”Professor Norman is awarded the prize for his highly original and innovative research within the field of medical education,” says Professor Peter Aspelin, chair of the Karolinska Institutet prize committee. ”His research has had a significant impact on our understanding of the practice of medicine, as well as our knowledge of complex issues such as pattern recognition, clinical reasoning and clinical problem solving.”
Professor Norman’s primary research is in the area of expert diagnostic reasoning – how clinicians arrive at a diagnosis. His research has revealed that experts use two kinds of knowledge to come to a diagnosis – one is the formal analytical knowledge of signs and symptoms, physiologic mechanisms, and another is experiential knowledge based on the hundreds or thousands of patients they have encountered. Further, experimental studies have shown that these individual experiences remain in memory and are accessible to solve new problems, although the clinician is likely unaware of this retrieval process.
Following from this research is an interest in various aspects of how medical students learn. Professor Norman has contributed to the theoretical foundation of problem-based learning. He has also conducted experimental research in many areas related to education, including anatomy learning from computers, use of simulations in clinical learning, and the role of basic science in medical education. He is currently exploring the use of high ?delity simulation in clinical learning.
”His research is characterised by theoretical rigour and methodical skill. He has been able to contribute considerably to developing the subject area of quantitative analysis. In this subject area, Professor Norman has made good use of his solid background as a physicist and has been able to provide the readers with a clear explanation of statistical methods and how they are used in research,” Aspelin adds.
Professor Norman’s research has showed that transfer, using a previously learned concept to solve a new, apparently different problem, is difficult. Students are typically only able to access a previously learned concept to solve new problems 10% to 30% of the time. However, having students work through parallel, apparently different, problems can have positive effects. Active learning with multiple examples can have large effects on a student’s ability to apply concepts to solve new problems.
Professor Norman – who in his own words ”stumbled into the field of medical education” – has demonstrated that conventional approaches to education can sometimes be more effective than cutting-edge technology. He claims that researchers need to understand more about the strengths and limitations of the way people think, so the advantages of technology can be used better. For example, his research has found that attempting to learn anatomy from dynamic virtual reality can actually impede learning if a person has a low spatial ability.
”Sometimes it is important to look at what computers can do that a book can’t, but we must also take into account how our brains process information,” says Geoffrey Norman. ”Computers can help us gain 3D views of the human anatomy, for example, but this does not always produce the best learning results. Our brains find it easier to process information where only two views, such as the front and the back of an object, are displayed.”
”The challenge,” says Professor Norman, ”is to develop new ways of delivering knowledge, based on technology, but derived from an understanding of the way we think and learn.”
”Delivering new information is not enough if it isn’t put into practice. We need to understand the psychology that guides the way people assimilate and apply new information,” he says.
Professor Norman’s contributions have been of enormous value for medical practice and subject areas such as knowledge measuring, clinical skills, visual perception, and the development of curricula for health and nursing training programmes all over the world.
Reflecting on his work, Professor Norman says: ”I think my contribution to the world of medical education has been to question everything in order to find interesting things. I never had a great desire to change the world; I just figured that if I find enough interesting or important points during my research, something good will come out of it in the end. If something is interesting enough, the impact will follow. In my case, I am part of a small number of people who have helped to change the world of clinical reasoning through my research.”
Professor Norman played a central role in developing the new ’concept-based’ curriculum at McMaster University in Canada. The curriculum is an evolution of McMaster’s emphasis on problem-based learning (PBL), which has been adopted by over 100 medical schools worldwide. Concept-based learning attempts to combine the best of PBL, with its emphasis on active learning around problems, and traditional learning, which highlight the importance of systematic scientific knowledge of how the body works.
Norman is also a popular lecturer at universities across the world, and a mentor to graduate and undergraduate students. Numerous junior researchers – including the likes of Kevin Eva – working with Professor Norman have since developed into prominent scholars in their own right.
Commenting on his prize win, Professor Norman says: ”It’s an astonishing recognition. The prize, and Karolinska Institutet in particular, are so well known in my field of work so it’s a feather in the cap for both myself personally and for McMaster University. And although I plan to work for another few years yet, this prize is a nice culmination to a long career.”
