     bring out the critical aspects on which to intervene
isting literature, both in content and methodology.         continually improving levels of intra-group interac-
However, several illuminating and important find-           tion. The aim is to promote the ability to work in
ings appear consistently across study designs, study        inter-professional environments, which direction
groups and professions. They are summarized below:          they are moving all the professional sectors, espe-
The focus of education has changed from teaching            cially related to medical practice.
to learning. This educational model stresses stu-
dent outcomes that include critical thinking, effec-
tive communication, and students’ ability to reflect        Implications for research and practices
their own learning.                                         The literature synthesis highlights several questions
These studies have shown that experiential learning         for further study. We raise these questions here.
is a methodology that can help practitioners and
health care in the new learning and management of           Does the experiential learning enhance the practices?
emotions connected to clinical practice.                    All studies show that experiential learning has facil-
The experiential learning, in fact, gives the subject       itated the sharing of knowledge and emotions and
an active role as builder of knowledge, which is also       we have evidence that best practice by experiment-
the result of “exchanges” between him and the sur-          ing with some models of experiential learning [76].
rounding environment.                                       Unfortunately, there is limited time for reading,
However, emerging terms such as “experiential               meeting with colleagues, or reviewing their own
learning”, “collaborative learning”, “critical thinking”,   practices. We must continue to creative, efficient,
“cooperative learning”, “reflection” and “reflection        and innovative approaches that change their behav-
practices” that seem to be often used as synonyms.          ior and help physicians improve the quality of health
Perhaps we could say that the experiential learning         care [77]. In particular:
includes all these elements, precisely because it is        – It is critical to continue to measure physician
primarily about learning from experience to reflect             performance;



                                                                                                               37
  tutor Volume 14, Numero 1, aprile 2014

                   – changing physician behavior must devolves more          Finally, Wolf M. and Mehl K. [86] demonstrate as
LAVORI ORIGINALI




                       than one approach;                                    interventions that draw upon experience and group
                   – change often occurs within organizations and            action might be a valuable addition to psychotherapy.
                       barriers to change must be understood;                Burnard [87] (1993), however, highlights the need
                   – should approaches to change and reflect, the            for experiential learning groups to be evaluated ef-
                       specific issue to be based on model of physician      fectively and the learning that takes place in them to
                       decision making;                                      be linked to the clinical nursing arena.
                   – medical informatics holds great promise, but has        Further qualitative and quantitative investigations
                       an unclear role in the ambulatory setting;            are needed to support the results of the studies
                   – traditional continuing medical education should         and determine which components of experiential
                       be changed.                                           learning programs are essential for developing clin-
                   For Ringsted C. [78] (2009) experiential learning         ical reasoning and critical thinking skills in future
                   in the learner is highly active in the practices pro-     allied health professionals.
                   cesses through trial and error, whereas in the step-
                   by-step approach takes the learner to more passive        What contextual influences hinder or enable the devel-
                   role.                                                     opment of experiential learning?
                   White K.R. [79] suggests pedagogical methods that         We have not found studies that address this topic,
                   enhance experiential learning. It also recognizes the     but we can draw some general considerations that
                   need for a renewed focus on diverse experiential          come from an analysis of material collected for this
                   learning opportunities, management and precep-            literature review:
                   tor development programs, and graduate program            – it is important to foster a climate of mutual trust
                   partnerships.                                                 between professionals within the working group;
                                                                             – the tutor can facilitate group members in devel-
                   Can experiential learning be assessed?                        oping and sharing their emotions and their own
                   Student evaluations reveal both immediate and                 knowledge, it is important that he always gives
                   long-term effects of this course on graduates’ clin-          feedback and show the connections and associ-
                   ical practice [80].                                           ations between their thoughts;
                   In a recent study of Aukes Leo C. et al. [81] en-         – need to educate the group to “ cognitive listen
                   hanced experiential learning has a positive effect            “ than the other, avoiding to consider empathy
                   on the personal reflection ability of undergraduate           as a “subjective variable innate” or, worse, as an
                   medical students.                                             element of mere “tolerance” of other person.
                   D’Amour R. and Guimond P. [82] demonstrate as             – need a “sensitivity” also by the institutions, so
                   an experiential teaching/learning model is a highly           that we can implement specific moments ded-
                   effective approach to increase knowledge and skills,          icated to experiential learning. On the oth-
                   as well as fostering reflective practice.                     er hand, if an institution believes in a learning
                   Delany C. and Watkin D. [83] provide some evidence            approach, this will be understood by the stu-
                   for the inclusion of critical reflection as a valid and       dent / professional such as a value assignment.
                   worthwhile component of early clinical education.             Conversely, if an activity is not enhanced, the
                   Dewar B. J. and Walker E. [84] report on an eval-             tendency of the student / professional will be
                   uation of work-based learning They highlight as it            to regard it as unimportant and “incidental” in
                   is by engaging in a reflective process in relation to         comparison to the traditional curriculum.
                   their own experience that educators can begin to
                   understand how to facilitate that process in others.
                   Lian-Kah Ti et al. [85] demonstrate as experiential       Conclusion
                   teaching methods with simulation result in better         In this review, we have synthesized the findings
                   learning of crisis management and endotracheal            of 47 studies of experiential learning in the health
                   intubation.                                               professions.



