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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