Contribution à l'étude de la construction des concepts scientifiques au cours de l'apprentissage par problèmes en médecine

L’approche d’apprentissage par problèmes (APP) a vu le jour, dans sa forme contemporaine, à la Faculté de médecine de l’Université MacMaster en Ontario (Canada) à la fin des années 1960. Très rapidement cette nouvelle approche pédagogique active, centrée sur l’étudiant et basée sur les problèmes biomédicaux, va être adoptée par de nombreuses facultés de médecine de par le monde et gagner d’autres disciplines. Cependant, malgré ce succès apparent, l’APP est aussi une approche controversée, notamment en éducation médicale, où elle a été accusée de favoriser un apprentissage superficiel. Par ailleurs, les étudiants formés par cette approche réussiraient moins bien que les autres aux tests évaluant l’acquisition des concepts scientifiques de base, et il n’a jamais été prouvé que les médecins formés par l’APP seraient meilleurs que les autres. Pour mieux comprendre ces résultats, la présente recherche a voulu explorer l’apprentissage de ces concepts scientifiques, en tant que processus de construction, chez des étudiants formés par l’APP, à la Faculté de médecine de l’Université de Montréal, en nous appuyant sur le cadre théorique socioconstructivisme de Vygotski. Pour cet auteur, la formation des concepts est un processus complexe de construction de sens, en plusieurs étapes, qui ne peut se concevoir que dans le cadre d’une résolution de problèmes. Nous avons réalisé une étude de cas, multicas, intrasite, les cas étant deux groupes de neuf étudiants en médecine avec leur tuteur, que nous avons suivi pendant une session complète de la mi-novembre à la mi-décembre 2007. Deux grands objectifs étaient poursuivis: premièrement, fournir des analyses détaillées et des matériaux réflectifs et théoriques susceptibles de rendre compte du phénomène de construction des concepts scientifiques de base par des étudiants en médecine dans le contexte de l’APP. Deuxièmement, explorer, les approches de travail personnel des étudiants, lors de la phase de travail individuel, afin de répondre à la question de recherche suivante : Comment la dynamique pédagogique de l’APP en médecine permet-elle de rendre compte de l’apprentissage des concepts scientifiques de base? Il s’agissait d’une étude qualitative et les données ont été recueillies par différents moyens : observation non participante et enregistrement vidéo des tutoriaux d’APP, interview semi-structuré des étudiants, discussion avec les tuteurs et consultation de leurs manuels, puis traitées par diverses opérations: transcription des enregistrements, regroupement, classification. L’analyse a porté sur des collections de verbatim issus des transcriptions, sur le suivi de la construction des concepts à travers le temps et les sessions, sur le role du tuteur pour aider au développement de ces concepts Les analyses suggèrent que l’approche d’APP est, en général, bien accueillie, et les débats sont soutenus, avec en moyenne entre trois et quatre échanges par minute. Par rapport au premier objectif, nous avons effectivement fourni des explications détaillées sur la dynamique de construction des concepts qui s'étend lors des trois phases de l'APP, à savoir la phase aller, la phase de recherche individuelle et la phase retour. Pour chaque cas étudié, nous avons mis en évidence les représentations conceptuelles initiales à la phase aller, co-constructions des étudiants, sous la guidance du tuteur et nous avons suivi la transformation de ces concepts spontanés naïfs, lors des discussions de la phase retour. Le choix du cadre théorique socio constructiviste de Vygotski nous a permis de réfléchir sur le rôle de médiation joué par les composantes du système interactif de l'APP, que nous avons considéré comme une zone proximale de développement (ZPD) au sens élargi, qui sont le problème, le tuteur, l'étudiant et ses pairs, les ressources, notamment l'artefact graphique carte conceptuelle utilisée de façon intensive lors des tutoriaux aller et retour, pour arriver à la construction des concepts scientifiques. Notre recherche a montré qu'en revenant de leurs recherches, les étudiants avaient trois genres de représentations conceptuelles: des concepts corrects, des concepts incomplets et des concepts erronés. Il faut donc que les concepts scientifiques théoriques soient à leur tour confrontés au problème concret, dans l'interaction sociale pour une validation des attributs qui les caractérisent. Dans cette interaction, le tuteur joue un rôle clé complexe de facilitateur, de médiateur, essentiellement par le langage. L'analyse thématique de ses interventions a permis d'en distinguer cinq types: la gestion du groupe, l'argumentation, les questions de différents types, le modelling et les conclusions. Nous avons montré le lien entre les questions du tuteur et le type de réponses des étudiants, pour recommander un meilleur équilibre entre les différents types de questions. Les étudiants, également par les échanges verbaux, mais aussi par la construction collective des cartes conceptuelles initiales et définitives, participent à une co-construction de ces concepts. L'analyse de leurs interactions nous a permis de relever différentes fonctions du langage, pour souligner l'intérêt des interactions argumentatives, marqueurs d'un travail collaboratif en profondeur pour la co-construction des concepts Nous avons aussi montré l'intérêt des cartes conceptuelles non seulement pour visualiser les concepts, mais aussi en tant qu'artefact, outil de médiation psychique à double fonction communicative et sémiotique. Concernant le second objectif, l’exploration du travail personnel des étudiants, on constate que les étudiants de première année font un travail plus approfondi de recherche, et utilisent plus souvent des stratégies de lecture plus efficaces que leurs collègues de deuxième année. Ceux-ci se contentent, en général, des ouvrages de référence, font de simples lectures et s’appuient beaucoup sur les résumés faits par leurs prédécesseurs. Le recours aux ouvrages de référence essentiellement comme source d'information apporte une certaine pauvreté au débat à la phase retour avec peu d'échanges de type argumentatif, témoins d'un travail profond. Ainsi donc, par tout ce soutien qu'elle permet d'apporter aux étudiants pour la construction de leurs connaissances, pour le type d'apprentissage qu'elle offre, l’APP reste une approche unique, digne d’intérêt. Cependant, elle nécessite d'être améliorée par des interventions au niveau du tuteur et des étudiants.

