Perspectives from Education

1. Perspectives from Education Sarah Hean, Deborah Craddock, Cath O’Halloran

2. Focus and Definitions • Definition of educational theories is very wide and hence focus to learning theory. • Learning is considered to be a relatively permanent change in behaviour with behaviour incorporating both observable activities along with internal processes such as thinking, attitudes and emotions (Burns 1995).

3. What would help our understanding? • Present an overview of contemporary learning theories and their appearance in IPE literature • First step in creation of a “theory tool kit” • How have these theories have found application in IPE? Their usefulness? • Identify gaps, discuss relative strengths of each in context

4. Methodology • From educational literature, identified contemporary key theories of learning. • Search IPE literature (curriculum and evaluation) for explicit use of these theories; • Search IPE literature (curriculum and evaluation) for implicit use of theories; • Present some of the preliminary results of this process

5. Our overview of contemporary learning theories (used in IPE) MICRO BEHAVIOURISM Professional competencies ADULT LEARNING Self directed, experiential, problem based, discovery interprofessional, collaborative CONSTRUCTIVISM MACRO Cognitive Developmental/stage theory Self directed, experiential, problem based, discovery Social Social conflict theory Socio-cultural learning Situated learning Collaborative learning Interprofessional learning Expansive learning Activity theory Communities of practice Focus on reflection: Transformative learning Reflective practitioner Experiential learning Focus on uncertainty/absence of a teacher/non linearity Expansive learning Complexity theory

6. Overview of Behaviourism • Early version of behaviourism described by Thorndike’s early experiments with hungry cats. • hungry cats kept in boxes in sight of a food stimulus. Access to food through trigger in door mechanism. Cat through a series of trial and error attempts eventually trigger mechanism and are released. They progressively released themselves more rapidly as they learnt from the consequences of their own behaviour • Learning occurs through experiencing the consequences of one’s own behaviour. • Trial and error may be part of such learning. • All behaviour is learned and all learning involves an observable change in behaviour. • Extreme behaviourists take positivist approach through belief that only what can be measured can be regarded as learning. • Less interested in thought processes and how learning has occurred, but focus on learning outcomes.

7. Contribution of behaviourism • Outcome based curricula and evaluation • Activity based (simulation, scenarios, training wards) • Students’ own activity is central Criticisms • Focus on the outcomes or products of learning ignores processes. • Emphasises learning by doing. Students become involved in practicalities of experience, and fail to reflect on their actions during this process • Students may also become overly focussed on the assessment and achieving the stated behavioural objectives.

8. Application to IPE • Identification of competencies: • Norris et al. (2005): The ability to: • work in challenging situations • managing change • resolve conflict • Negotiate • Arrendo et al. (2004) • Foundational knowledge e.g. theories of interprofessional collaboration, theories of organizational behaviour). • an awareness of their own beliefs and values. • Be able to distinguish between what they know and do not know in different and contexts in terms of their abilities to collaborate. • an appreciate and act on different, conflicting world views

9. Barr (1998): The ability to: • Work with other professions to assess, plan and provide care. • Describe their roles and responsibilities to other professions; • Recognise and respect the roles, responsibilities and competence of other professions; • Cope with uncertainty and ambiguity; • Facilitate interprofessional case conferences and meetings; • Handle conflict with other professions; • Curriculum • Explicit application of IPE competencies rather than competencies in an interprofessional manner: Nil

10. Evaluation • Freeth et al (2002), for example, proposed an adaptation of Kirkpatrick’s model of evaluation. E.g. one of levels is measurement of change in attitudes, acquisition of knowledge. (McNair et al 2005)(Carpenter et al. 2005) • If a broader definition of competencies includes student attitudes and knowledge as well as behaviour then there are several instances in which competences have been incorporated into evaluations. For example, changes in students attitudes are seen as IPE learning outcome monitored in several evaluations (Hean et al, 2006; Mandy et al, 2005; Hind et al., 2003). • Model of evaluation focusing on measurement of learning outcomes alone and any process measures are excluded.

