Developing mentors to support students in practice, Part 4: Facilitation of learning
Summary
Following on from the last article that looked at the importance of creating an effective learning environment this article will set the context for the facilitation of learning. This will start by first visiting some of the key principles and theories for understanding and describing the process of learning. Examples will be provided to link these concepts to practice but the more practical aspects of utilising these theories in a practice setting will be discussed in the fifth article ‘Developing mentor and practice teachers to support student in practice, Part 4: Facilitation of Learning. Together these Articles will provide mentors and practice teachers with a firm grounding and understanding of the learning process. This will then enable them to meet the requirements of standard 3 ‘Facilitation of Learning’ set out in the Nursing and Midwifery Council (NMC (2008) ‘Standards for Supporting Learning and Assessment in Practice’ (SSLAP). These are highlighted in box 1 below for both Mentors and Practice Teachers respectively.
Introduction
It can very easily be argued that the central feature of mentorship, is learning. More specifically; how it is undertaken, what promotes it, what detracts from it and how it is managed. The use of the word learning here is very deliberate and this word will be used throughout this article given that the focus will be upon how people learn, not necessarily on how they are taught. This dichotomy of language is an often-discussed topic within the literature. The general basis of this argument is that engaging in the act of teaching does not necessarily mean that someone is learning something (Robinson 2013). Likewise, it can be feasibly argued that learning does not necessarily require direct tuition. Thus the emphasis within mentorship is on the facilitation of learning not of the teaching of nursing skills. Its feasible to assume some amount of teaching may take place, but this would be but one aspect of the facilitation process.
variation of ideas comes out. This is because learning is a very multifaceted process that requires an appreciation of many different factors in order to understand it (Gardner 2012) and this is very much reflected in the ever-evolving understanding of how people learn. This presents a particular challenge for mentors as they are faced with the need to find ways to promote meaningful learning opportunities for their students.
The theories and concepts discussed below are rooted in the social sciences; initially psychology but many of the later theories also incorporate strong sociological influences as well. Each has its own features that separate it from the other theories yet many ideas and concepts are shared between them. Along with this, each has its own strengths and weaknesses and consequently individuals will have differing levels of affinity towards them. Mentors and practice teachers should seek to develop a clear understanding of the different theories of learning and avoid a tendency towards adhering to a single one (Gaberson et al. 2015). This will enable them to be adaptive in their facilitation of learning for different individuals and in different circumstances. In addition to this it provides a wide repertoire of knowledge with which to review and analyse the process of learning, particularly in new situations or instances where students are struggling. This comprehensive analysis will then provide a good starting point from which the mentor and practice teacher can devise a plan of how to better support learning.
Before continuing it is worth noting at this point that these theories need not be mutually exclusive. Whilst they are born out of very different assumptions and worldviews they can be complimentary to each other. The different theories of learning did not evolve from each other in a clear chronology. Instead they developed over time, in some cases and extended period of time, along side each other, often cross-pollinating each other. Skilful and experienced mentors/practice teachers will use a combination of theories in order to create a very rich and engaging learning experience that challenges different aspects of a student’s abilities.
One of the earliest theories of learning is that of Behaviourism. This theory dates back to the beginning of the 20th century and the work or researchers such as John Watson, Burrhus Skinner and Ivan Pavlov (Kellogg, 2002). Behaviourism is very objective in its nature and seeks to only analysis that which is readily observable, such as people’s behaviours and any changes in those behaviours that result from some kind of stimulus or response (Skinner 1969). Within this theory individuals become conditioned to either avoid or repeat particular actions, habits or activities based on the response they receive. The emphasis here is on the feedback received in response to the actions or behaviours performed and whether or not this promotes repetition of those initial actions or behaviours. This theory has no concern with what thought processes might be going on in relation to behaviours performed or the feedback received. It is only concerned with whether or not a particular action receives a positive response, such as a reward, then they are more likely to repeat that action. Conversely, if an action elicits a punishment or some other kind of negative response, then they are less likely to repeat that action again.