                     38
                                  The effects of educational models based on experiential learning in Medical Education



Experiences are now accelerated, fragmented, vir-                    Aukes Leo C et al. (2008). The Effect of Enhanced
tual, often contradictory, no longer transmitted by                  Experiential Learning on the Personal Reflection of
generation, but through building a creative effort.                  Undergraduate Medical Students, Med Educ Online,
We need to “do” the experience and what happens                      13:15; Boenink AD, Oderwald AK, De Jonge P, Van Til-
                                                                     burg W & Smal JA, 2004, Assessing student reflection
when we transform everyday events into learn-
                                                                     in medical practice. The development of an obser-
ing. It takes the body a different knowledge than
                                                                     ver-rated instrument: Reliability, validity and initial
those traditionally found in the lexicon of trainers                 experiences, Medical Education, 38: 368-377; Boud .,
(knowledge, skills, interpersonal skills).                           Keogh R, & Walker D, 1985, Reflection: Turning expe-
This is the knowledge that comes from experience.                    rience into learning, Kogan Page, London; de Mennato
Yet, as understanding of experiential learning and                   P, Orefice C, Branchi S. (2011). Educarsi alla cura. Un
develops the field matures, there will be a need for                 itinerario riflessivo tra frammenti e sequenze. Lecce: Pen-
studies with rigorous designs that will allow us to                  sa Multimedia; Dewey J (1933). How we think: A re-
evaluate the effect of different educational strate-                 statement of the relation of reflective thinking to the
gies to promote its development.                                     educative process. New York: D.C. Heath and Com-
                                                                     pany; Epstein RM and Hundert EM (2002), Defining
                                                                     and assessing professional competence, Journal of the
ACKNOWLEDGEMENT                                                      American Medical Association, 9;287(2): 226-35; Epstein
                                                                     R.M., 1999, Mindful practice, Journal of the American
I wish to thank Dr. Silvia Mamede, MD PhD, for
                                                                     Medical Association, 282, 833-839; Fabbri L, Striano M,
the professionalism and the highest availability she                 Melacarne C, (2008). L’insegnante riflessivo. Coltivazio-
has shown in following the path of my internship.                    ne e trasformazione delle pratiche professionali. Milano:
I would also like to thank Prof. Dr. Marise Born -                   Franco Angeli; Ferro Allodola V, Canocchi E (2011).
Head of the Department of Psychology, Erasmus                        Prevenzione e cura. Lavorare con le rappresentazioni.
University of Rotterdam (The Netherlands) - for                      Lecce: Pensa Multimedia; Hatton N & Smith D (1995),
putting me up for more than two months, from Jan-                    Reflection in teacher education: Towards definition
uary to March 2011.                                                  and implementation, Teaching and Teacher Education,
I would also like to thank Prof. Dr. Patrizia de                     11, 33–49; Jarvis P, 1992, Reflective practice and nur-
Mennato, PhD, Full Professor of Pedagogy, my                         sing, Nurse Education Today, 12(3), 174-181; Knowles
PhD Supervisor and Director of the Laborato-                         MS (1975). Self-directed learning: A guide for learners
                                                                     and teachers. Englewood Cliffs: Prentice Hall/Cambri-
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medicaleducation-unifi.it), Faculty of Medicine and
                                                                     of experiential learning. M.I.T. Alfred P. Sloan School of
Surgery, University of Florence (Italy), for having                  Management, Cambridge, Mass; Mamede S & Schmi-
always encouraged and supported research in Med-                     dt H (2004). The structure of reflective practice in
ical Education.                                                      medicine. Medical Education, 38: 1302–1306; Mamede
                                                                     S & Schmidt H (2005). Correlates of reflective practi-
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[80] Lockhart JS & Resick LK (1997). Teaching cultural        [84] Dewar BJ & Walker E (1999). Experiential learning:
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                                                                                                                    43
                                                                                                                                LAVORI ORIGINALI


