Applying educational theory in practice

How many times have we as teachers been confronted with situations in which we really were
not sure what to do? We “flew by the seat of our pants,” usually doing with our learners what
had been done with us. It would be useful to be able to turn to a set of guiding principles based
on evidence, or at least on long term successful experience.

Fortunately, a body of theory exists that can inform practice. An unfortunate gap between
academics and practitioners, however, has led to a perception of theory as belonging to an “ivory
tower” and not relevant to practice. Yet the old adage that “there is nothing more practical than a
good theory” still rings true today. This chapter describes several educational theories and
guiding principles and then shows how these could be applied to three case studies realting to the
“real world.”

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Adult learning theory

Malcolm Knowles introduced the term “andragogy” to North America, defining it as “the art and
science of helping adults learn.” Andragogy is based on five assumptions—about how adults
learn and their attitude towards and motivation for learning.

Andragogy—five assumptions about adult learning

 Adults are independent and self directing

 They have accumulated a great deal of experience, which is a rich resource for learning
 They value learning that integrates with the demands of their everyday life
 They are more interested in immediate, problem centred approaches than in subject centred
ones
 They are more motivated to learn by internal drives than by external ones

Knowles later derived seven principles of andragogy. Most theorists agree that andragogy is not
really a theory of adult learning, but they regard Knowles' principles as guidelines on how to
teach learners who tend to be at least somewhat independent and self directed. His principles can
be summarised as follows:

Establish an effective learning climate, where learners feel safe and comfortable expressing
themselves •

Involve learners in mutual planning of relevant methods and curricular content •

Involve learners in diagnosing their own needs—this will help to trigger internal motivation. •

Encourage learners to formulate their own learning objectives—this gives them more control of
their learning •

Encourage learners to identify resources and devise strategies for using the resources to achieve
their objectives •

Support learners in carrying out their learning plans •

Involve learners in evaluating their own learning—this can develop their skills of critical
reflection. •

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Self directed learning

Self directed learning can be viewed as a method of organising teaching and learning in which
the learning tasks are largely within the learners' control (as with the adult learning principles
described above).
It can also be viewed as a goal towards which learners strive so that they become empowered to
accept personal responsibility for their own learning, personal autonomy, and individual choice.
Success in the first view would lead to attaining the second.

Self directed learning

 Organising teaching and learning so that learning is within the learners' control
 A goal towards which learners strive so that they become able to accept responsibility for their
own learning

Philip Candy identified in the literature about 100 traits associated with self direction, which he
synthesised as the ability to be methodical and disciplined; logical and analytical; collaborative
and interdependent; curious, open, creative, and motivated; persistent and responsible; confident
and competent at learning; and reflective and self aware.

How do we develop these traits in our learners? Most importantly, learners must have the
opportunity to develop and practise skills that directly improve self directed learning. These
skills include asking questions, critically appraising new information, identifying their own
knowledge and skill gaps, and reflecting critically on their learning process and outcomes.

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Self efficacy

According to Albert Bandura, people's judgments of their own ability to deal with different
situations is central to their actions. These actions include what they choose to do, how much
effort they invest in activities, how long they persist in the face of adversity, and whether they
approach the tasks anxiously or assuredly.

These judgments, called “self efficacy,” may or may not be accurate, but they arise from four
main information sources. In decreasing order of their strength, these sources are: performance
attainments, observations of other people, verbal persuasion, and physiological state. Successes
raise our self efficacy, while failures lower it. Failures are particularly likely to lower our self
efficacy if they occur early in the learning process and are not due to lack of effort or difficult
situations.

Observing other people similar to us performing successfully can strengthen our beliefs that we
can perform similar tasks, especially when the tasks are unfamiliar. Verbal persuasion from a
credible source also can help.

Self efficacy—roles for the teacher

 Modelling or demonstration
 Setting a clear goal or image of the desired outcome
 Providing basic knowledge and skills needed as the foundation for the task
 Providing guided practice with corrective feedback
  Giving students the opportunity to reflect on their learning

Finally, we (both teachers and learners) need to re-interpret our anxiety or nervousness in
difficult situations as excitement or anticipation, rather than as an ominous sign of vulnerability.

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Constructivism

Constructivism has important implications for teaching and learning. Firstly, the teacher is
viewed not as a transmitter of knowledge but as a guide who facilitates learning. Secondly, as
learning is based on prior knowledge, teachers should provide learning experiences that expose
inconsistencies between students' current understandings and their new experiences. Thirdly,
teachers should engage students in their learning in an active way, using relevant problems and
group interaction. Fourthly, if new knowledge is to be actively acquired, sufficient time must be
provided for in-depth examination of new experiences.

The primary idea of constructivism is that learners “construct” their own knowledge on the basis
of what they already know. This theory posits that learning is active, rather than passive, with
learners making judgments about when and how to modify their knowledge

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Reflective practice

The theory of reflective practice is attributed primarily to Donald Schön, whose work is based on
the study of a range of professions. He argues that formal theory acquired through professional
preparation is often not useful to the solution of the real life “messy, indeterminate” problems of
practice.