The apparent simplicity of the behaviourist theory of learning can hide its usefulness in both managing learning and diagnosing problems with learning and or behaviour in general (Miltenberger 2012). There are two main models that could be considered key in understanding learning within the mentorship context. Firstly there is ‘Classical Conditioning’ which was a model developed by Ivan Pavlov (Pavlov 1960) who undertook experiments to see if he could cause dogs to exhibit a physiological response to an associated and natural external stimulus. In these experiments he would ring a bell each time a dog was fed. Overtime the dogs linked the sound of the bell to the expectation of food. Thus after repeated reinforcement in the form of rewards, the dogs would salivate as if anticipating food at the ring of a bell. The important aspect of this association is that it is formed in the prescience of a neutral factor that does not itself elicit any kind of response but becomes perceived as such.
these associations between a stimulus and neutral factor that falls under operant conditioning which will be discussed shortly. Instead, it is likely that such individuals may notice such reinforcement occurring naturally and chose to pick up on this and further reinforce such behaviour. This could be where learners are seeking out particular opportunities (such as talking to patients) because of the enjoyment (engagement from patients) they derive from them or conversely, avoiding them because of previously troubling results (awkward silence or unwelcomed questions).
Another very popular model within behaviourism is that of Operant Conditioning which was first explored by Burrhus Skinner (Skinner 1969). Within this model behaviour is deliberately conditioned through the application of different types of reinforcement in response to the exhibited behaviour (Skinner 1969). The most commonly held view of this model is the application of either a positive or negative stimulus in order to encourage or discourage repetition of that behaviour (Kinnell & Hughes 2010). So the exhibition of good behaviours are encouraged through some kind of positive reward, which in Skinners experiments would have been a highly desired food item. Unwanted behaviour would be discouraged by either punishment, or the withholding of the positive reward, thus this is considered to be negative reinforcement (Kinnell & Hughes 2010). In Skinners original work however he broke these down into four categories: - positive, negative, no reinforcement and punishment. In his original work negative reinforcement was distinct from punishment and it was mainly a technique applied by the learner to make situations more bearable and avoid detriment to themselves (Skinner 1969).
Learning activity 1. Reflection Point – Consider the behaviourist learning theories discussed above in the context of clinical practice. Make a list of all the different aspects of your role, such as the skills, knowledge and attitudes required to undertake your nursing role. How easy would it be to facilitate the learners development of these different aspects using the principles of operant
conditioning discussed above? What are the factors that would make the use of operant conditioning difficult for some aspects?
provided the chastisement in the first place (an example of negative reinforcement). Truancy in school is another good example of this kind of avoidance behaviour.
It is for the reasons noted above that the provision of a positive stimulus (e.g. praise or reward) to the desired behaviour is more powerful (Butts & Rich 2014; Killgallon 2012). There is a much clearer link between the reward and the desired behaviour and this makes it easier for the learner to then repeat the behaviour that instigated the reward in the first place. Mentors and practice teachers need to be mindful however that positive stimuli work equally well for encouraging the repetition of undesirable behaviour as well as desirable behaviour. This is because it is recipient of the stimulus who essentially decides if it was pleasant or unpleasant, thus reward or punishment. For example a student may find that by cutting corners and rushing particular aspects of their roles they can get them completed quicker. This in turn gives them more time to engage in the activities they enjoy as well as getting them praise from their mentor or practice teacher. Thus positively reinforcing the behaviour
or rushing
their work and cutting corners. Now
Social Learning Theory
The ability to learn from the action and response scenarios of behaviourism are not tied exclusively to the individual’s own interactions in the world. Albert Bandura (Bandura 1977) developed a Social Learning Theory that described how individuals can observe the outcomes achieved by the actions of others in order to decide if this is behaviour they would want to emulate. He undertook a very famous series of experiments with children in which different groups of children observed an actor in a playroom. Some groups would see the actor being aggressive towards a Bobo doll (large inflatable clown) and other would see the actor only playing with the doll. Those who had witnessed the aggressive behaviour were more likely to exhibit the same behaviour. Equally, if the children saw the actor receiving punishment for their aggressive behaviour, they would be discouraged from enacting it themselves for the fear of the same outcome.
