Health Professional Education Editing and Proof Reading Services

Health Professional Education Editing and Proof Reading Services

Introduction

The study undertaken focuses on the recent growing trend of active learning approach in developing competent health care professionals and replacement of the traditional methods of teaching. The literature review including nursing academic databases and peer reviewed journals is done undertaking in to account the aspects of health professional education assignment including GP setting (doctors), clinical or classroom setting (nurses or midwifes). Also a valid justification is sought out to the practice of active learning benefits to the teaching as supported by works of Bonwell and Eison (2010) who define active learning as involving synthesis, reflection and application. Various theories of active learning have been discussed in order to understand the process of active learning and its approach. Also while planning active learning sessions the key points that teacher has to bear in mind are discussed and analyzed in a GP setting, clinical or classroom environment. According to Hoellwarth and Moelter (2011), the learning in healthcare professionals improves from 12% to over 50% (as 38% in their studies) as measured using Force concept inventory, which is now an accomplished measurement for learning measurement in physics.

Active Learning

Humans learn continuously through interactions and discovery about the environment. In classroom setting, Learning is actually the outcome of teaching and teaching without learning is of no meaning. According to Bonwell and Eison (2000), active learning involves critical thinking about what they are doing. With the advent of technology the concept of learning is shifting from metaphorically placing knowledge into students to more consequential skills and knowledge application. A shift to a more learner centered approach of teaching like through application of knowledge and skills through case studies, subsequent discussions and other activities to generate long term learning and critical thinking (Kember et al 1994).

Active learning is a spectrum emerging in the field of teaching as using or doing something with the information gained through the process. According to Mc Kinney and Kathleen (2010), active learning helps the people participation through collaborative groups helping them to attain wisdom and allows revival of the work from time to time. It has the ability to challenge the student’s thought process through the use of imaginary and real life examples and situations. According to Bonwell and Eison (2010), it requires greater participation on the part of the student and through involvement in the classroom activities designed by tutors thus providing greater motivation and relevance through the use of cases, debates, role playing, virtual tours and physical experiments in the new learning environment. It aims at increasing the involvement and accountability on part of the student in self directed learning outcomes. As often the teaching based on traditional methods involves one way flow of information generally, aimed at learning or memorization of knowledge which gets washed up over time whereas meaningful learning outcomes can be achieved through active learning approach (Kapur et al, 2011). Whereas the traditional teaching focuses on being alert and careful listening, the active learning often stresses the application of the acquired skills and knowledge in the constructive learning environment as done in teaching doctors and nursing professionals through dissections done by students. It is beneficial to the students as allowing the learner to develop specific strengths, providing opportunity for learners to adapt according to their interests and preferences and also it averts the boredom that underlies traditional approach (Prince, 2004).

The importance of teaching through active learning can prove very beneficial to the health professional education including doctors, nurses and midwifes by enabling two way communication between teachers and students and facilitating students helping each other in understanding and solving problems as a team. According to Karahocca (2010), in health professional education, complex skills are at the heart of education and learning and just making the students memorize those will not be enough and the application of skills and knowledge is of utmost importance for the practice of doctors, midwifes and nurses to make them perfect in handling patients and providing medical aid. Although active learning may encounter problems in transfer of knowledge from one context to another and decision as to what type of skills will be required in a particular setting by a doctor, nurse or midwife as in each case the risk involved is as big as the life of the patient.  Hence through the use of various examples in teaching various contexts and principles of health professional education, a doctor, nurse or midwife must be made confident and accountable through active learning requiring a modification of the course content by including live cases, modeling, role play, virtual tours, etc (Weimer, 2003).

To promote active learning in health professional education including doctor, nurse or midwife, the teacher may undertake following strategies while developing their teaching programs and reviving the course structure and format to support active learning methods. According to Bens (2005), Cooperative learning is the process where teacher forms groups of student with different skills and knowledge and assign them particular task focusing on learning from their peers or colleagues as cited by Social Interdependence Theory of learning. Also as per Johnson and Smith, increased pressure of application of skills could be subsided by social support and interactions. According to Kapur and Bielaczyc (2011), Problem-based learning can also be used as the process of putting a student or a small team in a real world problem situation and gaining insight into how they come out of the situation. Some knowledge and skills already exist with them while some new knowledge and skills need to be acquired by the students with the help of teachers and other resources thus involving the students and making them responsible for their own learning outcomes. Team learning involves the strategic formation and management of teams in the classroom activities by the teachers and posing quizzes and readiness tests involving course content and promoting teamwork as in practice it would help them out (Westermann and Rummel, 2012). A Case based learning approach involves the real world cases in a setting with large classes with small lectures and suggested readings and lecture time being used for discussing the application of knowledge and skills thus involving all the students rather than just few of them in learning outcomes. Ability-based education approach or Assessment learning first determine what particular skill need to be acquired by the student and then assigning them practical work as homework or classroom activities including each student receiving individual feedback and assessment based on preset performance criterion helping them to improve their performance in practice (Albrecht, 2006).