Schön labels professionals' automatic ways of practising as professional “zones of mastery”—

that is, areas of competence. Unexpected events or surprises trigger two kinds of reflection.

The first, “reflection in action,” occurs immediately. It is the ability to learn and develop
continually by creatively applying current and past experiences and reasoning to unfamiliar
events while they are occurring. The second, “reflection on action,” occurs later. It is a process of
thinking back on what happened in a past situation, what may have contributed to the unexpected
event, whether the actions taken were appropriate, and how this situation may affect future
practice.

Seven principles to guide teaching practice

 The learner should be an active contributor to the educational process 1

 Learning should closely relate to understanding and solving real life problems 2
 Learners' current knowledge and experience are critical in new learning situations and need to
be taken into account 3
  Learners should be given the opportunity and support to use self direction in their learning 4
 5 Learners should be given opportunities and support for practice, accompanied by self
assessment and constructive feedback from teachers and peers
 Learners should be given opportunities 6 to reflect on their practice; this involves analysing and
assessing their own performance and developing new perspectives and options
 7 Use of role models by medical educators has a major impact on learners. As people often
teach the way they were taught, medical educators should model these educational principles
with their students and junior doctors. This will help the next generation of teachers and
learners to become more effective and should lead to better care for patients

Through the process of reflecting both “in practice” and “on practice,” practitioners continually
reshape their approaches and develop “wisdom” or “artistry” in their practice. Activities such as
debriefing with peers or learners, seeking feedback from learners on a regular basis, and keeping
a journal can provide vehicles for reflective practice.

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Converting theory into practice

Each of the educational theories presented here can guide our teaching practices. Some theories
will be more helpful than others in particular contexts. However, several principles also emerge
from these theories, and these can provide helpful guidance for medical educators.

Three cases studies

The boxes (right) describe three “real world” case studies representing situations encountered in
medical education settings. The educational theories described above, and the principles which
emerge from them, can guide us in solving the problems posed in these three cases.

Case 1 solution

You could present an interactive lecture on the autonomic nervous system. You could distribute
a notetaking guide. This would contain key points, space for written notes, and two key multiple
choice or “short answer” questions requiring higher level thinking (principle 1, see box above).
You could stop twice during the lecture and ask the students to discuss their response to each
question with their neighbours (principles 1, 3, and 5). A show of hands would determine the
class responses to the question (checking for understanding) and you could then give the correct
answer (principle 5). Finally, you could assign a learning issue for the students to research in
their own time (principle 4).

Case 1: Teaching basic science

You have been asked to give a lecture on the autonomic nervous system to a first year medical
class of 120 students. This has traditionally been a difficult subject for the class, particularly as it
has not been explicitly covered by faculty in the problem based anatomy course. You wonder
how you can make this topic understandable to the class in a 50-minute lecture.
Case 2 solution

You could assign the students to small groups of four to six, and ask each group to submit two
case studies describing clinical ethics issues in their local hospitals (principles 1 and 2). The
ethics theory and approach needed to analyse these cases could be prepared by experts and
presented on a website in advance of the sessions (principles 4, 5). The first of the six blocks of
two hours could be used to discuss the material on the website and clarify any misunderstandings
(principle 5). You could then show the students how to work though a case, with participation by
the class (principle 7). The other five blocks could then be used for each small group to work
through some of the cases prepared earlier, followed by a debriefing session with the whole class
(principles 5 and 6).

Case 2: Ethics education

You are a member of a course committee in the department of internal medicine, which is
charged with the task of integrating the topic of ethics into the third year medicine rotation. Your
committee has been given six blocks of two hours over a 12 week period. You wonder how to
make the material engaging, understandable, and useful to the students.

Case 3 solution

You could first invite the registrar to observe you with patients, and do a quick debrief at the end
of the day (principles 2, 6, and 7). With help from you, she could then develop her own learning
goals, based on the certification requirements and perceived areas of weakness (principles 1, 3,
and 4). These goals would provide the framework for assessing the registrar's performance with
patients (principles 5, 6). You could observe and provide feedback (principle 5). Finally, the
registrar could begin to see patients alone and keep a journal (written or electronic) in which she
records the results of “reflection on practice” (principle 6). She could also record in her journal
the personal learning issues arising from her patients, could conduct self directed learning on
these, and could document her findings in the journal (principles 1, 4, and 6). You could provide
feedback on the journal (principle 5). If practical, the cohort of registrars could communicate via
the internet to discuss their insights and experiences (principle 6).

Case 3: General practice training

You are the trainer for a first year registrar in her first year of a general practice training
programme. Your practice is so busy that you have very little time to spend with her. You
wonder how you can contribute to providing a valuable learning experience for your trainee.

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Conclusions

This article has attempted to show how the gap between educational theory and practice can be
bridged. By using teaching and learning methods based on educational theories and derived
principles, medical educators will become more effective teachers. This will enhance the
development of knowledge, skills, and positive attitudes in their learners, and improve the next
generation of teachers. Ultimately, this should result in better trained doctors who provide an
even higher level of patient care and improved patient outcomes.