A teacher can never truly teach, unless he is still learning himself.
Robindranath Tagore
The contemporary thinking in medical education lays emphasis on “teaching-learning”, as opposed to the greater importance previously attached to “teaching” alone. We are now more interested in understanding what and how students learn, why some of them do not learn and when do they learn better. Is the learning relevant to the health needs of the community ? What should they learn in this context and how? Hence, the attention is more focused on learning and the learner.
The purpose of teaching is to facilitate learning and encourage the learners to learn more effectively. The purpose of teaching is not merely dispensing information, but to develop skills and attitudes also.
It is wrong to presume that all the information transmitted to the students is always learnt or since that does not happen, a lot more information should be transmitted so that something will be learnt! It is also wrong to presume that students are immature and irresponsible. The students tend to behave in a manner similar to what they are considered to be. If they are considered to be responsible, they will behave in a responsible manner.
The role of a teacher is not of bossing around and being authoritarian. The role of a teacher is to be a considerate and a friendly person, who creates 2an appropriate atmosphere for effective learning, so that learning is an enjoyable and a pleasurable process.
Are we, as teachers, able to create such an atmosphere in our institutions? Let us consider in this context, learning in more detail.
What is learning? Learning is a process resulting in some changes or modifications in the learner’s way of thinking, feeling and doing as a result of practice. The change may be temporary or permanent.
The more effective the learning experience, better is the learning. Provision of effective learning experiences depends on the teacher. Therefore, depending on the ability of teacher to deliver an effective lecture or conduct a clinic or demonstrate an experiment, the quality of learning would vary.
Learning is a cyclical process; however, it can also be considered as an uprising spiral motion where with time, there is a change in the level of attainment. It is this sequence which can be referred to as learning spiral and makes learning a dynamic process.
When and where one gets the new experiences and how often these are repeated, is referred to as learning opportunities. A new experience or a new piece of information may be first heard and seen during a lecture and may be accepted and analyzed as something relevant and important. On reflection, it may seem to be significant for some purpose. On recall it may be spoken aloud or written/drawn on a paper, analyzed to be incompletely recalled, may be read further in the library or may be discussed with peers and ultimately may become a part of the permanent memory. This is how learning occurs. Learning is to progress from one step to another.
Learning is individual: We all learn different things at different rates and hypothetically anybody can learn almost anything given sufficient time and resources. However, at a practical, level, our learning is limited. We all learn different things attaining different levels of achievement.
3The scope and magnitude of learning depends to a large extent on the personality types of the individuals for example those who prefer ‘sensing’ would learn better about those things which they can see, hear or touch, whereas those who prefer ‘intuition’ would like subjects that allow to create abstract ideas. Ideas and hypotheses would fascinate them.
Now let us consider some basic principles of learning:
- Relevance: Learning is better with subject matter of immediate relevance. When the relevance is remote or obscure and the student has to learn with a belief that the knowledge perhaps might be of use some day, learning is difficult. However, a student can be motivated to learn effectively by explaining the importance of subject matter with reference to his ultimate goal, e.g. the future clinical practice in the community. This could mean that some of the basic principles are relevant and important to be learnt now and some finer details could be learnt later in actual practice.
- Sequential learning: We learn by progressing from simple to complex matters. A suitable example or interesting anecdote may attract the learner’s attention and through it some facts and principles can be communicated.Learning is better, when it progresses from an observation to reasoning, from a particular point to a generalization, from a particular experience to an abstract concept. However, sequence is a matter of commonsense and it is not essential to adhere to any rigid order or sequence while teaching a subject matter. Depending on the topic to be explained or taught and depending on the learning atmosphere and opportunity, the learning sequence can be altered and adjusted accordingly.
- Cumulative learning: We learn by adding to what we already know. An implication of this is that prior knowledge needs to be activated to build new learning. If prior knowledge is not there or is not activated, then it will become very difficult to build new knowledge. Of the three principles stated here, this seem to be the most important not only in theory but also from practical point of view. As discussed later in this chapter, this is an important cornerstone of adult learning. Cumulative learning is considered the most important aspect of adult learning.
Let us now have a look at factors which promote learning:
- Active involvement: Learning is more effective with an active involvement of the learner in the process, e.g. a small group discussion is more effective than a lecture.
- Formative assessment and feedback: Learning being a process of acquiring new knowledge and skills which enable the students to do 4something that they could not do before, providing feedback on their performance helps the students to learn better. You will learn more about it in the chapter on Student Assessment.
- Rebound effect of assessment: The system and process of assessment has a direct effect on learning and learners. Students are generally blamed to be examination oriented. However, the fact that students learn for the sake of examinations, assessment can be utilized for better learning. For example, if more questions are asked regarding the common health problems faced by the community, students would work more for those topics and would learn more about them.
- Social and cultural ethos: The degradation of social and cultural values is affecting education also. Medical education is no exception. An observation that nondeserving candidates may score better does affect the learning behavior in a negative manner. Maintaining a positive atmosphere in the educational institutions is a joint responsibility of all teachers and students.
ADULT LEARNING
It may be interesting to look at the characteristics of adult learners as identified by Knowles. Many of these are liberally used in designing instruction for adult learners (e.g. medical students).