     APPENDIX 1




44
     Appendix 1 Studies included with Abstract
                             Study design and data Study population and     Study location/ Sample
     Source                                                                                        Brief abstract
                             collection            discipline               Author location size
                            Qualitative Research     Under-graduate                                 Students were asked to consider contemporary health
     1) Acosta V. M. (1991) using Learning Style                                 USA           69   problems and how these affected their own lives and the
                            Inventory (LSI)          Health Professionals                           lives of others.
                                                                                                  This study’s aim was to test the expectation that en-
                                                     Under-graduate
                                                                                                                                                                  tutor Volume 14, Numero 1, aprile 2014




     2) Aukes Leo C. et al. pre and post-test fol-                                                hanced experiential learning is an effective educational
                                                                                 USA          184
        (2008)              low-up design                                                         method that encourages personal reflection in medical
                                                     Medicine
                                                                                                  students.
                                                                                                    This article offers a perspective on why culturally
                                                     Under-graduate
                                                                                                    integrated behaviors are important for allied health
     3) Barrett K. (2002) Qualitative Research                                   USA
                                                                                                    education and suggestions of methods to facilitate such
                                                     Health Professionals
                                                                                                    behaviors.
                                                     Under-graduate and                             Acquisition of the necessary knowledge, skills and atti-
     4) Bligh J. and Parsell                         Graduate                                       tudes required for effective interprofessional behavior is
                             Editorial                                            UK
        G. (1999)                                                                                   conditional upon a large number of variables, over many
                                                     Health Professionals                           of which practitioners may have little control.
                                                                                                    The University of Maryland School of Pharmacy has
                                                     Under-graduate                                 systematically implemented professionalism assessment
     5) Boyle Cynthia J. et
                            Action research                                      USA                to establish expectations in experiential learning and to
        al. (2007)
                                                     Medicine                                       create a mechanism for holding students accountable for
                                                                                                    professionalism.
                                                     Graduate and                                   This paper offers an epistemological theory divided into
                                                     under-graduate                                 three domains: propositional knowledge, practical knowl-
     6) Burnard P. (1987) Reflective article                                   Australia
                                                                                                    edge and experiential knowledge, as a basis for a theory
                                                     Health Professionals                           of experiential learning.
                                                                                                    Experiential learning has been advocated as a means of
                                                     Under-graduate
                                                                                                    helping students to learn about aspects of nursing. This
                             Modified Grounded
     7) Burnard P. (1991)                                                      Australia            paper reports an analysis of two language styles identified
                             Theory Approach         Nurses
                                                                                                    during a research project that explored nurse tutors’ and
                                                                                                    students’ perceptions of experiential learning.
                                                     Graduate                                       This paper offers some of the findings from a study into
     8) Burnard P. (1992) Interviews in depth                                     UK           12   nurse tutors’ and student nurses’ perceptions of experi-
                                                     Nurses                                         ential learning.
                            Study design and data Study population and    Study location/ Sample
     Source                                                                                      Brief abstract
                            collection            discipline              Author location size
                                                   Under-graduate                                The paper highlights the need for experiential learning
                                                                                                 groups to be evaluated effectively and the learning that
     9) Burnard P. (1993) Reflective article                                    UK
                                                   Nurses                                        takes place in them to be linked to the clinical nursing
                                                                                                 arena.
                                                                                                 The exploration of personal values is an essential first
                                                   Under-graduate                                step in developing cultural awareness in order to move
     10) Carpio BA, Majum-                                                                       learners beyond ethnocentrism through awareness,
                           Reflective article                                  USA
         dar B. (1993)                             Nurses                                        understanding, acceptance, and appreciation of other
                                                                                                 cultures if learners are to truly adopt a multicultural
                                                                                                 approach to their professional practice.
                            A quasi-experimen-                                                   This study examined the effects of participation in a
                                                   Under-graduate
                            tal, nonrandomized                                                   1-week, experiential, hands-on learning program on the
     11) Coker P. (2010)                                                       USA          25
                            pre- and                                                             critical thinking and clinical reasoning skills of occupation-
                                                   Occupational Therapy
                            post-test design                                                     al therapy students.
                                                   Graduate and
                                                   undergraduate                                 This article examines several approaches to learning
     12) D’Eon M. (2004)    Reflective Article                                Canada             that can help IPE (Inter-professional Education) fulfill its
                                                   Medicine and health                           expectations.
                                                   professions
                                                                                                 The purpose of this article is to describe the process
                                                   Graduate                                      utilized to develop, implement, and evaluate a workshop
     13) D’Amour R., Gui-
                          Reflective article                                  Canada             on Creutzfeldt-Jacob disease (CJD) for nurses and other
         mond P. (2010)
                                                   Health Professionals                          health care providers. Kolb’s experiential teaching/learn-
                                                                                                 ing model was used as a framework for this workshop.
                           Interpretive research
                                                                                                 This paper describes and examines the effect of a three
                           design drawing from
                                                                                                 hour per week, six week critical reflection program,
                           the methodological      Under-graduate
     14) Delany C., Watkin                                                                       grounded in knowledge paradigms of postmodernism, re-
                           standpoint of inter-                           The Netherlands
         D. (2009)                                                                               flexivity and critical theory, on third year undergraduate
                           pretivism, and the      Health Professionals
                                                                                                 physiotherapy students’ experience of their first clinical
                           related method of
                                                                                                 placements.
                           constructivism
                                                   Graduate                                      This paper reports on an evaluation of work-based learn-
     15) Dewar B. J. and    case studies
                                                                                UK               ing within a post-registration community health nursing
         Walker E. (1999)
                                                   Nurses                                        degree programme.




