Strategies for Healthcare Education

How to Teach in the 21st Century

Jan Woodhouse, Peter Athanasos, Jan Woodhouse

• Publisher: CRC Press
• Year: 2019
• Print ISBN:
  9781846190063
• eBook ISBN:
  9780429606809
• Edition: 1
• Topic: Medicine
• Subtopic: Education Theory & Practice

This work contains a Foreword by Dorothy Marriss, Deputy Vice Chancellor and Dean, School of Health and Social Care, University of Chester. This practical guide promotes evidence-based teaching. It provides a thorough, critical analysis of various healthcare teaching strategies, offering new strategies and an integrative approach promoting blended learning, self-directed study, simulation, the use of medical humanities and story-telling. Health and social care educators in all sectors and across all fields will find this book invaluable, as will education policy makers and shapers, and health and social care professionals with an interest in education and professional development. 'This book gives the reader an immensely readable account of the move healthcare education has made into the 21st Century. The move from a syllabus of training detailing concise statements in relation to learning to a curriculum for education that emphasises learning strategy and outcomes is a fairly recent development in education planning. Now the teacher is a facilitator of learning with the expertise to create a stimulating learning environment. I highly recommend this book as a rich source of education development for the new teacher and as a refresher for the more experienced teacher' - Dorothy Marriss, in the Foreword.

CHAPTER 1

Introduction: from the twentieth to the twenty-first century

Jan Woodhouse

The journey

In order to consider how to teach in the twenty-first century, it is perhaps wise to look back at the twentieth century both to see where we have come from and to understand the changes in approaches to education. Turning back the clock to the early 1900s would lead us into the classroom setting, where the main resources were chalk and blackboards. There was a limited range of books available, and those that did exist were expensive and contained only a limited amount of graphic material. It is hardly surprising that the main teaching strategy was the lecture – in which notes were dictated, diagrams were copied from the blackboard and the knowledge base was often based on opinion rather than on research.

With these scarce resources it is hardly surprising that the educational ideology that predominated was the acquisition of knowledge by the process of memorising information. Hence the teaching strategies used were repetition, rote learning and the use of mnemonics. Assessment of learning involved testing of the memory by means of oral, written and/or practical examinations. Often the learning that took place was purely for the purpose of passing examinations and bore no context to the work environment in which the students would later find themselves.

Healthcare education in the early 1900s had two strands, namely medical education based in universities, and unregulated schools of nursing based in local hospitals. The medical model’ was a method of teaching in which history taking, signs and symptoms, diagnosis and treatment formed the basis of education for doctors and nurses alike. Doctors were taught more anatomy and physiology, dissection, chemistry, microbiology and examination skills, whereas nurses were taught cookery for the sick, along with bathing and bandaging techniques. By today’s standards the knowledge base for both professions was small. The education received was considered sufficient to last a lifetime and was very broad, so that an individual could step into any situation, whether in hospital or in the community, and be served by that education. The post that an individual obtained was theirs for life, so any additional knowledge gained was learned through experience.

As the twentieth century progressed, emerging healthcare professions became established, including radiologists, pharmacists, physiotherapists, occupational therapists, speech and language therapists, psychologists and nutritionists, to name just a few, as well as specialisms within the disciplines.

As our knowledge base increases so does the demand for specialism, because we can no longer expect to know everything about healthcare as we might have done 100 years ago. In the twenty-first century we are aware that learning is a lifelong process, and in order to keep up with the rapidly expanding knowledge base we have to participate in continuing professional development. It is no longer acceptable to base our practice on the opinion of one individual – we must use evidence to support the care that we deliver. We no longer have jobs for life – organisations are always seeking new ways to deliver value-for-money services, which means that an individual may have to change their practice by acquiring new skills or working in a different fashion. The ideology of transferable skills comes to the fore. Alongside it, the notion of working as a team towards a shared goal is enhanced by inter-professional learning.

The concept of the professions learning together has been enhanced by several higher education institutions (HEIs) which have curricula that bring student doctors, nurses, physiotherapists and others together in a way that would not have been dreamed of even 50 years ago.

