TEACHING AND LEARNING

Teacher-centred Student-centred

Content-oriented Learning-oriented
Imparting information Facilitating understanding
Presenting content or process Facilitating understanding through
engagement with both content and
process

Where do we need to be?

Teacher-Centred Student-Centred
+ +
Content-Oriented Learning-Oriented

Less lecturing and more active learning!

Understanding how people learn

Implications for teaching & learning

Two approaches to learning:
• surface approach
- concerned with remembering words
• deep approach
- concerned with understanding the ideas behind the words

Looking at how students acquire knowledge

• surface approach students rely on the teacher to define learning tasks

• deep approach students look for meaning and react critically with what they
are learning
• not all students develop thinking skills;
rote learners probably do not
Students need to be able to adopt a deep approach to learning

• knowledge is not “absorbed”

• knowledge is not about “remembering”
• knowledge is structured by individuals in meaningful ways which grow and
change over time
• the way in which knowledge is stored is related to the way it is encoded when
it is learned
• new content can be meaningfully learned only where the student can relate the
content to already-existing cognitive structures in a meaningful way
 • understanding of content is an activity of
a constructivist nature which is carried out by the student using cognitive
strategies

Schema Theory
• Schema: the “building block” of cognition
• new ideas are built on to the student’s existing knowledge structure
– relevant prior knowledge is therefore important
• the student constructs a meaningful representation in a network of propositions
• schema is a valid explanation for how learners process and interpret
information
• strongly situated schemata might make it difficult for learners to develop
functional problem-solving skills that are appropriate across knowledge
domains

Thinking & Learning

• thinking is essential to the acquisition of knowledge
• knowledge is essential to thinking
• skillful thinking is the ability to apply knowledge effectively
• people possessing the same knowledge can differ significantly in how
skillfully they apply what they know
• high level thinking skills can be improved by training
• teaching of thinking skills is complementary to the teaching of content
• thinking ability and knowledge are the warp and woof of intellectual
competence
• most people have the potential to develop far more effective thinking skills
than they do

 experts differ from novices in that they know more about their area of
expertise
 experts not only know more,
- they know they know more,
- they know better how to use what they know,
- what they know is better organised and more
readily accessible,
- and they know better how to learn still more
(Nickerson et al, 1985)
 Cognitive skills that are necessary, or helpful, to the acquisition, use, and
control of knowledge, and other cognitive skills, can be thought of as
metacognitive skills
(Nickerson et al, 1985)
• Metacognition
a person’s knowledge concerning his/her own mental processes and the active
monitoring and consequent regulation and orchestration of these processes
(Flavell, 1978)
• Ethical and intellectual development
progression from simplistic acceptance of facts through confusion about the
nature of knowledge to a recognition of need for a personal philosophy of life
(Perry, 1970)
 Students have different abilities in relation to cognitive and metacognitive skills.
Appropriate training can help each student to develop both cognitive and
metacognitive skills.
More highly developed cognitive and metacognitive abilities will result in better
learning and more competent application of knowledge.

Students need:
• to learn how to learn
• to develop a deep approach to learning
• to develop thinking skills
• to develop metacognitive skills
• to become more self-directing in their learning

Learning how to learn and how to think can be encouraged:

• through study skills courses
• within the content area
- encouragement to think about what is being taught
- encouragement to think about how it is being learned

Implications for Health Professions Education

• The curriculum and its assessment are key factors affecting quality of learning
• The teacher needs to create learning experiences which facilitate the
construction of meaning and to develop assessment procedures which measure
the organisation and utilisation of knowledge

SEVEN – JUMP

Ref : David et al., 1999

STEP 1 Clarify unfamiliar terms

STEP 2 Define the problems
STEP 3 Brainstorm possible hypothesis or explanation
STEP 4 Arrange explanations into a tentative solution
STEP 5 Define learning objectives
STEP 6 Information gathering and private study
STEP 7 Share the results of information gathering and private study

STEP 1. Clarify unfamiliar terms

 Process
Students identify any words whose meaning is unclear – other group members
may be able to provide definitions. Students should be able to feel safe,
enabling them to be honest about anything they do not understand.
 Reason
Unfamiliar terms act as an obstacle to understanding. Clarification of even
half-stood terms may start the process of learning.
 Written output
 Words or names on which group cannot agree a meaning should be listed as
learning objectives.