11. Gaps • Lack of measurement of actual behaviour (Barr et al., 2006): • Much on changing attitudes but little on changing students’ actual behaviour. • some few exceptions include: • Mcnair et al (2005) self reports of their developing interprofessional competencies and interprofessional confidence and involvement. • suggest that facilitator observation of student working be included in future measurement of behavioural change • Pollard et al (2006) collects students ‘self reports of their own communication skills • Dearth because measurement of behavioural change in IPE programmes (team work behaviours) are hard to identify and measure effectively.

12. Overview of Constructivism • Articulate the processes of learning • Emphasise the importance of personal experience and interpretation of learning. • Students construct new concepts based on current knowledge • Curriculum should build on what they have already learned. • cognitive constructivism • concerned with how learners comprehend things/cognitive structures. • (Dewey (1966) and Piaget (1973). • higher order skills such as problem solving and the development of insights (Burns 1995). (Atherton 2005) • social constructivism. • Social constructivism emphasises how social encounters influence learners’ meanings and understanding (Atherton 2005). • Learner is more actively involved in the of constructing new meaning in a collaborative enterprise with the tutor (Atherton 2005).

13. Contribution of Cognitive Constructivism • Curriculum needs to take account of students’ existing knowledge. • Advocated importance of activity, experience and self direction in development. • Adult learning theories (Experiential learning (Kolb, 1984); Inquiry based learning) • Developmental/stage theories and processes of assimilation, conflict and accommodation, social conflict (Piaget) • Stages translated into moral and ethical development

14. Application to IPE Curricula: • Constructivist approach manifest in numerous descriptions of experiential, inquiry based learning etc in IPE curricula . • Hughes et al. (2004) describes a third year undergraduate online interprofessional module, UWE. • An inquiry based learning approach was taken to this initiative but the theories of Piaget, Vygotsky and Schon are integrated into the design. • Good example of using bits of theory from tool kit • Students given the opportunity to revisit and rework initial submissions of group work in an iterative process. • Hereby successive layers of knowledge added to existing knowledge through each cycle of the process. • In keeping with Piaget’s processes of assimilation or accommodation of new knowledge.

15. Evaluation • Evaluation explicitly assessing constructivist learning (Hughes and Daykin, 2002) • Realistic method of evaluation (Pawson and Tilley, 1997) in which mechanisms and processes are addressed in the evaluations of IPE modules (Clarke et al., 2005).

16. Application to IPE of developmental theories • Explicit reference in curriculum design and evaluation to measure of stages of development: Nil; • Theoretical development of theory • Daghlen(2006): Stages of interprofessional development and decentering. • Clark (2006): 4 stages in their development of interprofessional knowledge and values. These stages were termed dualism, multiplicity, relativism and commitment to relativism. • a commitment to relativism, in which they are prepared to take a stand or a particular perspective but are aware that this perspective is governed by a system of value and belief systems and recognise that others may also have committed to a different but equally valid perspectives based on their own value and belief systems.

17. Contribution of Social constructivism Socio cultural learning theory • Developed mainly through work of Vygotsky • Student Learning is mediated by through socio cultural tools such as language • Description of Zone of Proximal Development • Scaffolding

18. How have theories been applied in IPE • Zorga (2006) • describes a developmental–educational model of professional supervision in practice. • The supervisor mediates the learner’s reflection on a work issue from which they wish to learn/develop. The process of supervision is seen as a cultural product that can accelerate learning across the ZPD, a form of scaffolding for the learner under supervision. • Interdependnce is not encouraged and the supervision sessions are finite in order that scaffolding can be removed once the subject has developed sufficiently. Hughes et al (2004) • Describe the interactions between peers and peer review activity within a virtual IPE programme. • Describe this in terms of Vygotsky’s ZPD.