Dimensions of University Student Learning in Medicine and Pharmacy

Study orientations in higher education consist of various dimensions, such as approaches to learning, conceptions of learning and knowledge (i.e. epistemologies), self-regulation, and motivation. They have also been measured in different ways. The main orientations typically reported are reproducing and meaning orientations. The present study explored dimensions of study orientations, focusing in particular on pharmacy and medicine. New versions of self-report instruments were developed and tested in various contexts and in two countries. Furthermore, the linkages between study orientations and students epistemological development were explored. The context of problem-based (PBL) small groups was investigated in order to better understand how collaboration contributes to the quality of learning. The participants of Study I (n=66) were pharmacy students, who were followed during a three-year professionally oriented program in terms of their study orientations and epistemologies. A reproducing orientation to studying diminished during studying, whereas only a few students maintained their original level of meaning orientation. Dualism was found to be associated with a reproducing orientation. In Study II practices associated with deep and surface approaches to learning were measured in two differing ways, in order to better distinguish between what students believed to be useful in studying, and the extent to which they applied their beliefs to practice when preparing for examinations. Differences between domains were investigated by including a sample of Finnish and Swedish medical students (n=956) and a Finnish non-medical sample of university students (n=865). Memorizing and rote learning appeared as differing components of a surface approach to learning, while understanding, relating, and critical evaluation of knowledge emerged as aspects of a deep approach to learning. A structural model confirmed these results in both student samples. Study III explored a wide variety of dimensions of learning in medical education. Swedish medical students (n=280) answered the questionnaire. The deep approach to learning was strongly related to collaboration and reflective learning, whereas the surface approach was associated with novice-like views of knowledge and the valuing of certain and directly applicable knowledge. PBL students aimed at understanding, but also valued the role of memorization. Study IV investigated 12 PBL tutorial groups of students (n=116) studying microbiology and pharmacology in a medical school. The educational application was expected to support a deep approach to learning: Group members course grades in a final examination were related to the perceived functioning of the PBL tutorial groups. Further, the quality of cases that had been used as triggers for learning, was associated with the quality of small group functioning. New dimensions of study orientations were discovered. In particular, novel, finer distinctions were found within the deep approach component. In medicine, critical evaluation of knowledge appeared to be less valued than understanding and relating. Further, collaboration appeared to be closely related to the deep approach, and it was also important in terms of successful PBL studying. The results of the studies confirmed the previously found associations between approaches to learning and study success, but showed interesting context- and subgroup-related differences in this respect. Students ideas about the nature of knowledge and their approaches to learning were shown to be closely related. The present study expanded our understanding of the dimensions of study orientations, of their development, and their contextual variability in pharmacy and medicine.

