MY EXPERIENCES OF TEACHING AND LEARNING

As I entered teaching I began with a certain view of teaching and knowledge. I saw knowledge as a fairly fixed entity which you were “filled up” with when you went on a course. As a teacher I was the oracle or sage and my job was to present this knowledge in as much detail as I could. Students had to understand it and regurgitate it to pass the exam and become a health professional. If I missed out any aspects of a topic area I was not doing my job properly and I had to memorise all the facts that students needed. I am an anxious personality type and found the early teaching experiences very stress full. Especially as I felt I was failing my students due to my inability to cover all the facts in as much detail as I felt I should. I did not know everything that they should know.

But why was this view prevalent? I had studied for a teaching qualification in 1989 and had supposedly learnt about teaching. Reflecting upon this event revealed some interesting insights into teaching and learning. The qualification I studied for was a Further & Adult Education Teaching Certificate that I took at Acton Technical College in London. The group with whom I was taught was a mixture of people from the professions and other services. There were policemen, hairdressers, healthcare workers to name but a few and we gelled quite well as a group. One of the policemen, an inspector, was the self-appointed spokesperson for the group. The tutor for this course, Mr Eric Soto, used to teach us by presenting us with short extracts from a range of texts. I remember work by Piaget, Skinner, Holt and Abercrombie. We were asked to read the piece and then he would say speak to the person next to you and have a chat about it. Then he encouraged us to have a group discussion on the issues raised from the text and our own thoughts.

Sometimes he would leave the room and let us discuss the issues without him. The group reaction to this was that he was not doing his job properly and that we were not learning anything about teaching. We wanted to know how to stand up in front of a class and teach, how to construct overhead transparencies, how to manage classroom behaviour and to be able to present information more effectively. Eventually the whole class rebelled and called a meeting to discuss this with him. The atmosphere was quite hostile and the tutor was clearly upset by our complaints. At a subsequent session he came in and read to us a letter from a former student he had taught on the course. The letter described how this student had found, years afterwards, that the course had been a powerful learning experience which had fundamentally changed the way that they had taught. We were still

not convinced but completed the course and passed our classroom observations. This uprising of students was, as I see it now, due to our traditional view of teaching, which was to pass on pieces of knowledge and to essentially reproduce the way that we had been taught. It also shows how a teacher has to work with students to enable them to learn and that even if you think you are doing a good job teaching if the students are not with you, you will not be able to encourage them to learn. Another perspective here is the one that values the ‘deep end’ effect. This is where there could be value in throwing students in at the deep end and letting them experience learning in the real world with all its complexity and ambiguity. When we were looking at the excerpts from these educational texts we were being asked for our view. I think we were expecting to be told what view to have by the teacher. Asking students to think for themselves might enable them to develop the skills required to exist and develop in the real world. There were other valuable lessons learned from this experience.

He taught us several basic teaching principles. That teaching is a compromise between what the teacher would like to do, what the students would let them do and what the other stakeholders, such as funding bodies, the general public and the government, would allow teachers to do. He also said that some of the principles of teaching were to make the student an active learner, working directly on the material to be taught and that the focus should be on student learning not on the teacher teaching. He explained to us about the value in encouraging the students to use their cognitive and affective domains (Bloom 1964) to enhance the learning experience. I am not sure much of this excellent advice was understood or acted upon at the time and our tutor is probably unaware of the effect he has had on my teaching. In 1994, several years after the course, I discovered problem-based learning. This was a revelation to me and changed my view of knowledge and teaching.

1.5.1 Problem-based learning

This form of learning has several features (Schmidt and Bouhuijs 1983). Small groups of six or seven students are presented with a ‘problem or issue’ that they have not met before. Through a series of predetermined and structured stages the students discuss the ‘problem or issue’ and its meaning to them to obtain a clear group view. They then set about trying to identify what they currently know about the ‘problem or issue’ and what they do not know. This is followed by discussion, debate and questioning leading to formulation of

learning objectives that the students believe they need to know in order to answer the problem or address the issue. They then go away and through private or group study they gather information and learn about the areas they identified in their learning objectives. They return the following week and present their findings to the group. Through discussion and debate they then try to resolve the problem with a more informed debate than they had previously. This form of learning requires very different skills of the teacher. In stead of being the font of all knowledge the teacher now becomes a facilitator of the learning process and enables students to discover the answers for themselves.