This has pretty serious and significant implications from the clinical learning perspective that mentors and practice teachers need to be very mindful of. It demonstrates that learners in a clinical environment are likely to look at the practice of those around them as a guide for how they need to act
Learning activity 2. Reflection Point – Think now about Bandura’s social learning theory and the chances that students may emulate the behaviour of more senior nurses. Think about intentional and unintentional role modelling. In unintentional role modelling the nurse demonstrates something that isn’t best practice, but perhaps ‘gets the job done’. It is unwitting behaviour. In intentional role modelling the nurse demonstrates behaviour that meets best professional standards as well as being effective. It is designed to help students learn. What do you think this means for your role modelling before the student? Do you have a part to play helping students to evaluate unintentional role modelling seen in others?
In the ‘retention’ phase the learning will observe closely the behaviours and outcomes and store them for later use. They will then start to practice these behaviours during the ‘reproduction’ phase. The purpose of this is twofold; firstly it is to gain a degree of skill or expertise the behaviours they are modelling. Secondly, it is to see if they get the same kind of results or feedback as the role model. This is a very key phase for mentors and practice teachers to be aware of since their reinforcement or lack of it here will influence how likely they are to continue those behaviours. This then progresses into the ‘motivation’ phase where the individual will decide if they have the motivation to continue those practices based on their expertise at them, and the response they have gained.
Whilst it is very important to recognise and reinforce the desired behaviours, at this stage, it is also
behaviour may entice the learner into developing ways to hide it. In addition to this, the mentor or practice teacher can be pivotal in helping the learner make sense of the how and why in relation to the success or failure of particular actions or behaviours. Now complete learning activity 2.
Cognitive Theories of Learning
As effective as behaviourist approaches can be in the delivery of learning, they do have significant limitations. Much of the original research undertaken to develop the behaviourist theories was undertaken with animals and at a time when there was very little understanding of neural functioning. As a result they do not overly concern themselves with what the learner may be thinking, or what impact things like mood, motivation or social context might have on learning (Butts & Rich 2014). In particular there was no adequate explanation for how people would apply learning gained in one situation to another distinctly different scenario. This is a challenge students are faced with all the time in clinical practice. They may develop a degree of skill in providing care for a patient within their own home, but what processes enable them to bring these skills to the resuscitation room of a busy accident and emergency department?
be something more internal and introspective on the part of the learner. Nursing care may carry an intrinsic reward, a personal feel good factor associated with care well delivered. It can easily be argued that the learner gained positive re-enforcement in the form of the feelings of accomplishment and/or pride they gained from providing good care. This positive re-enforcement from providing such care may be significantly delayed and/or require the sequencing of less rewarding activities to get to the end result. Behaviourist theories of learning focus on a much more immediate and obvious reward of ones actions. It was questions and shortfalls in explanation such as this that lead to the creation of the cognitive school of thinking upon which the majority of modern psychology is based (Kellogg 2002).
Like the behaviourist theories that came before them, cognitive learning theories started out based on experimentation and observation of animals. The difference was that cognitive theorists placed a greater emphasis on exploring some of the less observable factors such as the role of memory, abstract thinking and how information from the environment is processed (Kellogg 2002). One of the key realisations gained from this school of thought was that learning does not have to centre on actions and the resulting effects of those actions in a real world situation. People are able to use their imagination to conceptualise and plan out different scenarios and how they may turn out based on different courses of action. This is often referred to as Gestalt Thinking (Burn, 2013). By giving precedence to the ability of people to be able to think through a problem scenario in the abstract sense in order to work out the best course of action; it provided a clearer explanation of how learning is transferred. Thus an individual when faced with a problem can recall from memory their experiences of similar or closely linked problems and consider how that fits within the context of the current scenario. This then enables them to think through multiple courses of action and how they may play out before choosing the one they want to implement.
experiences and interpretations of it. This internal model can then be utilised to test out new ideas and courses of action in order to select the most desirable approach or response to utilise in the ‘real’ world.
Learning activity 3 Reflection Point – When someone starts learning to drive and the instructor asks them to make a right hand turn, their memory is instantly filled with all the things they need to consider. Gears, mirrors, other traffic, distance to the turn, speed of the car etc, it takes a great deal of concentration. If they are asked to make a right hand turn a couple of years after passing their test, they may not even notice what they are thinking about in order to accomplish the task. All the various things that previously filled their memory have been combined into one single task.
Consider your developing practice as a health care professional, can you think of any things that you now do that at one point felt impossibly complicated? Try to break this down into its component parts, what where the individual steps or aspects you needed to master? If you were to teach this to a student, how would you structure it so that they did not become overwhelmed?
