Teaching Goals & Strategies
As I have alluded to, core competencies or objectives of learning are necessary outcomes of health education, although they should not be limited to these alone. But how are they achieved? My educational practices are predicated on constructivist assumptions, whereby rationalism and empiricism are both valued. They also assume a learning process that follows David Kolb's (1984) experiential cycle involving concrete experience, reflective observation, abstract conceptualization, and experimentation stimulated by the generation of new concepts. By incorporating reflection into this process, I acknowledge the importance of selective perception of subjective and objective experiences, resulting in variable explanations and behaviours that give meaning to individuals (Elias & Merriam, 2005).
Education, to me, involves an interaction between teachers and learners resulting in the acquisition of knowledge, skills, or attitudes. Thus, even within an institutional and sociocultural context, the “individual constraints, experiences, and preferences” (Taylor & Hamdy, 2013, p. e1561) of the students, and I would add, the teacher, determine what learning is emphasized. Some characteristics may be generational, as Arhin and Cormier (2007) would argue, but such generalizations ignore uniqueness in both our innate features and capacity for change. Like Taylor and Hamdy (2013), I see the concept of adult learning as an artificial distinction; rather, as an ideal pedagogy at one end of the learning continuum, emphasizing autonomy and self-actualization. My belief about which characteristics define good teachers and learners is similarly grounded in these theories, but entering this program is my attempt to be open to differing views and immerse myself in the “scholarship of teaching and learning” (Hutchings, Huber, & Ciccone, 2011, p. 15), so I can learn through practice.
With this in mind, there are several major goals that I have currently established for myself as an educator:
01
To assist in the development of self-actualizing individuals with improved self-concept
Rationale: This goal encompasses two objectives that are co-dependent, in my opinion. They are grounded in the humanistic philosophy, which values individuality and potentiality. Medicine is such an broad field, with a multitude of different niches calling for special interests, talents, skills, values, and attitudes. Medical students and residents must identify these underlying individual aspects of the self within a short period of training. As Elias and Merriam (2005, p. 121) point out, one’s self concept “has a great influence on one’s ability to grow and develop,” and thus, as medical educators, we need to promote the individuality of learners by assisting in their self-evaluation. Once a self-concept is better established, it can be enhanced by actualizing one’s potential for growth and development (Elias & Merriam, 2005). In essence, medical training is a challenging and demanding process, and when it is all said and done, one needs to feel good about what they are doing and how well they are doing at it. In practice, self-actualization in education allows learning to become a “memorable and motivating experience” (Premkumar et al., 2013).
Strategies: To me, a self-actualizing learner is a self-directed learner. But this is not to mean the learner is autonomous. As Grow (1991) suggests in his staged self-directed learning model, the learner can be variably progressing towards this goal, depending on the learning situation or context, and educators can help prepare the learner in this advancement. Thus, the strategies are similarly variable and are guided towards the particular stage of the learner. In the clinical setting, this may be achieved by allowing for increasing responsibility in patient care as the learners’ comfort and performance improve within a given environment. In all settings, this incorporates the practice of social cognitive theory, whereby learners are encouraged to identify learning needs upon which to set goals and monitor their progress towards them, while still learning through the observation of role models. (Mann, 2011). As a mentor, one can assist this process by encouraging reflective practice within the learning environment, and offering honest feedback. These practices can help the learner gain better insight into the self, while nurturing individual skills and highlighting further areas for growth.
Evaluation: It is challenging to objectively measure an outcome that is ultimately subjective. Student satisfaction can be assessed informally, or through formal qualitative or quantitative assessment tools such as surveys or questionnaires. Reviewing reflective exercises would be another strategy to evaluate this outcome.
Self-reflection/Assessment: I believe this goal is central to my role as a clinical educator, while justifying my support for more didactic, traditional teaching methods and helping orient learners in the more dependent stages of learning. While I can always improve in this intricate balancing act, I believe that I am generally able to help students advance in their self-directed learning, which has been reported as a strength in some of the assessments of my teaching. I also believe the feedback that I offer is informative and generally well-received by learners, again based on some of the feedback that I have received specifically on this basis. As a mentor, I believe I practice what I preach as a self-directed learner, and that this is modeled for other members of the team. Clicking the in-text links will lead to supporting documentation, My biggest area for improvement, however, is in allowing for opportunities for learner self-reflection, particularly at the conclusion of an educational experience. I also would like to continually improve my teaching designed at earlier learners, such that it becomes more active and engaging.