STEP 2. Define the problem

 Process
This is an open session when students are encourage to contribute their view
of the problem under discussion. The tutor may need to encourage them all to
contribute to a fast-moving and wie-ranging analysis.
 Reason
It is quite possible for every member of tutorial group to have a different
perspective on a problem. Comparing and pooling this views broadens the
intellectual horizons of those involved and defines the task ahead.
 Written output
List of issues to be explained.

STEP 3. Brainstorm possible hypothesis or explanation

 Process
A continuation of the open session but students now try to formulate, test and
compare the relative merits of their hypotheses as explanations of the problem
or case. The tutor may need to keep the discussion at a hypothetical level and
discourage going into too much detail too quickly. In this context:
 A hypothesis means a supposition made either as a basis for reasoning,
without assumption of its truth, or as a starting point for investigation.
 Explanation means make known in detail and make intelligible, with a
view to mutual understanding.
 Reason
This is a crucial step, that prompts the use of previous learning and memory
and allows students to test or draw on another’s understanding; links can be
formed between the items of incomplete knowledge exist within the group. If
well handled by the tutor and group, it pitches learning at the deeper level of
‘understanding’ rather than the superficial level of ‘facts’.
 Written output
List of hypotheses or explanations

STEP 4. Arrange explanations into a tentative solution

 Process
Students will have thought of as many different explanations as possible of
what is occurring. The problem is scrutinized in fine detail and compared
against the proposed hypotheses, or explanations, to see how it will match and
if further exploration is needed.
 Reason
This stage actively processes and restructures existing knowledge and
identifies gaps in understanding. Making written records of learning objectives
too soon hinders thinking and short-circuits the intellectual process, resulting
in objectives that are too broad and superficial.
 Written output
This involves organizing explanations for problems, representing them
schematically, trying to think new ideas with each other, with existing
 knowledge and with different contexts. This process provides a visual output
of the relationship between different pieces of information and facilities
storage of information in long-term memory. (Note that in memory, some
elements of knowledge are organized schematically in frameworks or
networks than semantically like a dictionary).

STEP 5. Define learning objectives

 Process
The group agrees a core set of learning objectives that all students will study.
The tutor encourages them to be focused, not too broad or superficial and
achievable within the time available. Some students may have objectives that
are not shared by the whole group because of their own personal learning
needs or interests.
 Reason
The process of consensus uses the expertise of the entire tutorial group (and
tutor) to synthesize the forgoing discussion into appropriate an attainable
learning objectives. This not only define the learning objectives but also pulls
the group together and concludes the discussion.
 Written output
Learning objectives – these are the main output of the initial group work in
PBL. The learning objectives should be preferably be in the form of issues that
address specific questions or hypotheses. For example, ‘the use of cantle
charts to assess the growth of children’ is better and more precise than the
global topic of ‘growth’.

STEPS 6. Information gathering and private study

 Process
This could include finding material in textbooks, carrying out a computerized
literature search using the internet looking at pathological specimens, talking
to an expert, and anything else that will help provide information the student is
seeking. A well-organized PBL course will include a course or block book
providing advice on how to obtain or contact specific learning resources that
might otherwise be difficult to find or access.
 Reason
Clearly an essential part of the learning process is gathering and acquisition of
new information, which students do on their own.
 Written output
Students’ individual notes

STEP 7. Share the results of information gathering and private study

 Process
This take place a few days after the first session (step 1-5). Students begin by
returning to their list of learning objectives. They first identify their individual
sources of information, pool their information from private study and help
each other understand and identify areas of continuing difficulty for further
study (or expert help). After this, they attempt to undertake and produce a
complete analysis of the problem.
 Reason
This synthesizes the work of the group, consolidates learing and identifies
areas of uncertainty, possibly for further study. Learning is inevitably
 incomplete and open-ended, but this is quite deliberate because students
should return to the topics where appropriate ‘triggers’ occur in the future.
 Written output
Students’ individual notes

SELF DIRECTED LEARNING

Ref : Lifelong Education for Adults : An International Handbook, ed. Colin J Titmus,
Pergamon Press, 1989

Theory building:
1. Self-directed adults will learn more, better, retain, and make better use of
learning than do reactive learners
2. Effective adult living requires lifelong, continuous effective, and creative self-
guided learning
3. The motivations, attitudes, inner resources, and skills needed to engage in this
lifelong learning can be developed and enhanced by participating in well-
designed learning situations that give the opportunity to practice them in a
conscious way.