The attention paid to memory and its internal representation by the Gestalt psychologists lead to a number of advancements in the understanding of how it works that have a significant impact the understanding of learning. Along with the defining of long and short term memory came a greater understanding of working memory, this place where information that is currently being mentally manipulated is stored (Baddeley 2012). The details of working memory are complex and there is significant variation between individuals based on age, experience and the type of activity being undertaken (to name but a few) (Butts & Rich 2014). The important conclusion that needs to be taken from it however is that it has limited capacity. The implications of this are that learners are only able to keep so many ‘chunks’ of information in working memory at any given time. Too many, and they will begin to struggle
Experiential Learning Cycle
One of the most widely utilised cognitive theories is that of the ‘Experiential Learning Cycle’ developed by Kolb (Kolb 1984). Within Kolb’s cycle successful learning need to progress through four distinct phases; Concrete Experience, Reflective Observation, Abstract Conceptualisation and Active Experimentation. One of the key features of this cycle is the learner can technically enter the cycle at any point, but in order for successful learning to occur, they need to progress through all stages. In addition to this, it is iterative with no defined end point and a cycle can be of vastly varied length. What seems important however is that the student is helped to understand how they are reasoning and what the value is of each stage within a cycle. If the learner learns the mechanism of learning, then they can learn more for themselves. The cycle itself can be utilised as a form of diagnostic checklist by mentors and practice teachers to help them move students through the different stages and this may involve making the process very explicit with the learner. This means that learners can continuously build upon their learning and even explore the consequences of what might happen in different scenarios or if different approaches had been tried.
focus. From here the learner needs to reflect upon that experience, this can be aided by mentors and practice teachers asking questions or highlighting key issues that should be focused on (So what should I have done). The reflection will yield questions or queries that expose a gap in the learner’s knowledge, or things they need to investigate further (what are the ways in which I could help). During the abstract conceptualisation phase they will set about investigating these ideas and formulating alternative courses of action should the event occur again (I know have a range of tools to attempt should the situation occur again). This may result in the need to either physically test out some aspects of the new knowledge/idea or to experiment with them theoretically. Either way, the result of the active experimentation phase is a clearer understanding of how the situation would be handled in the future. Thus they are now back to the ‘Concrete Experience’ stage we can itself then instigate another progression through the cycle.
Constructive & Humanistic Learning Theories
This shift in the way knowledge is viewed gave rise to constructivist theories of learning which placed a greater emphasis on the individuals experience and interpretation of learning. Constructivist theories of learning depart from the premise first discussed by Jean Piaget who noted that acquisition of knowledge should enable individuals to adapt their practices and behaviours: not to become copies of those instructing them (Fosnot 2005). This is a fairly organic view of knowledge and its development, and shares its ideological principles closely with evolution theory. In this respect knowledge is not developing to an end point of absolute knowing. Instead, knowledge, evolves and develops in order to enable survival, be that’s physical survival or emotional survival. Indeed, some knowledge is developed in order to ensure a person’s direct survival, such as what to eat and what not to eat, or how to safely cross the road. In the new thinking the purpose of learning was not to secure absolute or perfect knowledge, but knowledge that was workable, that enabled the practitioner to practice their profession when the situation around them was constantly changing.
The principles described above share many similarities with the experiential learning cycle described by Kolb; there are opportunities to reflect, test, experience and postulate. The key difference however, is this is not considered to be a cyclical process within constructivism. Instead it is much more loose and the learner may jump back and forth between reflecting and discussing before putting something into practice. For this reason it can be very challenging for a mentor and practice teacher to facilitate learning using constructivist principles, particularly in the very risk adverse context of modern healthcare. The need to allow mistake and errors however should not be interpreted as students being given free rein to potentially cause harm for the sake of learning. Instead it is more a matter of providing an environment in which ‘mistakes’ are made conceptually and without the burden of reprimand or negative judgements.
Learning activity 4 Reflection Point – The pace of learning in many clinical areas can be very fast and learners face enormous challenges to master the skills and knowledge
required. This may lead many mentors and practice teachers to adopt a more instructional approach by directly providing the information to the students.
Think of some key learning points associated with your clinical area. Consider how you could facilitate students to explore and make sense of these key areas of learning at their own pace. What strategies could you deploy to allow the student to link them to their own experiences? What resources would you need to enable this exploration.