Theories of Learning

Learning theories are structured principles and constructs that help to understand and predict the way people learn. Behaviorist theories of learning includes various theories proposed by Pavlov, Thorndike, Hull, Guthrie, Watson, Toloman, Skinner, etc where the change in behavior 0r response(R) takes place due to external environment based stimulus(S)  often called S-R model and the purpose of education is to control the stimulus or respondent conditioning and make the desired change in behavior .According to Bush(2006) the role of educator lies in managing the environment and stimulus to elicit favorable response which is basically development of skills and competencies. Here the behavior is reinforced through use of rewards which increase the favorable response and punishments decrease the unwanted response (Drisscroll, 2005) Due to certain limitations like focus on external rewards and punishments and limited applicability in humans, it is often clubbed with other theories to understand learning.

Cognitive theories of learning have been proposed by Lewin, Koffka, Piaget, Kohler, Bruner, Gagne, etc it mainly focuses on the internal thought process or meta-cognition and existing knowledge and perceptions of an individual including the processing and filtering of information and gaining insight into the content for learning to take place. Thus it focuses on how to learn and thus locus is on the cognitive thought process. It assumes that useful knowledge already exists as past experiences and perceptions, how the individual mental process works to acquire and understand, expectations and social factors influencing and how memory stores it, is important to the educator (Linnenbrink et al, 2004). Here Gestalt principle explains how a patient listening to own complex disease information processes and simplifies it into simple form. Also there exist Humanist theories of learning including theories proposed by Maslow and Rogers, etc focusing on the individual emotions and his affective and cognitive needs and subsequent fulfillment through education. Thus the role of education is to make the individual find autonomy and self actualization for oneself through self directed learning (Thompson et al, 2001). As these theories focus less on the social perspective and interactions, they were replaced by social cognitivism theories (Sternberg, 2006).

Social and situational theories of learning include theories proposed by Saloman, Bandura, Lave, Wenger, etc where the focus is on society and community and interactions taking place between individuals in this setting. According to Bandura (2001), learning is seen as a relationship between people and environment where the focus is on full participation in the group processes and utilization of community resources. Thus individuals are made to learn from the others or peer in the team when placed with a certain problem requiring knowledge and skills which the team members possess or gain from resources like peers, teachers, etc in the learning environment (Barr et al 1995). Clinical supervision process by the manager actions such as challenging the nurses and their competencies, integrating knowledge with practice, willingness to provide guidance and sharing experiences (Berggrenn & Severinsson, 2006) In nursing, this theory applies to addressing psychological problems, working with teenage mothers, addressing problems like alcoholism and maximizing use of support groups (Kane Urrabazo, 2006).

Constructivism theory of active learning stats that people learn by constructing understanding based on what they already know or based upon their existing knowledge and experiences. Thus David Ausubel supports the meaningful learning view that most important factor affecting learning is how one organizes the instruction based on prior knowledge. Also Jerome Bruner supported this discovery learning view by promoting the students discover new ideas for themselves when placed in such a situation. Thus it becomes important for the teacher to consider the existing knowledge while designing a teaching program. Also several forms of constructivism apply to the active learning process but the social constructivism has gained much attention and has been described by Bandura and Vygotsy as social interaction and their benefits to construction on knowledge as man is a social animal and does not live and learn isolated from the society thus involving in questioning, predictions, answering the questions, summarizing and cognitive thinking (Rusbult, 2010).

According to Demarco, Hayward & Lynch (2002), instruction allows nursing student develop strategic approach and learning. Here the students are made to involve actively in the process of learning through role plays, live experiments, virtual tours, etc rather than passive traditional pattern. Collaborative learning is a setting where a small group works together towards a common goal resulting in learning from social interactions as in social learning theory. Cooperative learning is where a specially designed group strives towards a goal with individual being assessed and held accountable separately as the group is being actively involving in mutual interactions and where the group is promoted by joint incentives and avoidance of competition aspects (Mckeachie and Svinicki,  2006). The process of placing an individual or a group with a problem situation and learning results from interactions with the teachers, peers and social environment(Michael, 2004). Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) have been used in neurological studies to understand arousal and tracking attention while learning experience (Byrnes, 2001)

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Considerations for Planning a Teaching Program in a GP Setting (Doctors), Clinical or Classroom Environment (Nurses and Midwifes)

In order to effectively deliver learning outcomes in a healthcare education where large amount of complex information has to be delivered in a advanced practice setting within a short time period, the educator must effectively develop strategies to design teaching program for the future doctors, nurses and midwifes, etc. According to Kowalczyk and Leggett (2005), the students must develop long term learning, critical thinking and quick problem solving techniques in groups order to practice healthcare in future where the risk is as big as patient’s life. Lecture though a traditional process but retains its importance pertaining to delivery of large amount of critical information to large classes in short periods but to avoid passive learning and boredom, the educators must focus on involving the students through active discussions and classroom activities (Hartley et al, 2000).