The twentieth century also saw a technological revolution as a result of the development of photography, cinematography, sound-recording equipment, radio, television, telephone, video, computers, the Internet and digital imagery. One by one, these marvels have found their way into the classroom until we have reached the stage of the ‘virtual classroom’, where teachers and students meet in cyberspace. This means that our students’ needs now differ from those previously encountered. There may be residues of the dependent relationship that existed a century ago, but the likelihood is that self-directed learning will increasingly predominate for the student. Indeed it is a quality that is currently encouraged in students and is supported by Knowles’ concept of andragogy.¹

This brings us to another aspect of change. Our knowledge of learning and teaching has expanded exponentially, so the following sections of this chapter address those aspects that any teacher who is new to the profession needs to consider before they step in front of their students.

The work of the theorists

It was in the early twentieth century that interest in how learning takes place became the subject of research. A plethora of scientists have postulated theories and researched on this topic, and although this book cannot cover them all, it is worth mentioning those who do appear frequently in the healthcare literature, and those who are included in subsequent chapters of this book. Some of the theorists have been grouped under schools of thought and are known as behaviourists, cognitivists and humanists.²

■ Behaviourists. The names that get a mention in this category include Thorndike (learning curve), Pavlov (stimulus/response and classical conditioning) and Skinner (the importance of pleasurable rewards as reinforcers). These ideas have been developed, and one could include Berne, who proposed transactional analysis theory and considers that ‘positive’ and ‘negative’ strokes to the self-esteem play an important part in our learning.

■ Cognitivists. One of the early theorists in this category is Piaget, who considered that we process information as a schema. He recognised that different types of learning takes place as we develop from infancy to adulthood. Another theorist in this school is Gagné, who identified different types of learning, also related to age, such as verbal association and problem solving. One could also include Dreyfus and Benner here, as their work is particularly relevant to the field of healthcare education. They acknowledge that in terms of skills acquisition a learner moves from being a novice to being a potential expert.

■ Humanists. In this category, which takes the stance that we are individualistic in our learning, the names of Maslow (motivational hierarchy of needs), Bandura (social learning theory and role modelling) and Rogers (self-directed learning and unconditional positive regard) are prominent. These theorists remind us that our learners are people – who learn from each other, and have different driving forces and life problems.

There is a further school of thought known as constructivism,³ according to which knowledge itself is a constructed entity that is reliant on individual interpretation. For example, ask someone to define pain’ and you will get a raft of different answers. Perhaps it is time, though, to add another school, as it is such a prevalent notion in the healthcare literature, namely reflectionism.

■ Reflectionists. The names that feature in this school are Dewey⁴ (interaction, reflection and experience), Lewin⁵ (groups, experiential learning and action research), Kolb¹ (the learning cycle) and Schon (reflecting in action and reflecting on action, and double loop learning).⁶ All of these theorists pay heed to what goes on inside an individual’s head – their thinking – and give due regard to the idea that we can use this to identify learning. Not only that, but we can start to think in a different way – a reflective way.

Finally, there are some theorists who help us to consider what we teach and who we teach. What we teach has been considered by Bloom,⁷ utilising a taxonomy divided into three domains – cognitive, affective and psychomotor. Within each of these domains the student can demonstrate progression using the taxonomy. Similarly, Steinaker and Bell⁸ have produced a taxonomy of experiential learning by identifying the stages of exposure, participation, identification, internalisation and dissemination. These taxonomies help the teacher to consider the levels of learning attained by the student and give direction to future goals.

With regard to who we teach’, Knowles considers the notion of andragogy (adult and self-directed learners) versus pedagogy (learners who rely on being led).¹ The hope is that the student will move from dependency (such as that experienced in primary and secondary education) to independence (as promoted in higher education). In addition, the teacher must also have an awareness of another aspect of the ‘who’, and give consideration to the individuality of the students that they teach. This can be achieved by the recognition, knowledge and influence of different learning styles.