02
Help learners seek out and integrate the constantly evolving and expanding volume of medical information into their practice.
Rationale: On the surface this seems like a lofty goal, but it is not a novel concept, having already been identified as a necessary means of transforming health sciences education (Frenk et al., 2010). While there will always be a need for foundational knowledge in medicine and its associated fields, we can no longer assume that medical students and residents will be able to know everything there is to know within their area of clinical interest before embarking on practice. Even if this were the case, it is also unreasonable to think that what is learned at a given point in time will be applicable indefinitely, or that all information will be retained. Thus, specific emphasis must be placed on learning how to seek out and critically appraise new data while evaluating its relevance to one’s patients, as well as on the processes and systems that are ultimately necessary to improve the quality of patient care. We must also teach ways to organize and manage this information so it can be efficiently retrieved or recalled when needed. This is the best way to ensure that the impact of a medical education is still relevant in the future, anticipating the rapidly increasing amount of information and its relative ease of access that continues (Frenk et al., 2010).
Strategies: In preclinical education, there are several opportunities to instill these skills. Problem-based learning (PBL), the critical appraisal of topics (CAT), and journal clubs are important exercises that are taught and practiced, and can be paired with instructive sessions or toolkits to support these tasks. Digital curation of medical literature is a newer method that also benefits a group by simultaneously creating an easily accessible resource for both the learner and for others. Clinical teaching strategies should apply these strategies to real-life patients. Learners should not only be expected to report and interpret the information that they gather on their patients, but to challenge themselves to manage patients using such principles in order to become medical experts.
Evaluation: Part of the challenge in promoting scholarship in medical education is that it is difficult to evaluate the behaviours related to lifelong learning, with a relative paucity of assessment tools studies for this purpose. Establishing a portfolio, with learners asked to document self-learning projects and their associated reflections, becomes a longitudinal tool that can be readily accessed to assess trainee progress (Bandiera et al., 2006). Direct observation and feedback has been the traditional way to assess teaching and critical appraisal skills, and this can be done in a variety of learning environments in both preclinical and clinical medical education. Multi-source feedback, possibly including peers, is another way of formalizing and expanding this feedback.
Self-reflection/Assessment: This goal is consistent with my personal desire to develop agency and increasing independence as both a lifelong learner and as a clinician. As I have increasingly appreciated the importance of this teaching, I am quicker to participate in such scholarship during group learning sessions such as journal club, and will more readily recognize a student who has initiated self-learning projects as they pertain to patient care. However, upon reflection, I often find myself sharing articles and references with junior learners in the clinical setting, rather than challenging them to find and interpret relevant literature on their own. Tasking learners with more self-learning projects, therefore, may be a better way of challenging them to communicate or share the information with others through various means.
03
Facilitate learning experiences that are contextual and relevant to the learner
Rationale: This is ultimately rooted in my belief in experiential learning and the assumptions of adult learners that characterize Malcolm Knowles’ theory of adult learning. Namely, I believe that such learning satisfies the learner’s desire to understand the importance of an educational experience, as well as the life-centered orientation of adults towards tasks and problems (Knowles, 1970). Thus, education that centers around the challenges that learners face is more likely to meaningful and intrinsically motivating (Russell, 2006).
Strategies: Kolb’s (1984) experiential learning cycle has been already alluded to, and is a model that guides how I try to engage students during clinical experiences. Each experience with a patient generates observations that can become a source of reflection for learners. Asking students within this context to read around their patients becomes a process of taking some of these observations and using them as a means of fueling inquiry. The teacher can use his or her own experience to highlight other clinical problems for a given patient, to help the medical student or trainee identify other experiences or observations as a source of learning and development and they are challenged to make decisions in the best interest of patient care. Part of this orientation to the value of an experience can be suggested in advance, as a means of priming the learner. By identifying the student’s current interests or educational needs, clinical opportunities can be provided wherever possible that may further motivate the learner. During lectures and small group sessions, incorporating patient scenarios and emphasizing the importance of the material presented may also help contextualize an otherwise didactic session.
