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Scaffolding Knowledge Building in a Web-Based Communication and Cultural Competence Program for International Medical Graduates

Lax, Leila R.; Russell, M Lynn; Nelles, Laura J.; Smith, Cathy M.

Section Editor(s): Manuel, Stephen PhD; Tamblyn, Robyn PhD

doi: 10.1097/ACM.0b013e3181b37b4d
Applications of Technology: Student Selections, Communication, and Learning

Background Professional behaviors, tacitly understood by Canadian-trained physicians, are difficult to teach and often create practice barriers for IMGs. The purpose of this design research study was to develop a Web-based program simulating Canadian medical literacy and culture, and to evaluate strategies of scaffolding individual knowledge building.

Method Study 1 (N = 20) examined usability and pedagogic design. Studies 2 (N = 39) and 3 (N = 33) examined case participation patterns.

Results Model design was validated in Study 1. Studies 2 and 3 demonstrated high levels of participation, on unprompted third tries, on knowledge tests. Recursive patterns were strongest on Reflective Exercises. Five strategies scaffolded knowledge building: (1) video simulations, (2) contextualized resources, (3) concurrent feedback, (4) Reflective Exercises, and (5) commentaries prompting “reflection on reflection.”

Conclusions Scaffolded design supports complex knowledge building. These findings are concurrent with educational research on the importance of recursion and revision of knowledge for improvable and relational understanding.

Correspondence: Leila Lax, MEd, PhD(c), Assistant Professor, Biomedical Communications, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Room 3259, Toronto, ON, Canada, M5S 1A8; e-mail: (

© 2009 Association of American Medical Colleges