A Tutorial on Integrating CDS/ISIS Databases with the World Wide Web

With the emergence of Internet, the global connectivity of computers has become a reality. Internet has progressed to provide many user-friendly tools like Gopher, WAIS, WWW etc. for information publishing and access. The WWW, which integrates all other access tools, also provides a very convenient means for publishing and accessing multimedia and hypertext linked documents stored in computers spread across the world. With the emergence of WWW technology, most of the information activities are becoming Web-centric. Once the information is published on the Web, a user can access this information from any part of the world. A Web browser like Netscape or Internet Explorer is used as a common user interface for accessing information/databases. This will greatly relieve a user from learning the search syntax of individual information systems. Libraries are taking advantage of these developments to provide access to their resources on the Web. CDS/ISIS is a very popular bibliographic information management software used in India. In this tutorial we present details of integrating CDS/ISIS with the WWW. A number of tools are now available for making CDS/ISIS database accessible on the Internet/Web. Some of these are 1) the WAIS_ISIS Server. 2) the WWWISIS Server 3) the IQUERY Server. In this tutorial, we have explained in detail the steps involved in providing Web access to an existing CDS/ISIS database using the freely available software, WWWISIS. This software is developed, maintained and distributed by BIREME, the Latin American & Caribbean Centre on Health Sciences Information. WWWISIS acts as a server for CDS/ISIS databases in a WWW client/server environment. It supports functions for searching, formatting and data entry operations over CDS/ISIS databases. WWWISIS is available for various operating systems. We have tested this software on Windows '95, Windows NT and Red Hat Linux release 5.2 (Appolo) Kernel 2. 0. 36 on an i686. The testing was carried out using IISc's main library's OPAC containing more than 80,000 records and Current Contents issues (bibliographic data) containing more than 25,000 records. WWWISIS is fully compatible with CDS/ISIS 3.07 file structure. However, on a system running Unix or its variant, there is no guarantee of this compatibility. It is therefore safe to recreate the master and the inverted files, using utilities provided by BIREME, under Unix environment.

Operators for Similarity Search: Semantics, Techniques and Usage Scenarios

This book provides a comprehensive tutorial on similarity operators. The authors systematically survey the set of similarity operators, primarily focusing on their semantics, while also touching upon mechanisms for processing them effectively.

The book starts off by providing introductory material on similarity search systems, highlighting the central role of similarity operators in such systems. This is followed by a systematic categorized overview of the variety of similarity operators that have been proposed in literature over the last two decades, including advanced operators such as RkNN, Reverse k-Ranks, Skyline k-Groups and K-N-Match. Since indexing is a core technology in the practical implementation of similarity operators, various indexing mechanisms are summarized. Finally, current research challenges are outlined, so as to enable interested readers to identify potential directions for future investigations.

In summary, this book offers a comprehensive overview of the field of similarity search operators, allowing readers to understand the area of similarity operators as it stands today, and in addition providing them with the background needed to understand recent novel approaches.