EXTERNALIZING THE CRITICAL THINGKING

IN KNOWLEDGE DEVELOPMENT
AND CLINICAL JUDGEMENT

Ref : Facione NC, Facione PA. Externalizing the critical thinking in clinical judgment.
Nursing Outlook. 1996;44:129-36.

Critical thinking is defined as purposeful, self-regulatory judgment which results in

interpretation, analysis, evaluation, and inference, as well as explanation of the
evidential, conceptual, methodological, criteriological, or contextual considerations
upon which that judgment is based.

Critical thinking is reasonable, reflective thinking focused on deciding

what to do or believe

Characteristics of Critical Thinking

 Making reasoned judgements
 Being reflective
 Ability to analyse
 Ability to synthesise
 Evaluating the evidence
 Demonstrating problem solving abilities
 Making inferences
 Examining evidence
  Making reasoned arguments to support your conclusions
 Ability to explain the pattern of your thinking

The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason,

open-minded, flexible, fair-minded in evaluation, honest in facing personal biases,
prudent in making judgments, willing to reconsider, clear about issues, orderly in
complex matters, diligent in seeking relevant information, reasonable in the selection
of criteria, focused in inquiry, and persistent in seeking results which are as precise as
the subject and the circumstances of inquiry permit.

Example :
The initial presentation of the situation : Mr. Jackson, a 50 year old automobile
salesman, has been diagnosed with throat cancer related to his cigarette smoking.
The opening question : “What is the significance of Mr. Jackson’s impending total
laryngectomy and left radical neck dissection surgery to treat his cancer of the
hypopharynx?” If necessary, you might paraphrase the question (interpretation).
“How might we approach the care of Mr. Jackson?” If it should become necessary to
stimulate discussion or focus abstractions, you might ask, “What meaning will the
surgery have for his physical, psychological, and social functioning?”

BLOOM’S TAXONOMY

Learning domain :

Knowledge
Cognitive
Cognitive
Attitudes

Affectivee

Psychomotor
Skills

 Cognitive : knowledge, thinking, evaluating, synthesizing information

 Psychomotor : physical & perceptual activities & skills
 Affective : feelings (e.g. receiving), preferences (e.g.responding), values

Cognitive objective (from lowest to highest):

 Knowledge
 Focuses upon the remembering and reciting of information
 Comprehension
 Focuses upon relating and organising previously learned information
 Application
  Focuses upon applying information according to a rule or principle in
a specific situation.
 Analysis
 Critical thinking which focuses upon parts and their functionality in
the whole.
 Synthesis
 Critical thinking which focuses upon putting parts together to form a
new and original whole.

 Evaluation
 Critical thinking which focuses upon valuing and making judgements
on the available information

GAGNE’S “CONDITIONS OF LEARNING”

 Intellectual skills
 discrimination
 concrete concepts
 defined concepts
 rules
 higher-order rules (problem solving)

 Cognitive Strategies
 Learning how to learn and think

METACOGNITIVE STRATEGIES

 Metacognition
 A person’s knowledge concerning his/her own mental processes and
the active monitoring and consequent regulation and orchestration of
these processes.

REASONING

 for a purpose
 for solving problems
 gathering information in light
of the problem
 interpreting information
 using concepts
 making assumptions
 implications of interpretation
 consequences
 within a frame of reference

Language of reasoning
  Evidence
 Opinion
 Inference
 Support
 Proof
 Refute
 Fallacy
 Etc

Example of reasoning :
A documentary TV programme on “reflexology” claimed that pressure massage of a
certain region of the foot would relieve congested sinuses.
What evidence would be necessary before you would accept such a claim?
Indicating Argument :

 Therefore …….
 Because ……
 So ……..
 Thus ……
 If …………. then …………
 ………… must

Indicating Inference

Words or phrases that signal that an upcoming statement is to serve as a premise in

support of another statement in the immediate vicinity.

 After all, ……..

 Given that ……..
 In asmuch as ……
 Since ……..
 In view of the fact that ………...