I experienced this new form of teaching by accident rather than by design. I was strongly encouraged by my then boss to get involved in something new. She was always pushing her staff to take up new roles and new ideas. So in 1994 a colleague and I joined the multiprofessional teaching team at Salford University which taught the multiprofessional modules in the Faculty of Health and Social Care using problem-based learning. There were three modules one in each year of the undergraduate degrees and they were shared with physiotherapy, prosthetics and orthotics and radiography. The module content was designed around three strands, research methods, information technology and the sociology and psychology of health and illness. I had considerable worries about doing this as it was outside my sphere of knowledge and experience, radiography, and used an unfamiliar teaching and learning strategy, that of PBL. I asked about the induction programme for teachers new to this style of teaching and the module leader said we could have a chat about it. My colleague, the module leader and I discussed the process and what would be required of us as facilitators. We talked through some of the ‘problems’ in the same way that the students might. Subsequently my colleague and I went through the other problems we would be facilitating to try to work out what sort of discussion the students might have so that we would be prepared for their responses. This was our staff development in preparation for what was to be a major shift in my role as an educator. A week later the programme and our problem-based learning experience started with the new first years that began their course with the first multiprofessional module People in Society.

For the first few weeks I felt out of my depth, not knowing whether to interject in the student’s discussion or to sit quietly and listen. I felt I was not doing my teaching job properly, as I was not peddling knowledge. I subsequently learned that this is a common feeling for teachers going through this paradigm adjustment (Mayo et al 1995) and this has

influenced the way I have led the PBL staff development for my colleagues. On reflection I was at times too quiet and the students discussion flowed unfocussed, sometimes missing out on some of the expected learning outcomes. At other times I was too active and contributed too much to the discussion, leading and controlling the group. But after a few weeks of the experience I observed some surprising effects. The students were often all active and were sometimes emotionally involved (using their affective domain) discussing the issues stimulated by topics such as euthanasia or stress. They were searching out literature, extracting from this the pertinent issues and many were coming to the groups and discussing these issues without any more than a glance at their detailed notes. Personally I felt excited by this. The students were demonstrating higher order skills in the first module of year one and they appeared to be enjoying the learning. As a facilitator I began to enjoy the sessions and relax a bit more. Teaching became a more exciting and human activity and the traditional barrier between teacher and students dissolved as the power relationship changed. This form of learning excited me and it felt right. When considering this student-centred form of learning which gives responsibility and empowers the student it occurred to me that this was what I lacked when doing my “A” levels. If the teaching and learning strategy had been more student-centred, would I have applied myself more and achieved better results at school? This is a difficult one to be sure about as there were many distractions as a sixteen to eighteen year old male in a mixed school. Football, music and girls were much more important than schoolwork and though my parents encouraged me I developed several strategies to give the impression that I was working for long periods when in fact I was not. One of the key issues though was that I was also kidding myself. Even after getting poor mock “A” level results I still managed to convince myself that they were only practice exams and that I might do better in the real thing. This lack of self-awareness may have been altered by a more empowering teaching method. This might have helped me to develop a greater responsibility towards and ownership of my studies. When teaching using this method I am keen to encourage every individual in the group to participate and have developed strategies for inclusion of such individuals. I want to help each individual, through effective teaching, to develop their full potential.

I developed as a teacher from a knowledge-focused oracle to a process-focussed facilitator of student learning. I now enable students to seek out the knowledge themselves and to critique this knowledge watching them develop their confidence and knowledge base as well as their ability to question. This gives me great satisfaction and has broadened my range of teaching skills. I still have anxieties about how much knowledge they have at the

end of the process and find facilitating is a demanding role but a rewarding one.

1.5.2 The value of problem-based learning to my profession.

During a set meeting a question was posed about what value PBL might have to my profession?

Current evidence of problem-based learning comes mainly from research in medical education and particularly from three meta-analyses into the effectiveness of PBL. These studies were undertaken during the 1970’s & 1980’s by Albanese & Mitchell, Vernon &

Blake and Berkson all published in 1993 and covering 17, 11 and 35 studies

respectively. This evidence claims that for ‘hard’ outcomes e.g. student assessment results, there is little difference between the problem-based and traditional curricula. However, for ‘soft’ outcomes e.g. satisfaction and happiness with the programme, students prefer the PBL way of learning (Marks-Maran & Thomas in Glen & Wilkie 2000). Another benefit according to Lewis and Buckley (1992) is that PBL encourages deep rather than superficial learning.