Let us also introduce you to the concept of types of learning. It is possible to identify three distinct types of learning strategies adopted by students. These include:
- Surface learning: This refers to a superficial approach to learning with the purpose of being able to recall information. Knowledge is stored in bits and pieces and generally there is no connection between these pieces. Knowledge acquired this way is short lived. Rote learning is a typical example of surface learning approach.
- Deep learning: This implies learning with the purpose of understanding. It is a slower process during which the learner tries to form connections between his prior knowledge and the new knowledge as well as between different pieces of knowledge. The purpose is to be able to apply this 5knowledge. This type of learning promotes retention, recall and application. This requires spaced practiced over a period of time.
- Strategic learning: This is the strategy used by students to do well in an examination. Learners try to categorize information by its utility for scoring good marks. Categorization of topics as ‘important’ is an example of strategic learning. This also promotes short-term knowledge, which is often forgotten after the examinations.
TEACHING
Some teachers have an inborn gift of the art and skill of teaching, but most of us learn and develop the skills as we progress in our career. Teaching is an interaction between the teacher and student under the former’s guidance in order to bring about expected changes in the latter’s behavior.
What is the Purpose of Teaching?
The purpose of teaching is to facilitate learning. Meaningful and effective teaching should help the student to:
- Develop an interest in learning for the topic in particular and more knowledge in general.
- Develop proper lifelong learning habits and attitudes.
- Acquire, retain and apply the knowledge.
- Achieve appropriate skills and use them with confidence.
Most teachers are interested in teaching effectively and some may work for an improvement in their methods. The technique of microteaching should be useful for such interested teachers. Later in the book, you will find a discussion on this simple technique for improving your teaching skills.
Often, teachers find themselves confronted with a large number of students, a vast body of knowledge to be comprehended, a rapidly changing field of information in many areas and a limited time available for teaching in which students are expected to achieve a maximum level of understanding. Therefore, the teacher may have to consider what experiences will motivate the students and enable them to learn; how the information can be structured for a given group; which sequence and form of presentation would be most effective and how the individual differences amongst the students can be taken care of.
6Considering all the above aspects, it evolves that a teaching-learning program based on community oriented learning by objectives should be most suitable in present circumstances. Properly developed learning objectives based on health needs of the community and current academic needs should be helpful both to the students as well as to the teachers.
Attempts are being made to develop learning objectives of different levels for different disciplines. However, for the time being, you may also consider to develop and document learning objectives for whatever topic the students would learn under your supervision. A similar exercise undertaken by a group of teachers working in a particular discipline or department would be even more effective and helpful to the learners.
What to Teach?
To learn everything in the field of medicine is impossible even in a lifetime. Some form of selection is therefore essential. A type of stratification is also necessary. You should categorize the subject matter into three viz. must know, should know and nice to know.
Since time is limited, the major aim of your teaching should be to cover the vital and most of the essential. The desirable could only be mentioned or suggested for self-study.
How to Teach?
We usually teach the way we were taught, unless there are reasons for change. How we teach also depends upon how much we care for the students, for the subject and for our reputation as a teacher; how much we respect ourselves, our students, our subject and our institution; and how much concern we have for the welfare of the students, community and the institution. If we do care, respect and have reasonable concern, it does not matter how we teach—it would automatically be effective and interesting. Perhaps there is nothing like ‘the way’ for teaching.
Teaching-learning process is therefore a complex phenomenon. It should an open ended spiral movement as compared to the linear model of 7conventional teaching. Considering the dynamic status of medical knowledge today, a medical teacher has to be a lifelong learner himself to keep up-to-date and be well-informed about recent advances in different fields.
SYSTEMS APPROACH
Although we will discuss more about it in the next chapter, we must introduce you to systems approach. A system refers to collection of components which are interdependent. Pancreas, adrenals, liver and brain are part of a system responsible for maintaining blood sugar levels. The key feature of this relationship is the ability to influence the functioning of others as well as get influenced in the process of attaining the desired outcome (i.e. maintaining blood sugar). In educational settings, objectives, materials, methods and assessment are all part of a system. We have lectures and practical, the student processes this information in his mind and then is able to do something which he could not do earlier (i.e. has learnt). This is called an educational system and can be diagrammatically represented as follows:
This is an example of what we call an open system. The output has no influence on the input or process. However, when we add a component of feedback, i.e. assessment data being used to modify teaching methods or teaching materials, then it becomes a closed system. All educational systems have to be closed systems to optimize the output.
The key concept of systems approach is that each of the components influences and in turn gets influenced by them. For example, any change in objectives demands a parallel change in examinations and any change in examinations also demands a corresponding change in teaching 8methodology. The crucial feature of a system is the existence of a feedback loop. We will learn in later chapters about the interdependence of various components in teaching and testing.
The present book is an humble attempt to induct medical teachers into the teaching-learning process. On the basis of what has been discussed in the preceding pages, it is possible to identify three distinct components of this process. These include:
- Learning objectives
- Subject matter and teaching methodology
- Assessment.
In the chapters that follow, we have tried to retain this basic format for our discussion. Let us emphasise here that all these components are interdependent and any of them cannot be sustained without adequate support from the others.