The design of the education program by the teacher is a complex process in healthcare where the overall learning objectives and goals are defined by educator bearing in mind what they already know and what they can do and what concepts, procedures and skills that needs to be developed. According to Carwhile and Murell (2002), understanding, communication, motivation, attitudes and collaboration are important factors in determining the process. It also uses Self directed learning approach is an important criterion in designing the healthcare professional education as the students cannot be spoon-fed and must bear accountability for their learning outcome by jointly involving in assessing the learning goals, resources, teaching program and subsequent evaluation of learning as evident from learning contracts, clinical logs and distance learning packages (Dewing , 2008). Self evaluation is used in active learning in healthcare education where students identify their strengths and weakness in the learning setting and become accountable for their learning outcome by setting personal goals with the help of educator where the educator mean scores and learner self evaluation scores differ significantly decides the student level of favorable attitude. It helps in increasing student confidence as they are accountable for their learning goals and outcomes, an important asset for healthcare education (Russell et al, 2007).

According to a neuroscience research by Black, learning can be enhanced by better brain functioning in a stimulus rich environment. According to Chan and Wai-Tong (2000), the teacher needs to involve in Learning contracts, written agreements between educator and students in health care education defining what the contracting educator will do in order to deliver desired learning outcome with defined learning resources, time period, evaluation criterion and learning expectation. Research shows that it yields long term learning, confidence in practice and higher satisfaction in clinical and healthcare education students in later practice of their professions. As per study of Ruhl, Schloss and Hughes, the teacher must introduce pauses in lectures to promote interaction and Questioning attitudes in student as it can help develop critical analysis and thinking and subsequent decision making in order to solve the problem stated in the question or more often a patient problem in healthcare practice for example asking a student to consider a patient allergy towards iodine and perform intravenous urogram for the patient. It is used often in classroom and clinical setting as Nurses are often questioned through context based seminars by the educators to help application of knowledge and skills. According to Scaffa and Wooster (2004), a Problem based learning approach can be used by teacher as it uses patient information in order to make the students apply the skills acquired to the practice and this is seen as helping the doctors, nurses, etc in generating response to real life situation as to what action should be taken thus promoting development of teamwork, skill application and acquisition and prompt problem solving skills. It is specially directed at skills development final year students and emergency or ambulance care nursing students.

Concept mapping is a process of representing relationship between concepts, principles and procedures through help of diagrams, graphs and hierarchical patterns which help the students in healthcare education as doctors, nurses or midwifes, etc to  visualize the interactions of complex concepts (Akinsanya & Williams, 2005). Problem based learning and scenarios under nursing and healthcare professional education are typically sorted using concept mapping techniques also helping in clearing of general misconceptions owing to student prior knowledge (Brenda et al, 2010). Case based learning is where after lectures the students are allowed to read the case content and scenario for the first time and thus it’s different from problem solving technique. Here the nursing and GP students are allowed to apply their clinical reasoning ability, logical thinking and problem solving to real or hypothetical situation (Carwhile and Murell, 2002). Thus in health care professional education it helps in developing clinical thinking and hence considered important by the educators in designing course structure.

Conclusion

The discussion basically involved the understanding of active learning in the present world and recent development over passive learning process used in the traditional approach of education .The theories of learning have been discussed with the theories like constructivism and social theory that best suits and supports the active learning process. According to Griffith and Ursick (2003), active learning helps by engaging the students in manipulation of knowledge. As the profession involves the delivery of complex and critical voluminous information over relatively short span of time and the risk in the practice involves the life of a patient at care system hence it is crucial for the educator or teacher to plan and design the effective and efficient course content delivery. Self evaluation or self directed learning can help the students in healthcare professional education and educators to figure out best teaching program. According to Hayward and Cairns (2008), with the advent of active technology the goal of healthcare educators must be developing competent clinical experts with critical thinking, problem solving and team working skills. Various strategies applied by the teacher in health professional education to promote active involvement and development of clinical thinking and decision making of the students include concept mapping, problem based learning, collaborative and cooperative learning, learning by discovery, case based learning, etc.

References

Kapur, M., & Bielaczyc, K. (2011). Classroom-based experiments in productive failure. In Proceedings of the 33rd annual conference of the cognitive science society, P- 2812-2817
McKeachie, W.J. and Svinicki, M. (2006). Teaching Tips: Strategies, Research, and Theory for College and University Teachers. Belmont, CA. Wadsworth.
Weimer, M. (2003) "10 benefits of getting students to participate in classroom discussions". Faculty Focus. Faculty Focus. Retrieved 21 March 2016.
Westermann, K., & Rummel, N. (2012). Delaying instruction: evidence from a study in a university relearning setting. Instructional Science, 40(4), 673-689.
Johnson, D.W. and Smith, K. (2000) Active Learning: Cooperation in the classroom, Edina interaction book company p 35-40
Bens, I. (2005). Understanding participation. In Facilitating with ease! Core skills for facilitators, team leaders and members, managers, consultants, and trainers San Francisco: Jossey Bass. P 69-77.