Indicating Conclusion

Words and phrases such as:

 Therefore ……..
 In short ……..
 We can conclude that ……
 So ……..
 Thus ………...
can signal that an upcoming statement is to be seen as a conclusion, relative to some
premise statement in the immediate vicinity.

Danger!

Because a written text has inference-indicating phrases or conclusion-indicating

phrases does not mean that the inference or conclusion is valid.
For an argument to be valid
both the premise(s) and the conclusion(s)
have to be true

Evaluating an argument

 Read it carefully to ensure that you have understood it.

 What is the author arguing for?
 Is there evidence for the assertions made?
 What is his/her reasoning?
 Is the argument logical?
  Are the views expressed consistent
with each other?
 Is it possible to distinguish clearly between what is fact and what is an
opinion?
 Is it possible to make a judgment from the information presented?

Argument
Scenario

 We need to make rail travel more attractive to travellers XXXX there are
so many cars on the road that the environment and human safety are
under threat
 People will not abandon the car in favour of the train without some new
incentive XXXXX we need to make rail travel more attractive to travellers
# Determine the appropriate argument indicator !

Planting genetically modified crops will enable farmers to use more powerful weed-
killers (which would have killed the crops if used previously), so there will be a
substantial reduction in the number and density of weed seeds on farmland. Thus, it is
likely that the many farmland birds which depend on these seeds to survive during the
winter will decline still further.
# Is there a sound logical argument in this paragraph?

Burning vast quantities of fossil fuels is causing global warning, which is hurting us
all, so it is vital to negotiate reductions in the production of the gases which are doing
the damage. Thus we need an international agreement under which countries reduce
the production of such gases in proportion to the extent to which they are creating the
problem. Therefore, the United States must not be allowed to ‘buy’ permissions to
produce these gases from other countries.
# Is there more than one conclusion here and is/are the argument(s) valid?

Argument
Evaluation

Random drug-testing of prisoners was introduced in 1995 in order to solve the many
problems associated with prisoners taking drugs. Since cannabis can be detected in
the body up to a month after having been smoked, prisoners are tempted to switch to
heroin, which stays in the system for only 48 hours. As a result, since drug-testing was
introduced, cannabis use has declined by a fifth, whereas heroin use has doubled.
Heroin is not only a much more damaging drug than cannabis, but it is also extremely
addictive. There is evidence that heroin addiction encourages prisoners to intimidate
others in order to pay for the drug.
# What conclusion do you draw from this paragraph?
 Possible conclusions

 the results of random drug testing have been unforseen and unintended
 random drug testing has not solved the drug problem in prisons
 if we want to combat drug taking in prisons we need new strategies
 random drug testing has not solved the drug problem in prisons
 prison officers must be colluding with prisoners

The Reading Process

Analysing Reasoning and Arguments

Critical reading
 Reading not just to see what is said, but to understand the bias, assumptions,
and perspectives underlying the discussion
 Actively recognising and analysing evidence
on the page
 Realisation that what the examples are is not important; what the examples are
examples of, is what is important
 Searching for meaning
 Recognising that meaning is contained not so much in individual words as in
collections of words conveying broader or more specific ideas
 Identifying the major topics and subtopics under discussion

The Writing Process

Synthesising Reasoning and Arguments

Want to write better?

To write better,
you must learn to read better
….. reading is primary.
www.critical-reading.com/principles.htm

How we discuss a text

is directly related to
how we read that text
Writing as a critical thinker

Writing
…. involves an understanding of
how ideas can be pieced together to convey broader meaning.
And while we can learn much from experience
and contact with good examples,
we cannot consciously improve our writing
without knowing how the language works to convey ideas to readers.
www.critical-reading.com/principles.htm

Planning how should we write

 Decide what you want to say
 Get your points in order
 Check your ideas
 Check your examples
 Write an introduction
 Write a draft of the remainder
 Write the conclusion or concluding paragraphs

Points to keep in mind

 Arranging and organising
 Beginning, middle, end
 The reader needs to know where they
have been and where they are going.
 Signposting
 Verbal and structural indications about
the direction your argument is taking
 Paragraphing
 Containers for separate points
or arguments

How should we write?