The search for Multiple Myeloma Stem cells: molecular characterization and self-renewal mechanisms involved in the disease persistence

The existence of Multiple Myeloma Stem cells (MMSCs)is supposed to be one of the major causes of MM drug-resistance. However, very little is known about the molecular characteristics of MMSCs, even if some studies suggested that these cells resembles the memory B cells. In order to molecularly characterize MMSCs, we isolated the 138+138- population. For each cell fraction we performed a VDJ rearrangement analysis. The complete set of aberrations were performed by SNP Array 6.0 and HG-U133 Plus 2.0 microarray analyses (Affymetrix). The VDJ rearrangement analyses confirmed the clonal relationship between the 138+ clone and the immature clone. Both BM and PBL 138+ clones showed exactly the same genomic macroalterations. In the BM and PBL 138-19+27+ cell fractions several micro-alterations (range: 1-350 Kb) unique of the memory B cells clone were highlighted. Any micro-alterations detected were located out of any genomic variants region and are presumably associated to the MM pathogenesis, as confirmed by the presence of KRAS, WWOX and XIAP genes among the amplified regions. To get insight into the biology of the clonotypic B cell population, we compared the gene expression profile of 8 MM B cells samples 5 donor B cells vs, thus showing a differential expression of 11480 probes (p-value: <0,05). Among the self-renewal mechanisms, we observed the down-regulation of Hedgehog pathway and the iperactivation of Notch and Wnt signaling. Moreover, these immature cells showed a particular phenotype correlated to resistance to proteasome inhibitors (IRE1α-XBP1: -18.0; -19.96. P<0,05). Data suggested that the MM 138+ clone might resume the end of the complex process of myelomagenesis, whereas the memory B cells have some intriguing micro-alterations and a specific transcriptional program, supporting the idea that these post germinal center cells might be involved in the transforming event that originate and sustain the neoplastic clone.

'Artificial Immune Systems Tutorial'

The biological immune system is a robust, complex, adaptive system that defends the body from foreign pathogens. It is able to categorize all cells (or molecules) within the body as self-cells or non-self cells. It does this with the help of a distributed task force that has the intelligence to take action from a local and also a global perspective using its network of chemical messengers for communication. There are two major branches of the immune system. The innate immune system is an unchanging mechanism that detects and destroys certain invading organisms, whilst the adaptive immune system responds to previously unknown foreign cells and builds a response to them that can remain in the body over a long period of time. This remarkable information processing biological system has caught the attention of computer science in recent years. A novel computational intelligence technique, inspired by immunology, has emerged, called Artificial Immune Systems. Several concepts from the immune have been extracted and applied for solution to real world science and engineering problems. In this tutorial, we briefly describe the immune system metaphors that are relevant to existing Artificial Immune Systems methods. We will then show illustrative real-world problems suitable for Artificial Immune Systems and give a step-by-step algorithm walkthrough for one such problem. A comparison of the Artificial Immune Systems to other well-known algorithms, areas for future work, tips & tricks and a list of resources will round this tutorial off. It should be noted that as Artificial Immune Systems is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from time to time and from those examples given here.

'Artificial Immune Systems Tutorial'

The biological immune system is a robust, complex, adaptive system that defends the body from foreign pathogens. It is able to categorize all cells (or molecules) within the body as self-cells or non-self cells. It does this with the help of a distributed task force that has the intelligence to take action from a local and also a global perspective using its network of chemical messengers for communication. There are two major branches of the immune system. The innate immune system is an unchanging mechanism that detects and destroys certain invading organisms, whilst the adaptive immune system responds to previously unknown foreign cells and builds a response to them that can remain in the body over a long period of time. This remarkable information processing biological system has caught the attention of computer science in recent years. A novel computational intelligence technique, inspired by immunology, has emerged, called Artificial Immune Systems. Several concepts from the immune have been extracted and applied for solution to real world science and engineering problems. In this tutorial, we briefly describe the immune system metaphors that are relevant to existing Artificial Immune Systems methods. We will then show illustrative real-world problems suitable for Artificial Immune Systems and give a step-by-step algorithm walkthrough for one such problem. A comparison of the Artificial Immune Systems to other well-known algorithms, areas for future work, tips & tricks and a list of resources will round this tutorial off. It should be noted that as Artificial Immune Systems is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from time to time and from those examples given here.