The features of constructivism described above share many of these basic ideologies with what is broadly termed Humanistic Learning Theory. Humanists place a great deal of emphasis on the individual’s feelings and emotions; aspects that they felt had previously been ignored by the earlier theories of learning. Like the constructivists, they also promote the idea of learning being a personal journey in which the educator is a facilitator not and instructor. As such learning is regarded as a persons progression towards fulfilment and their motivation to learn stems from the desire to self-improve and explore their own developing understanding of the world (Gopee 2011; Butts & Rich 2014). As with constructivism, this can be somewhat hindered by constraints put on learners within education programs, such as deadlines, learning outcomes and set knowledge that must be gained. This is not to say that such approaches cannot be accommodated, it does however, demand greater skill on the part of the facilitator. Now complete Learning Activity 4.
The Role of Power in Learning
Both the humanistic and constructivist theories of learning place a very different emphasis on the distribution of power within the learning environment. The more ‘traditional’ approaches to
learnt, the pace at which it should be undertaken, and largely, the methods used. Indeed, most educational systems (particularly compulsory education) are predicated on these principles of teacher control. Humanism and constructivism however, emphasise that it should be the learner who has greater control over these aspects. This is not to say that the learner should necessarily have total control, but it does mean that the system of delivery should be such that learners are able to exert as much freedom and control over their own learning as possible.
Student centred learning is a popular goal for many mentors and the arguments in favour can come from various standpoints. From an achievement perspective there is evidence to suggest that engaging learners in the process of learning is a powerful motivator and results in a deeper level of learning (Baeten et al. 2010). This is undoubtedly a favourable attribute given the need to develop a deep level of understanding and commitment within future practitioners. It can also be postulated that engaged learners also learn how to learn. As can be seen from the discussion of some of the learning theories above, there is scope for learners to gain a very good understanding of the processes they undergo when learning. There is however a deeper issue at the heart of the location of power within learning that highlights how learning can used to either emancipate or control. Engaging learners provides them with greater control of learning, but that in turn requires the mentor or practice teacher to trust their judgment.
Learning activity 5 Reflection Point – How realistic do you think are the ideals of student centred learning within clinical practice? If the student is also to be socialized to standards of best practice must compromises be found? If so, what sort of compromises have you negotiated with a student?
What effect do you think allowing students to have a greater degree of control or influence on what and how things are being learnt, has on development of the progression. At its extremes it could be argued that too much influence dilutes core standards whilst too little does not allow the profession to evolve.
constructivist theory of learning as well as the humanistic concepts of personal fulfilment and betterment.
Portfolio development
As noted above, this article relates to the 3rd of the Nursing and Midwifery Council standards for the support of learning and assessment in practice (See Box 1). To meet this standard, mentors and practice teachers need to demonstrate that they are able to facilitate learning within the practice setting. This requires a very firm grasp of how people learn and what can be undertaken to support that process and minimise the impact of potential barriers to learning. Completion of the reflective activities above will be helpful in evidencing this standard but there is still scope to expand on this evidence. The material presented above introduces a variety of viewpoints regarding how people learn. In practice it is likely that educators will need to use a fusion of these approaches in order to promote effective learning within their area. Think about the discussions presented above and try to write your own philosophy of learning. Keep this personal and reflective by relating it to your own experiences of learning and how this has influenced your current approach. Furthermore, note if and how the material above might have influenced your ideas and approach to the facilitation of teaching and learning in practice.
Summary
References
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Box 1 – Nursing and Midwifery Council, Standards for the Support of Learning and Assessment in Practice, Standard 3
Facilitation of Learning
Stage 2 - mentor
Use knowledge of the student’s stage of learning to select appropriate learning opportunities to meet individual needs.
Facilitate the selection of appropriate learning strategies to integrate learning from practice and academic experiences.
Support students in critically reflecting upon their learning experiences in order to enhance future learning.
Stage 3 – practice teacher
Use knowledge of the student’s stage of learning to select appropriate learning opportunities to meet individual needs.
Facilitate the selection of appropriate learning strategies to integrate learning from practice and academic experiences.
Support students in critically reflecting upon their learning experiences in order to enhance future learning.