 Grammatically correct
 Spelling accuracy
 Correct choice of punctuation
 Structure of content should be
easily seen
 Arguments clear
 Assumptions valid
 Sources correctly cited

Task – making an argument

 Topic
 Why should HWS/MONE introduce critical thinking into the undergraduate
curriculum?
Or
Does encouraging critical thinking mean that we will have to change our
assessment methods?
Each small group to come up with argument for one of the above and deliver a
5-minute presentation to the whole group

Critical Thinking Cognitive Skills and Sub-Skills

Interpretation: Categorisation
Decoding sentences
Clarifying meaning
Analysis: Examining ideas
Identifying arguments
Analysing arguments
Evaluation: Assessing claims
Assessing arguments
Inference: Querying evidence
Conjecturing alternatives
Drawing conclusions
Explanation: Stating results
Justifying procedures
Presenting arguments
Self-regulation: Self examination
Self correction

Are you a critical thinker?

Why do you think you are?
What do you have to change to become one?

THE COMMUNICATION PROCESS

Ref : Research, Principles, and Practices in Visual Communication. Assoc for Educational
Communication and Technology, 1960

The purpose of teaching is to facilitate learning. This means that teachers and trainers
need to be able to help learners make sense of what is being presented. To do that
they need first of all to be able to communicate effectively with the learners, and
secondly, to be able to present information in structured and organised ways which
help the learners to construct meaningful knowledge.

One of the most useful models for communication within the teaching/learning
process is the SMCR model developed by David Berlo in 1960.
Communication
who
says what
to whom
in which channel
to what effect
(Lasswade, 1947)

Communication

Encode decode

Source Message Channel Receiver

Communication Code Elements Seeing Television Communication
skills Hearing Film skills
Knowledge Touching Radio Knowledge
Attitudes Content Structure Smelling Print Attitudes
Social/cultural Tasting Social/cultural
context Treatment context

Instructional Design

the approach of Robert Gagne (Conditions of Learning, 1985)

 concerned with arranging external events (external to the mind) that support
internal processes (internal to the mind)
 a guide for organising what teachers and learners do that influences what goes
on inside learners’ minds so that they can learn
 how to organise instruction to achieve specific learning objectives
 critical aspects of instruction :
 the kind of outcomes to be learned
 the events of instruction
 the sequence of instructional events
 the appropriate activities within
each event
 consider the outcome to be achieved
 what kind of objective/outcome?
 organise specific instructional events
 provide information, activities, and interactions to facilitate learning
Events of Instruction (Gagne)

Nine activities carried out by a teacher and learners during instruction :

Prepare the learner for the instruction :

 Gaining attention
 Informing the learner of the objective
 Stimulating recall of prerequisite learning

Start the actual teaching-learning process :

 Presenting stimulus material
 Providing learning guidance

 Eliciting the performance

 Providing feedback about performance correctness
 Assessing the performance
 Enhancing retention and transfer
Instructional Design
the Schema Theory approach

Schema Activation

 helping the learner to “tune-in” to the correct wavelength

 encouraging the learner to bring to mind relevant prior knowledge
 assisting the learner to prepare his/her prior knowledge to be the foundation on
which new knowledge will now be constructed

Schema Construction
Helping the learner to make sense of the
new material by:
 linking it to existing knowledge
 making it relevant to learning need
 highlighting its significance to future
practice
 presenting it in an organised and
structured way
 providing appropriate explanations

Recognising the nature of the learning that needs to take place and facilitating such
learning accordingly:
 learning of concepts
 learning of principles
 learning of problem-solving
 learning of skills & procedures
 learning of attitudes

Schema Refining
 reviewing the topic to give the learner a chance to check his/her construction
 reviewing what has been presented to let the learner reflect upon what had
been learned
 reviewing the topic and projecting forward to situations that let the learner
make application of what has been learned

Identifying the outcomes

 Identification of learning outcomes,
i.e. areas of competence, their associated competencies, and the
pre-requisite knowledge, skills and attitudes on which the competencies are
built, is a crucial part of the instructional design process
 Topic and Task Analyses are helpful ways of identifying the nature of the
outcomes

Topic Analysis
 Essentially a learning hierarchy analysis
 Diagrammatic representation of the learning-prerequisite relations among the
components of the subject matter
 Blood Pressure