Evaluation: Self-reflection is required to some extent to assess achievement of this goal as an educator. Educators can assess this goal by direct observation of their learners to assess their level of engagement and interest in the clinical setting. Feedback from students and faculty can also be instructive.
Self-reflection/Assessment: This objective is rooted in more of a progressive philosophy, but one which ultimately assumes the humanistic theory of self-determination. While feedback related to my teaching has mostly suggested that I am able to emphasize the practical and relevant (enclosed in the relevant section of this portfolio), it has also informed me of the need to devote less attention to the basic concepts at times. Thus, this is an area of growth I would like to see as a lecturer and as a clinical educator. In the classroom setting, I hope to achieve this growth through my research project, which shifts the focus of class time away from discussing basic concepts. During clinical teaching, I am generally happy with my focus on this goal, but I do think that patient rounds and reviews can involve more bedside discussion as a source for contextual education.
04
Incorporate educational strategies that may appeal to a broader variety of learning styles and require higher order cognitive skills
Rationale: Simply put, accommodating the learning preferences of one’s students is a logical way of improving student satisfaction with the educational experience and facilitating learning. Awareness of the varied learning styles and how to accommodate them is a skill that is thus worthwhile as an educator to possess. Similarly, a medical educator should facilitate comprehension of material, but should challenge students to develop a deeper understanding of this material so that they can internalize and engage with the subject in a way that is applicable to patient care.
Strategies: These strategies are directly related to the goal itself. These involve, first, challenging students to incorporate higher level learning exercises on Bloom’s taxonomy (1956), while recognizing that students require comprehension of information before using it to gain a deeper understanding. Second, a diverse group of teaching strategies can be employed to favour visual, verbal, aural, physical, logical, social, or solitary learning styles to varying extents (Advanogy.com, 2004). I might add, however, that personal reflection on my teaching practices and performing a personal learning style inventory has been helpful in understanding what my preferences and tendencies as either a learner or educator have been. Having students reflect in a similar fashion might help them understand their learning preferences, and appreciate why activities demanding higher order cognitive skills are ultimately more rewarding to themselves as learners.
Evaluation: Students can subjectively evaluate their invested mental effort and assign a numerical value to it, based on previous research (Paas & Van Merrienboer, 1993). This lends itself to evaluations of an educator’s ability to challenge the learner at a level appropriate for their training. The success using a variety of teaching strategies can be gleaned from self-assessment after reviewing the learning styles, and through multi-source feedback from peers and students.
Self-reflection/Assessment: Completing a learning styles inventory identified preferences for a several learning styles, particularly logical, social, and visual (Advanogy Publishing, 2003). I scored relatively lower in the other four styles (physical-kinesthetic, verbal-linguistic, aural-auditory, solitary-intrapersonal), and I would agree that my teaching strategies could accommodate these styles more effectively. For example, scripting and the recording of narratives could appeal to the verbal-linguistic learner, and while I have synthesized a few mnemonics in my presentations and discussions, I could employ these more. Encouraging students to take notes or draw diagrams as part of clinical problem-solving has recently been incorporated into my teaching to appeal to physical-kinesthetic preferences. I could certainly use more sound and music in my presentations and stop to rephrase or summarize more often for the auditory learner, and promote self-study opportunities for those favouring solitary learning preferences. With respect to cognitive skills, I do regularly ask students to apply and analyze information during my instruction, but sometimes find it challenging to have them synthesize and evaluate, particularly in a teaching session. All of these relative deficiencies will hopefully be improved upon with the educational intervention I will be studying in the upcoming year.
05
Foster a collaborative and supportive work and learning environment
Rationale: As mentioned, although self-directed learning is important, medicine is never practiced autonomously. While an educator may be respected for different reasons, this respect must be mutual with the goal of establishing a non-hierarchical relationship between teacher and learner, in line with recently proposed medical educational reforms to build effective teams (Frenk et al., 2010). Literature supports cooperative learning or learning relationships, particularly showing the importance of peer interaction in improving learner engagement and mental effort, as well as educational outcomes and the learner’s sense of belonging in the group (Zepke & Leach, 2010). Supporting learners through challenges provides a safety net for them to participate more in the team setting, and this is where the educator can have a most powerful influence, be it positive or negative, on the environment for all learners in the group. Last, the educator can continue his or her commitment to life-long learning by collaborating with, and learning from, other learners.