45
                                                                                                                                                                  The effects of educational models based on experiential learning in Medical Education
                                                                                                                                  LAVORI ORIGINALI


                            Study design and data Study population and         Study location/ Sample




46
     Source                                                                                           Brief abstract
                            collection            discipline                   Author location size
                                                                                                      In this paper, the process and outcomes of reflection as
                                                     Graduate                                         experienced and described by the practitioners in the
     16) Gaby C. Jacobs     Qualitative case-study
                                                                                    USA               action learning programme, are discussed against the
         (2008)             approach
                                                     Health Professionals                             background of notions of reflection and reflexivity, criti-
                                                                                                      cal being and critical pedagogy.
                                                                                                      This article describes “unfolding cases,” a comprehensive
                                                     Under-graduate
     17) Glendon K., Ulrich                                                                           plan of learning that allows student practice time to solve
                            Qualitative research
         D.L. (1997)                                                                                  individually and collectively problems they may encounter
                                                     Health Professionals
                                                                                                      in clinical situations.
                                                                                                                                                                     tutor Volume 14, Numero 1, aprile 2014




                           Phenomenological with
                                                   Graduate                                           This enquiry has developed from the premise that there
                           the data analyzed using
     18) Green A.J. (1995)                                                           UK               is potential for students to learn effectively in experien-
                           phenomenological
                                                   Nurses                                             tial teaching sessions.
                           guidelines.
                                                                                                      This paper provides a report of the usage of a phenom-
     19) Green A.J. and     phenomenological         Under-graduate                                   enological research methodology to investigate the
         Holloway DG.       research technique                                       UK               influence on clinical practice of pre- and post-registration
         (1997)                                      Nurses                                           nurse education which makes explicit use of experiential
                                                                                                      teaching and learning approaches.
                                                                                                      This paper aims to provide an overview of some of the
                                                                                                      theoretical approaches to change and to integrate these
                                                     Physicians, nurses, and
                            Qualitative research                                                      approaches into a more general framework for changing
     20) Grol R. (1997)                              paramedics                 Netherlands
                                                                                                      clinical practice. The emphasis will be on changing the
                                                                                                      clinical practice of doctors and not on improving hospital
                                                                                                      management.
                                                     Under-graduate                                   The purpose of this paper is to serve as a tool for
     21) Hammer D. (2006) Reflective article                                        USA               preceptors to aid in pharmacy students’ development of
                                                     Medicine                                         professionalism.
                            randomized controlled Graduate                                            We developed and implemented a professional develop-
     22) Hewson Mariana
                            study                                                   USA          48   ment program involving experiential learning and concep-
         G. et al. (2006)
                                                  Medicine                                            tual change teaching approaches.
                                                                                                     The purpose of this study was to gather students’ opin-
     23) Hogg Doreen                                 Under-graduate
                          Qualitative research                                                       ions of the simulator learning experiences and to study
         Cleave & Morgan                                                           Canada        145
                          (satisfaction survey)                                                      and analyze their comments regarding the nature of the
         Pamela J. (2002)                            Medicine
                                                                                                     learning.
                                                     Graduate                                         We must continue to creative, efficient, and innovative
     24) Howard Bauchner
                         Reflective Article                                         USA               approaches that help physicians change their behavior
         et al. (2001)
                                                     Medicine                                         and improve the quality of health care.
                            Study design and data Study population and      Study location/ Sample
     Source                                                                                        Brief abstract