Systolic Diastolic
Pressure Pressure

 It is important to work out what the concepts are

 It is important to work out what their inter-relationships are
 Since new knowledge is built on existing knowledge, absence of pre-requisites
can mean that new learning does not take place
 Concept maps can be a useful alternative to a hierarchic arrangement

Task Analysis
 Procedural-prerequisite relations:
The performer must do X before he can do Y
 Procedural-decision relations:
Given condition A, the performer must do X rather than Y or Z

“The purpose of teaching is to facilitate learning”

The instructional design process is a valuable aid in this task since it involves:
- the identification of the nature of the learning
that is intended to take place,
- the development of an approach to teaching that
will facilitate achievement of that learning, and
- the provision of an appropriate assessment that
will enable the teacher and the student to
determine whether the intended learning has,
in fact, taken place.

Approaches to Teaching
Learning Outcomes
• To design instruction from which students will be able to learn concepts,
principles, and problem-solving
• To design instruction from which students will be able to learn skills and
procedures
• To design instruction from which students will be able to acquire attitudes
• To evaluate the potential of a range of teaching methods to facilitate learning
of specific types of outcome

Facilitating the learning of Concepts & Principles

Characteristics of Concepts
• A concept is a set of specific objects, symbols, or events which share common
characteristics (critical attributes), and can be referenced by a particular name
or symbol
• Concepts can be thought of as information about objects, events, and
processes that allows us to
• differentiate various things or classes
• know relationships between objects
• generalise about events, things, and processes
 • All concepts possess four components :
• attributes
• examples
• definition
• hierarchical relations
• Teachers facilitate concept acquisition by analysing these components

Concept “attributes”
• characteristics of a particular concept that help distinguish instances of the
concept from non-instances
• attributes may be relevant (i.e. common to all examples of a concept) or
irrelevant
(i.e. associated with certain examples but not with all examples)
• Attributes may be criterion-related
(i.e. they distinguish between related concepts)

Concept “examples”
• Examples of a concept possess all relevant attributes of the concept
• Non-examples of a concept lack at least one relevant attribute

Concept “definition”
• Concept definitions should contain references to both the relevant and
criterion-related attributes of the concept

Concept “hierarchical relations”

• Deals with relations between concepts
• Can be of three types
- superordinate, subordinate, coordinate –
and based on relevant attributes

Implications for Teaching

• A considerable amount of learning is concerned with learning concepts
• Teachers who understand the nature of concepts can adopt appropriate
instructional design approach for teaching the concept and can check
acquisition of the concept

Teaching a Concept
 give definition, followed by examples
 give examples, followed by definition

Teaching a Principle
A principle states a relationship between classes of events which enable us to
 predict consequences
 explain events
 infer causes
 control situations
 solve problems
Facilitating the learning of problem-solving
Problem-solving involves well defined steps to reach a solution
• Problem sensing
• Formulation of the problem
• Search for solutions
• Trade-off and selection of approach
• Implementation and evaluation

Programmed approach
 student given parts of a contrived problem to which he is to react
 student given a choice of actions
 student given feedback on consequences of action
 student given next choice

Simulation procedures
 student sees cues and consequences as in real life
 student placed in complex situations
 student acts as in real environment
 student receives feedback through natural channels

Facilitating the learning of skills & procedures

Principles of Teaching for Skills & Procedures
Information before the task
• provide precise, unambiguous objectives
• indicate the performance criteria
• provide an overview of the task by live demonstration or video
• avoid long verbal description

Information during practice

• help the student to discover critical cues and prompts intrinsic to the task that
will guide his behaviour

Information after practice

• provide feedback on the component parts of the task
• provide knowledge of results in relation to performance on the complete task
• provide debriefing to review performance

Conditions for practice

• should the trial attempts be massed together or spaced over time?
• more frequent practice sessions broken by rest periods is probably better
• mental practice - rehearsing in one’s mind - appears to be helpful

Facilitating the learning of attitudes

Teaching for “attitudes”

• Provide relevant information
• Provide examples or models
• Provide appropriate experience
• Encourage discussion of issues
• Use role-play
Explanations
“Explaining is giving understanding to another”
Interpretative
What are local anaesthetics?
Descriptive
How do local anaesthetics work?
Reason-giving
Why are local anaesthetics used?