Orienting Teaching Toward the Learning Process

Based on developments in educational psychology from the late 1980s, the authors present a model of an approach to teaching. Students’ learning processes were analyzed to determine teacher functions. The learning-oriented teaching (LOT) model aims at following and guiding the learning process. The main characteristics of the model are (1) the components of learning: cognition (what to learn), affect (why learn), and metacognition (how to learn); and (2) the amount of guidance students need. If education aims at fostering one’s ability to function independently in society, an important general objective should be that one learns how to fully and independently regulate his or her own learning; i.e., the ability to pursue one’s professional life independently. This implies a transition from external guidance (from the teacher) through shared guidance (by the student together with the teacher) to internal guidance (by the student alone). This transition pertains not only to the cognitive component of learning (content) but also to the affective component (motives) and the metacognitive component (learning strategies). This model reflects a philosophy of internalization of the teacher’s functions in a way that allows optimal independent learning after graduation. The model can be shown as a two-dimensional chart of learning components versus levels of guidance. It is further elaborated from learners’ and teachers’ perspectives. Examples of curriculum structure and teachers’ activities are given to illustrate the model. Implications for curriculum development, course development, individual teaching moments, and educational research are discussed. Acad Med. 2004;79:219–228. The rapid evolution in medical curricula can lead to confusion in teachers. As curricular content and process become more centrally controlled and guided by educational theory, teachers may have difficulty grasping the philosophies underlying curricular change and putting them into daily practice. Student-centered teaching, for example, may sound to many experienced teachers like a laudable approach, but not easily put into day-to-day practice. Particularly in clinical teaching, where models such as problem-based learning (PBL) are less well established, the teacher may have to independently develop or modify teaching methods to conform with current medical education philosophies. An understandable framework would be useful to help teachers reflect on their teaching practice, analyze what may explain unexpected student behaviors, develop and implement effective teaching methods, and understand why other strategies seem to fail in stimulating learning. In this article, we propose a model for teaching that can help teachers understand what motivates students and why learners should be the central focus of teaching activities. Rather than insisting on specific teaching behaviors, the model aims at a common understanding of teaching and learning processes, from a perspective about the process of education different from the one teachers may currently have. If teaching is to facilitate learning, clearly, teacher activities should be oriented toward the learning process. Two dimensions are central to our model: (1) the analysis of critical features of the learning process and the linking of teacher functions to these features, and (2) the interplay between external regulation and self-regulation of learning. Dr. ten Cate is professor and associate dean of education, School of Medical Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; Dr. Snell is professor of medicine, director of the Division of General Internal Medicine, and member of the Centre for Medical Education, McGill University, Montreal, Canada; Dr. Mann is professor and director of the division of medical education, Dalhousie University, Halifax, Canada; and Dr. Vermunt is associate professor, ICLON Graduate School of Education, Leiden University, The Netherlands. Correspondence and requests for reprints should be addressed to Prof. dr. ten Cate, University Medical Center School of Medical Sciences, Huispost Stratenum 0.301, PO Box 85060, 3508 AB Utrecht, The Netherlands; telephone: 31.30.2532338/8349; fax: 31.30.2538200; e-mail: [email protected] . A C A D E M I C M E D I C I N E , V O L . 7 9 , N O . 3 / M A R C H 2 0 0 4 219 This model, although logical, requires new ways of thinking by many teachers, particularly those with other responsibilities, such as patient care and research. Although elements of this model are not new, educational theory now offers a better description of the underlying learning processes and helps to encourage appropriate teacher activities. The model we describe has links to constructivism, apprenticeship-based learning theory, and Russian educational theory; elements of the model were previously discussed by Vermunt. DIMENSION 1: CRITICAL COMPONENTS OF THE LEARNING PROCESS The understanding of how people learn has grown substantially in the last few decades. Insights from cognitive psychology, developmental psychology, social psychology, information science, and neuroscience have improved our understanding. Many factors have been proposed that both influence the quality and quantity of learning, and raise research questions to validate hypotheses about the learning process. A number of features are robust enough to use as descriptors of the learning process and as guidelines to shape teacher functions. Several authors distinguish among cognitive, affective, and metacognitive components of learning reminiscent of Bloom’s domains of educational objectives. We believe these three features, or components, are critical to the learning process and may provide a framework for understanding. Bloom refers to educational objectives (i.e., to the outcome of learning), whereas the elements we will discuss refer to the learning process itself. More recently, Mayer elaborated on the skill, will, and metaskill needed for effective problem solving, which clearly parallel the components of our focus and are core elements in our learningoriented teaching (LOT) model. Cognitive Component of the Learning Process Learning occurs when the learner acquires knowledge of a topic or subject matter through processing information by reading, listening, thinking, memorizing facts, relating new facts to existing knowledge, analyzing problems, acquiring psychomotor skills, etc. Essentially, the learner must make a selection from the vast external body of knowledge—from books, living examples, the Internet, other media, etc. This aspect of learning can be summarized by the question “What should be learned?” That is, what is the content or objective of the learning, where should this content be found, and how should it be structured to adequately process the information? Affective Component of the Learning Process The affective component of learning deals with the learner’s motivation to start and persist in concentrated learning. This component pertains to extrinsic and intrinsic motivation, to emotional relationship to the content materials, and to readiness to study. Psychological constructs such as attribution style (interpreting causes of success and failure in learning and exams), self-efficacy (perceptions of one’s ability to carry out learning tasks), and coping with all kinds of emotions involved in studying belong to this component. The affective component may be summarized with the question “Why learn?” Metacognitive Component of the Learning Process The presence of cognitive skills and information combined with sufficient motivation to learn may not result in an adequate learning process if the student does not know how to learn. A learner needs metacognitive skills to process information: he or she must be able to plan study activities, to monitor and evaluate progress, to diagnose and address personal lack of knowledge. These have also been called metacognitive regulation activities. These three components represent essential questions that learners must address to adequately perform learning activities. These questions range from broad conceptional questions such as “What medical school should I choose to become a skillful plastic surgeon?” to detailed day-to-day questions, such as “Which book chapter shall I choose to read for tomorrow’s assignment?” Table 1 gives examples of these questions on all three components, from the learners’ macro and micro perspectives. We have chosen six labels in the cells, most of which were adapted from the work of Vermunt: the content conception of learning, the purpose conception of learning (“learning orientation” in Vermunt’s terminology), and the method conception of learning (“mental model”). Together, these establish the student’s learning style. In all fields the learners can modify their perspectives of the learning process. The macro perspective reflects personality characteristics and opinions of the learner and shapes a dominant learning style, whereas the micro perspective pertains to specific learning activities that must be accomplished. DIMENSION 2: THE INTERPLAY BETWEEN EXTERNAL REGULATION AND SELF-REGULATION OF LEARNING Education serves at least two major two purposes: (1) generating domain-dependent knowledge and skills in students, and (2) helping them develop into adult, responsible members of the community, who can further develop indepenA C A D E M I C M E D I C I N E , V O L . 7 9 , N O . 3 / M A R C H 2 0 0 4 220 T E A C H I N G A N D T H E L E A R N I N G P R O C E S S , C O N T I N U E D