                            collection            discipline                Author location size
                                                    Under-graduate                                 The authors discuss the need for experimental courses
     25) Ikemi A., Masui T.                                                                        for medical students to overcome the Cartesian view of
                            Qualitative research                                 Japan
         (1984)                                     Medicine                                       seeing others as “objects” and for developing humanistic
                                                                                                   ways of relating to other persons.
                                                    Graduate and
                                                                                                   This paper lays the foundations for a theory of practice
                                                    under-graduate
     26) Jarvis P. (1992)   Reflective article                                    UK               and paves the way for one useful way in which the rela-
                                                                                                   tionship between theory and practice can be understood.
                                                    Health Professionals
                                                    Under-graduate                                 Evaluation of the effectiveness of the Urinary Inconti-
     27) Karlowicz K.A.                                                                            nence Scales to measure change after student partici-
                            Quantitative research                                USA
         (2009)                                     Nurses                                         pation in a disability-incontinence experiential learning
                                                                                                   activity was the focus of this pilot study.
                                                                                                   This paper examines issues of contention regarding
                                                    Under-graduate and
                                                                                                   current practices and suggests the application of the
     28) Kidd T. and Kendall                        Graduate
                             Literature review                                    UK               experiential theory of learning
         S. (2005)
                                                                                                   (incorporating reflective practice) to advanced cardiac life
                                                    Health Professionals
                                                                                                   support (ACLS) training.
                                                    Under-graduate                                 This article describes an interdisciplinary, group experi-
     29) Kinyon J., Keith
                                                                                                   ential learning approach used with baccalaureate nursing
         C.B., Pistole M.C. Action-Research                                      USA
                                                    Nurses                                         students as group participants and graduate counseling
         (2009)
                                                                                                   psychology students as facilitators.
                                                    Graduate
                                                    Under-graduate
     30) Kolb, D.A. (1984) Qualitative study                                     USA               Kolbs’ Experiential Learning Model.
                                                    All the professionals
                                                                                                  Simulators provide an effective platform for the learning
                                                    Under-graduate
     31) Lian-Kah Ti et al. Statistical research                                                  of clinical motor skills such as endotracheal intuba-
                                                                              Singapore       224
         (2009)             (SPSS Version 15.0)                                                   tion, although the optimal learning technique remains
                                                    Medicine
                                                                                                  unidentified.
                                                    Under-graduate
     32) Lian-Kah Ti et al.                                                                        It present 2 pilot projects in which the efficacy of experi-
                            Simulation                                        Singapore
         (2006)                                                                                    ential learning with simulation is demonstrated.
                                                    Medicine
                                                                                                   To generate empathy in the care of vulnerable older per-
                                                    Graduate                                       sons requires care providers to reflect critically on
     33) Linus Vanlaere et Qualitative research
                                                                                                   their care practices. Ethics education and training must
         al. (2010)        (simulation)
                                                    Nurses                                         provide them with tools to accomplish such critical




47
                                                                                                   reflection.
                                                                                                                                                                  The effects of educational models based on experiential learning in Medical Education
                                                                                                                              LAVORI ORIGINALI


                            Study design and data Study population and     Study location/ Sample




48
     Source                                                                                       Brief abstract
                            collection            discipline               Author location size
                                                    Under-graduate
                                                                                                  An undergraduate course in transcultural nursing is
     34) Lockhart J.S.,
                            Reflective article                                   UK               described that relies heavily on experiential learning
         Resick L.K. (1997)                         Nurses
                                                                                                  activities and local community resources.