19. D’eon (2005) • Practical means of scaffolding applied to IPE. • They propose a range of increasing complex learning tasks for students must work through. • These tasks become progressively more complex in two ways: • from paper based scenario to real life setting. • From simple interaction between two professionals, to a case in which a range of professionals are involved. • When scaffolding is removed (i.e., the tasks are completed) students should be able to apply or transfer their interprofessional learning “to novel cases and situations”. • Evaluation: Nil

20. Gaps • Move adult learning theory theories from a “how to” to a “ a why to”? • Need to develop ideas of stages of IPE development beyond theoretical applying this to curriculum development and evaluation. • Need to increase prevalence and develop ideas of scaffolding, ZPD into curricula design and evaluation, e.g. e-learning as a scaffolding, an exploration of peer lead or tutor lead discussions.

21. Criticism • Concentrated on individual as unit of analysis

22. Overview of a macro level of analysis • An evolution of Vygotsky’s triangle of individual activity (mediated by cultural tools) into a description of collective human activity (2nd and third generation).

23. Expansive learning takes place within these collective activity frameworks. • Expansive learning takes place when contradictions in activity system occur. • Knowledge is unstable, unidentifiable and not understood. Is generated by joint activity

24. Application to IPE • Curricula: • Moving away from issues of curricula as no longer about individual learning; • Engstrom (2001) (Child care in Helsinki)

25. Robinson and Cottrell (2005): • An evaluation of decision making and knowledge sharing in multiagency teams. • Explore the professional knowledge generated, learning and ways of working created as result of being part of this activity system. • Evaluation: • Payler et al., 2007 • Evaluation of a IPE CPD intervention; • Used activity theory in relation to other theories to create a matrix with which a pedagogic evaluation of the latter was to be constructed.

26. Criticism • Ignores processes within the individual

27. Overall conclusions • Theories are not mutually exclusive but have a different emphasis • Much overlap between theories: learning by doing, student centeredness are key • Understanding of evolution and connectedness of theories helps position ourselves as practitioners. • IPE evaluation focussed on measurement of stereotype change • Positivist back ground • Outcome orientated: behaviourist • Moved into social psychology • Focussed on the individual • Contemporary learning theories in education are being reflected in interprofessional education also • Lack of theoretical underpinning limits potential of educational interventions (e.g. assessment opportunities) and their evaluation (see Mikkelson Kyrkebo et al., 2007)

28. Specific conclusions • Interprofessional competencies not translated into curriculum design • Need to increase and improve measurement of interprofessional behaviours and competencies • Adult learning can be subsumed under constructivism: • cognitive (e,g, experiential learning) • sociocultural learning (e.g. collaborative learning) • Adult learning theories need to progress from “how” to “why” application. • Ideas of interprofessional stage development needs to move from theoretical to curriculum and evaluation applications e.g. how to measure students’ stage of interprofessional development and enable them to progress to a stage of commitment to relativism.

29. And finally… • After some neglect, theory is moving towards socio cultural and more meso level stages of analysis but this is changing. • Ideas of scaffolding and ZPD could progress further to explore, understand and improve our educational practice using scaffolds such as e-learning and mediating learning through peer and tutor facilitated e-learning; • Greater application of issues of expansive learning and third generation activity systems to IPE curricula and evaluation (see Payler et al., 2007)

30. Group exercise • How does this framing of learning theories in IPE help me with my work in IPE? • Agree on an IPE curriculum or evaluation scenario relevant to your group. • Use the framework (or part thereof) as a tool to articulate the challenges of this scenario and ways in which to address these.

31. SEMINAR 3 • Seminar 3Prioritised theories from education 5th December 2008 UWE • Which theories should be prioritised? Who should be key speakers? • Possibles • : • Yrjö Engeström (University of Helsinki, Finland): Activity theory • Philip Clarke (Rhode Island University, USA), and Lars Owe Dahlgren (Linköping Universitet and Karolinska Institutet, Sweden): student cognitive/ethical development