Background information – Karolinska Institutet Prize for Research in Medical Education:
This international prize is awarded for outstanding research in medical education. The purpose of the prize is to recognise and stimulate high-quality research in the field and to promote long-term improvements of educational practices in medical training. “Medical” includes all education and training for any health science profession. The prize is made possible through financial support from the Gunnar Höglund and Anna-Stina Malmborg Foundation. It is presented every third year (every second year until 2010).
The 2008 Karolinska Institutet Prize for Research in Medical Education will be awarded to Professor Geoffrey R. Norman, McMaster University in Hamilton, Ontario, Canada, in Stockholm, Sweden on 28 October.
2006 – Professor Ronald M. Harden, Centre for Medical Education, University of Dundee, Scotland, United Kingdom
2004 – Professor Henk G. Schmidt, Chair of the Psychology Department and Honorary Professor of Medical Education, Faculty of Medicine and Health Sciences, Erasmus University, Rotterdam, The Netherlands
A number of prizes and awards are presented at Karolinska Institutet every year. Also, the Karolinska Institutet Nobel Assembly handles the awarding of the Nobel Prize in Physiology or Medicine.
Background information – Geoffrey R. Norman:
Geoffrey R. Norman, born 1944, is Professor of Clinical Epidemiology and Biostatistics at McMaster University in Hamilton, Ontario, Canada. He holds a BSc (Hons) (Manitoba), an MA (Michigan State), and a PhD (McMaster).
When Professor Norman began his research programme in clinical medicine in the 1970s, the dominant view was that clinicians possess some kind of general ’clinical problem-solving skills’ that students need to learn. The initial studies, along with work by Shulman and Elstein at Michigan State, clearly showed that this is not the case.
Professor Norman et al found that the process used by experts is seemingly the same as novices; early on, diagnostic hypotheses are generated from minimal cues, after which the inquiry is directed to identifying additional data to support or refute the hypotheses. Moreover, success on one problem is a poor predictor of success on other problems.
These findings had major impact on assessment in medical education. To that point, clinical assessment was typically based on one or very few cases, the so-called ’long case’. But the new results showed that it is necessary to sample multiple cases to achieve stable estimates of performance – a starting point for virtually all assessment methods in medical education today.
Professor Norman’s findings also caused a change in direction of research in clinical reasoning. Instead of pursuing a general process, investigators recognised the centrality of knowledge to successful problem-solving.
Other investigators opted to examine the role of formal knowledge, such as basic science mechanisms, and eventually found that this was a relatively minor determinant of problem-solving. Professor Norman pursued a different course, asking the simple question, “Early hypotheses are the key to successful problem-solving. Where do the hypothesis come from?”
This led to a successful collaboration with cognitive psychologist Lee Brooks at McMaster, and a research programme founded on a theory of categorisation, ’exemplar theory’, that assumes that people are able to identify natural categories – dog, tree, butterfly – in part because their world experience has provided them with myriad examples of each category. They use this exemplar knowledge to recognise the new presentation by matching with a specific example in memory, without any conscious awareness of the process.
This turned out to be a useful representation of medical diagnosis, and Professor Norman showed that, in a variety of domains, both novices and experts initially diagnose by recognising similarity to a previously encountered case. This then points to the critical role of clinical experience in medical expertise, and the necessity for a long apprenticeship period to acquire the many examples that are essential components of expertise.
His current research extends these ideas to examine how this experiential knowledge is integrated with more formal analytical knowledge, and the conditions that lead to integration of analytical and experiential knowledge. He is also examining the implication of this model for preclinical and clinical teaching and how the application environment – the hospital or clinic – might be organised to optimise learning.
Professor Norman is the author of a large amount of articles in scientific press, books and contributions to anthologies. He also co-edited the International Handbook of Research in Medical Education, which has strongly contributed to increasing the international reputation of medical education research.
Professor Norman’s contributions as editor of Advances in Health Sciences Education has made the journal a prominent player in the scientific world. He has also been a member of the prestigious Royal Society of Canada since 2007.
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Professor Peter Aspelin
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