                          Qualitative research
                                                    Graduate                                      The contribution of experience to learning is examined
                          (semi-structured
     35) Mander R. (1992)                                                        UK               in relation to data collected during a study of midwives’
                          interview
                                                    Nurses and Midwives                           care of relinquishing mothers.
                          Format)
                                                    Graduate
     36) Papai P., Bourbon-                                                                       Kolb’s experiential learning model was used as a frame-
                                                                                                                                                                 tutor Volume 14, Numero 1, aprile 2014




                             Kolb’s experiential
         nais F.F., Chevrier                                                    USA               work to help Chinese nurse educators reflect on their
                             learning model         Nurses
         J. (1999)                                                                                practice as clinical teachers.

                                                                                                  The authors describe the development and implemen-
                                                    Under-graduate                                tation of simple research projects in an undergraduate
     37) Phillips R.M., Bon- Qualitative research
                                                                                                  nursing research course and the collaboration among
         steel S.H. (2010)
                                                    Nurses                                        course faculty, nursing students, and the information
                                                                                                  literacy specialist.
                                                    Under-graduate                                In an attempt to excite baccalaureate nursing students
     38) Pugsley K.E, Clay-                                                                       about nursing research, a traditional, lecture-style nurs-
                            Reflective article                                  USA
         ton L.H. (2003)                            Nurses                                        ing research course was transformed into an experiential,
                                                                                                  interactive course.
                                                    Under-graduate and                            In experiential learning the learner is highly active in
                                                    Graduate                                      these processes through trial and error practice, whereas
     39) Ringsted C. (2009) Reflective article                                   UK
                                                                                                  in the step-by-step approach the learner takes a more
                                                    Health Professionals                          passive role.
                                                                                                  A perioperative nursing course that uses Kolb’s experien-
                                                    Under-graduate
                            Kolb’s experiential                                                   tial learning theory and learning cycle as a framework was
     40) Sewchuk D.H.
                            learning theory and                                 USA               developed to provide nurses new to the OR with a solid
         (2005)                                     Nurses
                            learning cycle                                                        knowledge base with which to further their practice.

                                                                                                  The models of reflective practice and experiential learn-
                                                    Graduate                                      ing, described within this article, provide the dental prac-
     41) Simpson K, Free-
                          Reflective article                                     UK               titioner and his/her team with realistic methods by which
         man R. (2004)
                                                    Dentist                                       they can improve their skills and working atmosphere,
                                                                                                  and also reduce occupational stress.
                            Study design and data Study population and       Study location/ Sample
     Source                                                                                         Brief abstract
                            collection            discipline                 Author location size
     42) Smith L.M., Em-                           Under-graduate
                                                                                                    An experiential learning approach that focuses on the
         mett H.E., Woods Reflective Article                                    Tasmania
                                                                                                    needs of the learner.
         M. (2008)                                 Nurses
                                                   participants from the
                                                   global pharmaceutical
                            Qualitative research                                                    This experiential learning method enabled participants to
     43) Vesper J. et al.                          industry, health care
                            (Questionnaires and                                  Turkey             visit, critically observe, discuss and report on the various
         (2010)                                    providers, national
                            focus groups)                                                           components of the cold chain process.
                                                   regulatory authorities,
                                                   and suppliers/vendors
                            Qualitative research
                                                     Graduate                                      Explore the effects of experiential learning in pre-hos-
                            (diaries and focus group
     44) Vidar Melby (2000)                                                        UK          141 pital emergency care by nursing students on placement
                            interviews)
                                                     Nurses                                        with the Northern Ireland Ambulance Service.

                                                   Graduate
                                                                                                    This article describes a continuing ethnographic study of
                           Qualitative research
     45) Wallace D. (1996)                                                         UK               critical thinking, reflection and experiential learning in
                           (ethnographic study)    Nurses
                                                                                                    nursing.

                                                                                                    This article suggests pedagogical methods that enhance
                                                   Graduate                                         experiential learning. It also recognizes the need for a re-
     46) White K.R. (2002) Reflective article                                     USA               newed focus on diverse experiential learning opportuni-
                                                   Health Professionals                             ties, management and preceptor development programs,
                                                                                                    and graduate program partnerships.
                          The high-rope evalua-
                          tion study is a prospec-
                                                                                                   A controlled study was conducted to investigate the
     47) Wolf M. and Mehl tive naturalistic study
                                                   Patients                       USA          247 effectiveness of high-ropes exposures as an add-on to
         K. (2011)        with a non-equivalent
                                                                                                   inpatient treatment in a naturalistic setting.
                          control
                          group design




49
                                                                                                                                                                   The effects of educational models based on experiential learning in Medical Education
