The application of scientific principles in diverse science domains is widely regarded as a hallmark of expertise. However, the role of basic science knowledge and principles in clinical medicine is the subject of considerable controversy. The study examined the understanding of complex biomedical concepts related to cardiovascular physiology. Subjects at various levels of expertise were presented with questions and problems pertaining to the concepts of cardiac output and venous return. The experiment employed the combined methods of a cognitive science approach to problem-solving with a focused clinical interview approach common in science education research. / The results indicated a progression of conceptual models of the circulatory system as a function of expertise. This was evident in subjects' explanations and applications of these concepts. The study also characterized the etiology of significant misconceptions and biases, evident in subjects' reasoning at each level of expertise. / This research has implications for a theoretical model of conceptual understanding in complex science domains, as well as, implications for medical instruction. It is proposed that the development of a clinically-relevant epistemology of basic science knowledge could contribute substantially to a revised medical curriculum that could impart a more robust conceptual understanding of biomedical concepts to medical students.

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published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

This study explores problem-based learning (PBL) as a form of pedagogy, and its interrelationships with the students, staff members and institution of the Medical Faculty at the University of KwaZulu-Natal. Little has been written previously about the interaction of student diversity and resource-constrained circumstances with PBL. I investigate perceptions and experiences of PBL as a pedagogic strategy, using Bernstein's theories of classification and framing as an organising framework. I draw also on his writings on discourses and knowledge structures and the pedagogic device. Within an interpretive methodology, I use three methods to generate data. I analyse numerically the test marks of a cohort of 202 students over three years for demographic influences on pedagogic engagement. I explore in semi-structured interviews the perceptions and experiences of PBL of 19 students and 6 staff members, and relate these to Faculty documents; I analyse these sources thematically in order to describe the roles of student, teacher and institution. These perceptions and experiences I then examine according to the eight elements of Bernstein's classification and framing. A number of contradictions emerge: between PBL theory, echoed by Faculty documents on one hand, and staff/student perceptions and experiences on the other; between staff members and students at some points but not at others; between high-achieving and low-achieving students; between different respondents' under-standings of "integration". Some demographic characteristics prove on analysis to be highly significant influences while others, counter-intuitively, are not. Bernstein's theories about knowledge structures are pertinent to the tensions revealed. Medicine has thought of itself as akin to the pure sciences – implying a hierarchical structure in which all knowledge aggregates towards a point of abstraction. However, the structure and function revealed by respondents suggests a horizontal knowledge structure, in which disciplinary knowledge is kept distinct. Students and teachers thus struggle to integrate areas of knowledge that are inherently discrete. In terms of Bernstein's "pedagogic device", some students are able to discern PBL's implicit rules of engagement, while others are not. Consensus on medicine‟s knowledge structure might settle ambiguities and help PBL achieve its potential as a complex pedagogy in a complex field. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.