Others cite personal experience as well as the literature and make further claims for the benefits of PBL. Schmidt (1983) states that PBL may help to reduce the amount of irrelevant material in traditional curricula, integrate subject matter from different disciplines and support the need for CPD. Dr Charles Engel has taught at the medical school at Newcastle in Australia for many years and is committed to PBL. He describes it as

“… not a mere method to be taken up and discarded as just another passing fashion.”

It is

“..an essential means for H.E. into the next century”

(Engel 1991)

The radiographic profession required practitioners to study to Diploma level for entry into the profession up until the late eighties. By the early nineties the first Honours degree qualified radiographers were produced who were expected to be more autonomous

practitioners able to think about their practice rather than just to follow protocols determined largely by the Radiologist, the qualified doctor specialising in the reading of x- rays. This alteration in level of qualification for entry into the profession began the change from producing practitioners following protocols to thinking autonomous professionals. However essentially the same people who had taught the Diploma course did the teaching. So a lead in time was required before these educationalists developed their educational practice to more effectively deliver the degree curriculum and develop the autonomous practitioner.

A move to a problem-based curriculum would appear to offer many benefits to a developing profession such as radiography. This form of learning requires students to learn in context. That is to say they are presented with a problem that they are likely to experience in the real practical world in which they will practice. As a result the students develop the skills necessary to learn about what is required to overcome that problem in that and other similar contexts. They become adaptable and able to respond to different situations. Confidence is built up and students feel more comfortable with the unknown.

Qualified practitioners would be developed who were autonomous and life long learners, more responsive to continuous professional development (CPD). CPD is a topical issue in radiography and new legislation requiring radiographers to get involved in compulsory CPD is planned after the new Health Professions Council begins operating in April 2002. If radiographers do not get involved in CPD they will not remain on the professional register and would be unable to practice in the Health Service. This new legislation is a government response to restoring public confidence in the health professions following high profile cases such as the incompetent child heart surgeons at Bristol Royal Infirmary, the organ retention scandal at Alderhey Hospital and the murders carried out by the G.P. Dr Harold Shipman.

PBL also breaks down the traditional and artificial subject area boundaries that have developed over the years. In radiography these subjects include physics, anatomy and physiology. The curriculum content can now be extensively reviewed and the knowledge and skills that are not relevant to practice can be identified and removed. In my view previous reviews in vocational programmes of study have been undertaken largely by subject specialists who have tended to hold on to traditional content in their subject. Indeed this may be taken further as it is often the subject specialists’ own area of interest, usually

their research interest, which is maintained in the curriculum. The content then is decided upon not always for the purposes of developing the profession but on occasion developing the teacher/researcher. The more direct focus on practice outcomes which will happen as a result of the new PBL curriculum model will make the new curriculum better able to deliver a practitioner who is well prepared for the demands of working in the modern health service.

Interestingly much of the research around problem-based learning comes from medical education and is heavily biased towards a medical model. That is the setting of hypotheses and then testing them out. Other health professionals are now adopting a problem-based learning approach but are adapting it to meet their own needs in midwifery (Glen & Wilkie 2000), occupational therapy (Sadlo in Glen and Wilkie 2000) and nursing (DoH Making a Difference 1999). The Directorate of Radiography at Salford is changing the curriculum to a problem-based one due to start in September 2002. This influence of the medical profession on health professionals thinking I will return to in chapter 2 and discuss how it has affected the development of the radiography and other health care professions.

At the time of starting my PhD I was already convinced of the value of student centred teaching and learning strategies and my interest in action learning stemmed in part from this interest. Having made the shift from lecturer to facilitator where would I next go to improve as a teacher? And what is the logical next step for society if higher education produces effective autonomous learners?

If higher education shifted its teaching and learning strategies to problem-based learning and to the facilitation of student learning it would produce autonomous learners. These learners would then be able to learn with little or no help from formal higher education. This is not only a desirable outcome but a necessary one. The increasing rate of change of knowledge will make it increasingly difficult for professionals to return to higher education for updating. There will simply not be sufficient time. Professionals will need to become self-motivated autonomous learners who continue to learn as they practice. They will need to identify gaps in their knowledge and skills and to use their ability as an autonomous learner to seek out and acquire this relevant information. Therefore this