Strategies: I believe that collaboration is essentially achieved by building relationships between individuals (Frenk et al., 2010). Supporting learners’ inclusions in the group can be aided by providing them with opportunities for involvement, showing genuine interest in them as individuals, and acknowledging their work and efforts. Role modeling, direct observation, reflection, and feedback are important ways to achieve growth in management, leadership, and communication skills, which are required for successful collaboration in addition to the cognitive and technical skills.
Evaluation: One’s achievement in such a goal is observed through the growth of the learners and the function of the team as a whole, which is difficult to assess based on the paucity of literature available on validated tools. While self-assessment questionnaires, simulations, multi-source feedback, and direct observations with in-training evaluation reports have been reported as preferred tools (Bandiera et al., 2006), their effectiveness is largely unknown. It is also reflected in the learners’ feedback, and in the relationships that are built.
Self-reflection/Assessment: Based on student feedback from the clinical setting, I believe this is a goal that I have met in the past, and one that I continue to strive for. While I personally model interprofessional collaboration, I have come to realize that it is not an area that I assess as frequently in the more junior trainees, so perhaps some of these assessment tools can be considered here. Last, I continue to strive for more collaborative learning in small group settings, which is another purported benefit of the flipped classroom.
References
Advanogy.com. (2004). Learning Styles Overview. In Learning-styles-online.com. Retrieved from: http://www.learning-styles-online.com/
Advanogy Publishing. (2003). Memletics learning style questionnaire. In: Memletics Accelerated Learning Manual. Melbourne, Australia: Advanogy Publishing. Retrieved from: http://learning-styles-online.com/inventory/questions.php
Arhin, A.O., & Cormier, E. (2007). Educational innovations. Using deconstruction to educate Generation Y nursing students. Journal of Nursing Education, 46, 562-7.
Bandiera, G., Sherbino, J., Frank, J. R. (2006). The CanMEDS assessment tools handbook. An introductory guide to assessment methods for the CanMEDS competencies. Ottawa: The Royal College of Physicians and Surgeons of Canada.
Bloom, B. S. (1956). Taxonomy of Educational Objectives: The Classification of Educational Goals: Handbook 1, Cognitive Domain. London, UK: Longmans.
Elias, M, & Merriam, S. (2005). Philosophical Foundations of Adult Education (3rd ed.). Malabar, FL: Krieger Publishing Company.
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., ... Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 376, 1923-1958.
Grow G. (1991). Teaching learners to be self-directed: A stage approach. Adult Education Quarterly, 41, 125–149.
Hutchings, P., Huber, M. T., & Ciccone, A. (2011). The Scholarship of Teaching and Learning Reconsidered: Institutional Integration and Impact. San Francisco, CA: Jossey-Bass.
Knowles, M. S. (1970). The modern practice of adult education: Andragogy versus pedagogy. New York: New York Association Press.
Kolb, D. A. (1984). Experiential Learning. Englewood Cliffs, NJ: Prentice Hall.
Mann, K. V. (2011). Theoretical perspectives in medical education: past experiences and future possibilities. Medical Education, 45, 60-68.
Paas, F. G. W. C., & Van Merrienboer, J. J. G. (1993). The efficiency of instructional conditions: An approach to combine mental effort and performance measures. Human Factors, 35(4), 737-743.
Premkumar, K., Pahwa, P., Banerjee, A., Baptiste, K., Bhatt, H., & Lim, H. J. (2013). Does medical training promote or deter self-directed learning? A longitudinal mixed-methods study. Academic Medicine, 88(11), 1754-1764.
Russell, S. (2006). An overview of adult-learning processes. Urologic Nursing, 26, 349-352.
Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: implications for learning and teaching in medical education. Medical Teacher, 35, e1561-e1572.
Zepke, N. & Leach, L. (2010). Improving student engagement: Ten proposals for action. Active Learning in Higher Education, 11(3), 167-177.