Some people consider teaching and learning much more difficult than
rocket science [1]. Teaching and learning is such a complex process that
researchers are still having debates in different areas including: how
it works, how to assess it, and how to research it. For the most part it
is safe to presume that different people have different
learning philosophies and
this is, most likely, how they teach [2]. Because we are a product of
our past and form strong habits, these might inadvertently impede
the search of more effective and efficient educational activities.
Research in education, just like research medical practice,
may challenge our most held beliefs and bring to light better
educational practices.
Does educational research make a difference?
Conducting and implementing educational research findings in and
outside of the learning environments is quite challenging. Learning is
very complex with numerous variables and confounding factors. Although
we can theorize and hypothesize how learning occurs we don’t have direct
evidence of this complex process. We can only predict that learning
might occur under certain situations or infer it has occurred
via evidence from certain assessments. The reliability and validity of
assessments as evidence of learning is another complex topic widely
covered in education and beyond the scope of this post. Most people,
formally trained in education or not, might base their teaching and
assessment practices on how they were taught or common beliefs. However,
sometimes these practices may be outdated, misunderstood, and even
erroneous [3].
Educational research plays an important role in improving practice,
dispelling misbeliefs, and debate different points of views. For
instance, in a manuscript by Kirschner et al advocate why direct
instruction works as an approach to learning, while stating that
minimally-guided instruction does not [4]. In reply Schmidt et al.
defended minimally-guided problem based learning as an effective
instructional method [5]. In contrast, Billett has done extensive work
on community of practice and how apprenticeship leads to construction of
knowledge in a situated learning environment [6]. These studies and
opinions demonstrate the existence of different points of views and
evidence when it comes to teaching and learning.
One size does not fit all
One of the principles of competency medical based education (CBME) is
recognizing that education is not one-size-fits-all. It is recognized
that students learn differently and at different rates. The model of
CBME is based on individualized learning and differentiation of
students’ learning. As stated by Gruppen et al [7]:
“Competency-based education promotes a necessary
flexibility in the time and sequence of what is to be learned that is
regulated by the needs of the learner. Therefore, CBE allows for a
highly individualized learning process rather than the traditional,
lock-step, one-size-fits-all curriculum.”
This suggests that educators should be more skilled in fostering a
professional practice that benefits every learner in his/her own
development. Individualized learning should be supplemented with
differentiated teaching practice to foster long-term, self-regulated
learning habits. In addition, new emerging pedagogical practices and
learning environments might pose a great challenge in if
learning conditions are not optimized.
Pedagogical practices in how we teach are not standardized
McLeod et al found a discrepancy in opinion between clinical
teachers and educator experts on the importance of which pedagogical
practices should have priority in medical education [8]. Differences in
practice have been categorized into several factors such as location and
years of practice, indicating that clinical teaching is not
standardized [9]. Unfortunately, even at the professional level,
practitioners do not see eye to eye when it comes to pedagogical
practices. Wide variations exist, maybe even at the local level.
That being said, the basics in pedagogical knowledge may be taught
[10]. Teachers can learn pedagogical practices and integrate it in their
daily teaching routines. For instance, teachers can practice in an
informed way if they practice in a scholarly manner [11]:
- Implement evidence-based teaching practices
- Make observations and reflect on their practices
- Discuss their practice with others and obtain peer evaluations
Scholarship of Teaching and Learning
Scholarly educational practices are important, because it dispels
bias, myths, misconceptions, or not optimized practices. Furthermore,
the scolarship of teaching and learning (So TL) takes scholarly teaching to a higher level where the
practitioner conducts research while educating and publishes the
results adding to the existing body of knowledge and for others’
consideration. In this video, education experts explain what scholarship
of teaching and learning means to them and the key characteristics of
its practice:
The Clinician Educator
Although the practice of SoTL has been around for some time, its
recognition and implementation have not been as successful as other
practices delineated in Boyer’s scholarship framework. Sherbino et al
identified key roles and competencies of the
Clinician Educator which
expand beyond bedside teaching [12]. These role and competencies may be
able to help implement the principles behind the SoTL and disseminate
its practice. The table below is extracted from the study and identifies
important competencies of the Clinician Educator which
support important aspects of teaching and learning.
Conclusion
We all have beliefs, evidenced or not, about how we learn, we are
also under the influence of tradition (“we have always done it this
way”). Tradition and tradition of “new” discourse might be reasons
why some might find it difficult to “get off the carousel” [13]. It is
very easy to think of teaching and learning as just “transferring”
knowledge from a textbook or from one person to another, but we have
come to understand that the process is much more complex than a simple
word or theory can describe [5]. Educational research, scholarly
teaching, and the scholarship of teaching and learning can bring a
better informed, effective, and efficient practice to the world of
medical education. We also have to keep in mind that not everything
discovered in research is practical, which again brings into play the
importance of context and professional judgement. The
Clinician Educator can be the agent who connects the whole in medical education.
The above question is common from patients with a history of an
allergic reaction seen for a repeat emergency department visit. The
manufacturers of EpiPen caution not to use the pen beyond the expiration
date, and if the drug solution becomes discolored (oxidation). But
EpiPens are expensive! Is there harm in using the pen beyond the
expiration date? What should we tell our patients?
