Joel Merenstein, MD is clinical professor and Emeritus Director of the Faculty Development Fellowship in the Department of Family Medicine at the University of Pittsburgh School of Medicine. Prior to directed the Fellowship, which he did for nearly 30 years, he developed courses and taught medical students at the School of Medicine. In addition Dr. Merenstein practiced family medicine in the same community for 42 years.
I have spent my career as a practitioner and teacher of adults, medical students, residents, fellows and faculty. Our guiding philosophy in this teaching has been adult learning theory which emphasizes the active involvement of the learner and the ineffectiveness of lectures or other methods of talking at people. Medicine is learned mostly by doing. We have assumed that teaching of medicine should be learned the same way.
In our fellowship program we have developed a series called Teaching and Learning In Different Settings. Our process is to review and discuss the literature, observe experienced teachers and then be observed, often on videotape. We then discuss these experiences. Some of the settings are in-patient teaching rounds, individual office visits and morning report as well as seminars, workshops and even lectures. Our focus is on the learner’s needs more than any general principles of how to teach any particular subject or in any particular setting. We concentrate on the individual learner, her strengths and weaknesses, her needs and desires and what motivates her to learn and change her behavior. We have used the Learning Pyramid
to show that most learning comes from teaching others or practice by doing and the least by lectures or reading.
Now education experts tell us there is little evidence supporting one method of teaching over another and a combination of multiple methods is probably best. This is not the same as saying there is evidence to prove no difference between methods.
Adult learning theory principles note that learners are self directed, draw on their own experience, want learning to be relevant to their own needs, want to use new information soon and have individual learning styles. This doesn’t sound different to me than the way children in K-12 learn.
I have no expertise in educational theory so I looked on the Internet and found a review of John Holt’s classic How Children Learn. Holt believes that children are natural learners motivated by their own curiosity, are problem solvers, like to think and deal with real world problems. This sounds a lot like what we say about adult learners.
So, then some possible questions to consider: Can we rely on theoretical conclusions when the evidence is missing? Should I encourage the M.D.s I teach and the other medical staff they teach to use a combination of methods and stop denigrating the lecture method? Should children, though not just little adults, be taught the same way as adult learners? If so, is this age dependent, i.e. OK for high school students but not kindergarten students or does it apply to all students?
I realize that children are more likely to be taught in large and small groups than my adult learners making it more difficult to apply the principles of adult learning. So for those that agree with me that children and adults can be taught with the same theoretical bases in mind the issue is how do you do that with a class of 35. Smaller classes alone won’t do it but combined with exploring one’s own curiosity and doing actively instead of passively absorbing, might work.
Last week I observed the actual application of what I am proposing. I observed my 9 year old grandson’s advanced math class in a private parochial school. There were only 8 children in the class, 5 boys and 3 girls. There were no desks. When we walked in the kids were working independently on their workbooks while sitting on a bench or lying on the floor. Periodically they would ask the teacher a question regarding their own work. She helped them find an answer rather than giving them one.
The teacher then went to the board and involved the group in a discussion of math systems that they had studied, the symbols, the base and the transfer of numbers between systems. At times they knew answers that she didn’t. She unabashedly accepted their comments.
Following this discussion she reviewed their assignment for the weekend. They had to develop a new math system of their own, do a poster and then teach it to the class. For this weekend their only assignment was “to think about their system.”
For me, I will continue to push physicians I teach to learn by doing and hope that we can find some way to apply Adult Learning Theory to all children.