Learning styles

At the beginning of the twentieth century the classification of individuals was simplistic and, for some, had the potential to do psychological damage. Students were labelled using terms such as ‘clever’, quick’, ‘stupid’, ‘daft’ and ‘dunce.’ Everyone was taught by the same approach and there was no room for differences. Then the concept of measuring IQcame into use, and there was an objective, numerical score to either confirm or deny the labels. However, individuals realised as they went through life that the initial labels that had been given to them at school no longer held true when they were adult, and that academic achievement was within their reach. What had changed for them was that they recognised that they had learned things outside the classroom, possibly because they were ‘doing’ – that is, having a hands-on, practical experience.

Today we have reached the point of recognition of the individualism of learning. Educationalists now take a more constructivist view and seek to identify particular learning styles in order to enhance learning. Several models will emerge within the following chapters.

One such model is that of Kolb,⁹ who considers the different processes of concrete and abstract thinking, together with experimentation and observation. This gives rise to four categories of learners, namely divergers, convergers, assimilators and accommodators. Students will have a preferred leaning towards one of the categories. For example, I am a diverger – I prefer using reflective observation and having a concrete experience over abstraction and experimentation.

Another model that is frequendy referred to is that of Honey and Mumford,¹ who draw on Kolb’s work, where students are categorised as activists, pragmatists, reflectors or theorists. Again I score highly on the reflective element of this model, although as I have progressed through academia, my scores on the theorist section have risen. This demonstrates that students may similarly change styles as they progress through their lifelong learning.

There are also models that consider the cognitive processes, and these are denoted by the abbreviations V-A-K¹⁰ and VARK.¹¹ These letters stand for visual (V), auditory (A), reading/writing (R) and kinaesthetic (K) learners. In other words, the student has a preferred sense that is used to enhance learning. The visual learner may prefer pictures, videos, diagrams and charts, whereas the auditory learner prefers lectures and sounds. The reader/writer learner likes to do just that – read and make notes, whereas the kinaesthetic learner needs to handle items such as handouts or models.

Neurolinguistic programming (NLP)¹² also makes reference to individuals thinking in terms of pictures, sound and feeling (here ‘feeling’ is referred to the emotional content, not the kinaesthetic/touch aspect). However, NLP also recognises that the other senses of taste, touch and smell are associated with memories, and therefore if aspects of these are incorporated into sessions then learning may be enhanced.

Still further work considers the functional aspects of the brain. This gives rise to the notion of left brain/right brain thinking.¹³ The left side of the brain is the logical side, where processes such as mathematics, organisation and problem solving take place. The right side of the brain deals with the imagination and interpersonal aspects, so communication, creativity and relationships may be processed here. These concepts have given rise to the idea that there may be gender differences in the way that we learn.

If the teacher has the time, identifying the preferred style of the individual or the group may be a useful indicator when choosing what teaching strategy to adopt. However, the more learning styles that are identified the more difficult it becomes to tailor teaching to a particular style. Consequendy, the teacher has to adopt several strategies within a teaching session in order to match the variety of styles. The underlying principle that has to be acknowledged is that in each interaction between the teacher and the student the learning opportunity is maximised. Similarly, it is important to recognise that teachers also have their own preferences with regard to the way in which they teach. This brings us to the topic of teaching styles, which are referred to several times in subsequent chapters of this book, acknowledging the relationship between the quality of teaching and the quality of learning.

Teaching styles

As early as the beginning of the twen...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• List of contributors
• Acknowledgements
• 1 Introduction: from the twentieth to the twenty-first century
• 2 The ‘dreaded’ lecture
• 3 Small group learning: greater than the sum of its parts?
• 4 Problem-based learning
• 5 Case study: a stilted tool or a useful learning and teaching strategy?
• 6 Reflecting on reflection
• 7 Storytelling and narratives: sitting comfortably with learning
• 8 Role play: a stage of learning
• 9 Creative activities
• 10 Simulation: transforming technology into teaching
• 11 Experiential learning exercises
• 12 Blended and e-learning
• 13 Self-directed study
• 14 Applying strategies to practice
• Epilogue
• Index