Learning-by-Concordance (LbC): introducing undergraduate students to the complexity and uncertainty of clinical practice


  • Nicolas Fernandez Université du Québec à Montréal
  • Amélie Foucault
  • Serge Dubé
  • Diane Robert
  • Chantal Lafond
  • Anne-Marie Vincent
  • Jeannine Kassis
  • Driss Kazitani
  • Bernard Charlin




undergraduate medical education, learning by concordance, qualitative


Background: A current challenge in medical education is the steep exposure to the complexity and uncertainty of clinical practice in early clerkship. The gap between pre-clinical courses and the reality of clinical decision-making can be overwhelming for undergraduate students. The Learning-by-Concordance (LbC) approach aims to bridge this gap by embedding complexity and uncertainty by relying on real-life situations and exposure to expert reasoning processes to support learning. LbC provides three forms of support: 1) expert responses that students compare with their own, 2) expert explanations and 3) recognized scholars’ key-messages.

Method: Three different LbC inspired learning tools were used by 900 undergraduate medical students in three courses: Concordance-of-Reasoning in a 1st-year hematology course; Concordance-of-Perception in a 2nd-year pulmonary physio-pathology course, and; Concordance-of-Professional-Judgment with 3rd-year clerkship students. Thematic analysis was conducted on freely volunteered qualitative comments provided by 404 students.

Results:  Absence of a right answer was challenging for 1st year concordance-of-reasoning group; the 2nd year visual concordance group found radiology images initially difficult and unnerving and the 3rd year concordance-of-judgment group recognized the importance of divergent expert opinion.

Conclusions: Expert panel answers and explanations constitute an example of “cognitive apprenticeship” that could contribute to the development of appropriate professional reasoning processes.


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Author Biography

Nicolas Fernandez, Université du Québec à Montréal

Fernandez, Nicolas, PhD, is Assistant Professor in the Department of Specialized Education and Training at the Université du Québec à Montréal, Canada. 




How to Cite

Fernandez N, Foucault A, Dubé S, Robert D, Lafond C, Vincent A-M, Kassis J, Kazitani D, Charlin B. Learning-by-Concordance (LbC): introducing undergraduate students to the complexity and uncertainty of clinical practice. Can. Med. Ed. J [Internet]. 2016 Oct. 18 [cited 2024 Jul. 14];7(2):e104-113. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/36690



Original Research