September 23, 2013

FUN Teaching Principles (based on learning theories)

Teaching is the process in which learning is facilitated through planning, presentation, observation, active reflection and feedback that results in external stimuli being perceived, translated, converted and comprehended in a manner which results in cognitive and/or behavioural changes.

Kaufman and Mann’s ‘Teaching and Learning in Medical Education’ chapter in “Understanding Medical Education” inspires this personal definition of teaching.  My interpretation reflects a cognitive constructivist philosophy in which the teacher and learner engage in a “continuous, dynamic, reciprocal interaction among three sets of determinants: personal, environmental (situational) and behavioural.” (Kaufman & Mann 2010)  The personal factors are the behind-the-scenes models/schemas the learner mentally constructs, the environmental factors are the learning setting/material and the behavioural factors primarily are the outcomes, building on prior knowledge.

My philosophy of teaching guided me to derive a set of simple teaching principles that form a simple mnemonic: FUN!
·         First things First (Planning and Presentation)
·         Understand the Learner (Observation)
·         Nurture and Guide (Active Reflection and Feedback)
These principles are not a step-by-step guide to develop a lesson plan, but they provide a framework for considering elements of cognitivist and social constructivist perspectives.  I will elucidate these points and provide an example from a lesson plan I developed with second-year residents on office efficiency.

First Things First:
Before a teacher picks up a set of learning objectives/syllabus or launches Powerpoint to make lecture notes, it is important to reflect and set priorities.  A series of questions based on Schön’s Reflective Practice (1983) may help create a learner-centered lesson plan.

Schön’s Reflective Practice
What was MY EXPERIENCE when I first started this subject?
What did I find most CHALLENGING initially?
What did I learn that was most IMPORTANT to me at that time?
How has my understanding of this subject CHANGED since then?
How do I use the subject-matter on a DAY-TO-DAY basis?

These questions walk a teacher through a mental progression starting as a novice learner, synthesizing the content into a mental model and then applying it.  Schön’s steps can help a teacher to recall a time when he or she was an early learner so as to avoid the expert’s pitfall of unconscious competence: taking mental short cuts and making assumptions that novices find difficult.
For example, when I created a lesson plan to teach second year residents how to function efficiently in the outpatient clinic, I first stepped back and recalled how I felt at that time in my learning.  I was overwhelmed and often fell behind because of the increased load of patients that I had to see in 20-minute segments.  I often felt I survived the day only by finishing hasty notes that felt sparse and inadequate.  I learned tools and workflows from co-residents and a teaching fellow.  Eventually with time and reflection, I was able to change my practices to shift from a 40-minute visit per patient to a more efficient 20-minute visit per patient mentality.
Based on this reflection, I decided that my lesson planning would follow a “typical day in clinic”: I would have each resident read and react to scenarios that progress through a normal resident’s workday.  The teaching would focus on practical issues like chart review/prep-work, lecture note-taking/review, and clinic/charting workflows, while reflecting on the frustrations of time management, chart closing, and difficult patients.

Understand the Learner:
While the first step emphasizes the teacher’s personal perspective to assist with priority setting and lesson planning, Understanding the Learner shifts the focus to learners’ perspectives to understand what learning styles may need to be considered in the lesson.  The Kolb Learning Cycle (1984) and the Honey and Mumford adaptation close the gaps through an experiential learning approach, building in elements that reinforce the lessons to be learned long-term.  During the process of lesson planning, the teacher considers where students enter the learning cycle and engages them using a variety of approaches.

Accessed 9/2013 from:

For example, in my lesson on office efficiency, I devised various case scenarios from a typical day to access Kolb’s “concrete experience” and “reflective observation” stages.  The group’s discussions accessed “abstract conceptualization” and their homework and subsequent ‘real work’ would access “active experimentation” to complete Kolb’s learning cycle.  These steps mirrored the reflective practice model as well: as each student read their scenario out loud, they reflected on what they would do (virtual reflection-in-action), discussed strategies with other R2s (experimentation) and then as homework, they created/utilized/tweaked personal workflows to gauge if there were any improvements (reflection-on-action).

Nurture and Guide:
Using the ‘clinic as the curriculum’ is a prime driver for my residency and this orientation helps facilitate individual learners to become self-directed adult learners and information masters, drawing strongly from an Adult Learning Theory/Andragogy model.  Knowles’ principles (1984) encourage a fun and safe environment, resident engagement in diagnosing learning needs and developing their own learning resources, and aiding them in carrying out their learning plan.  A curriculum that promotes an open, accepting, transparent and sharing culture of learning promotes a strong Community of Practice. (Wenger 1998)  Scaffolding occurs by building on prior knowledge and utilizing higher learners in a Zone of Proximal Development (Vygotsky 1986).

Accessed 9/2013:

Initially, the suggestion to learn more about office efficiency came from the residents as they were transitioning to more solid roles within the clinic.  This is an example of andragogy, wherein the R2s actively engaged with their curriculum development.  I deliberately crafted the office efficiency lesson so they would scaffold each other’s learning using principles of social constructivism.
The scenarios I created provide a framework: embedded within the cases are best practices that they share aloud.  The scenarios end with a point of contention: questions like “what do you do to keep yourself organized and how do you stay on track [with clinic flow]?” and “what sort of preparation work do you do tonight? The morning before [you see your patients]?”  If they are stumped, they can turn to me as a resource: as a fellow, I am a step between residency and attending, placing me in the role of a “more knowledgeable other.”  My recent experiences make me receptive to their needs and subsequently, they are receptive to my pearls.

In conclusion, the teaching principles “First things First,” “Understand the Learner” and “Nurture & Guide” or FUN, form the basis for my teaching philosophy.  Their application reflects the teaching theories of andragogy, reflective practice, cognitivism, and social constructivism. FUN is an easy to remember mnemonic, a practical tool to implement and most importantly, it provides a short checklist to help make teaching and learning fun!

Honey, P. & Mumford, A. (1982) Manual of Learning Styles. London: Peter Honey Publications, London.
Lave, J. & Wenger, E. (1991) Situated Learning: legitimate peripheral participation. Cambridge University Press, New York.
Kaufman, D.M. & Mann, K.V. (2010) Teaching and Learning in Medical Education. In T. Swanwick (Ed) Understanding Medical Education. ASME, Blackwell Publishing.
Knowles MS et al. (1984) Andragogy in Action: applying modern principles of adult learning. Jossey-Bass, San Francisco, CA.
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development.
Schön, D. A. (1983). The reflective practitioner: How professionals think in action . New York: Basic Books.
Vygotsky, L. S. (1986). Thought and language (A. Kozulin, Trans.). Cambridge: MIT Press.
Wenger, E. (1998). Communities of practice: Learning, meaning, and identity . Cambridge: Cambridge University Press.