Academic Medicine

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Academic Medicine:
doi: 10.1097/ACM.0000000000000080
Letters to the Editor

In Reply to van Merriënboer

Custers, Eugène J.F.M. PhD

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Medical education researcher, Center for Research and Development of Education, University Medical Center at Utrecht, Utrecht, the Netherlands;

Disclosures: None reported.

First, I believe it should be kept in mind that neither dual process theories (DPTs) nor cognitive continuum theory (CCT) were specifically developed to provide guidelines for instructional design in an educational context. Neither are they learning theories. Rather, they focus on problem solving or decision making. Thus, although van Merriënboer mentions “teaching models based on cognitive continuum theory,” such models do not exist; I only presented a few instructional recommendations which I derived from CCT.1 I do not know of any other attempt to do so.

Next, van Merriënboer’s letter nicely illustrates what I consider an important point in my recent paper. In the first section, he states, “The great advantage of DPT is … that it acknowledges that System 1 and System 2 processes … can be developed in parallel.” In the next section, we read that “this approach allows for the coordinated development of System 1 and System 2 processing.” Finally, in a recent paper he states that “learners must also learn to coordinate both types of processing” (i.e., System 1 and System 2 processing).2(p156) If my assumption that these three claims have basically the same meaning is correct, then my guess would be that DPT can be construed to support any instructional theory and can explain, post hoc, any outcome. For how are we ever to conclude that an instructional approach failed because learners did not learn to coordinate their System 1 and System 2 processing? In addition, the reader might also be aware that the idea that learners can coordinate both types of processing is particularly problematic. Does that old little devil, the homunculus, crop up here? For what makes this “coordination” possible if not the learners’ System 2? But surely System 2 does not “coordinate” its own workings? How are we to conceive of this? CCT enables us at least to avoid this problem. In sum, with respect to System 1 and System 2, we might say, analogous to Laplace’s famous reply to Napoleon, “we don’t need this hypothesis.”

Eugène J.F.M. Custers, PhD

Medical education researcher, Center for Research

and Development of Education, University Medical

Center at Utrecht, Utrecht, the Netherlands;

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1. Custers EJ. Medical education and cognitive continuum theory: An alternative perspective on medical problem solving and clinical reasoning. Acad Med. 2013;88:1074–1080

2. Van Merriënboer JJG. Perspectives on problem solving and instruction. Comput Educ. 2013;64:153–160

© 2014 by the Association of American Medical Colleges


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