The more teaching that I do the more fascinated I become with the entire process of learning and reflection. During the course of studying for a Postgraduate Certificate in Medical Education I had cause to start to look critically at some educational literature surrounding how learners learn and the article that follows is a reflection of my own ‘learning journey’ with reference to the literature I discovered during my studies.1
As a young child my mother nicknamed me ‘Little Miss Why’ because I was never satisfied with a simple answer and was always seeking deeper knowledge. At primary school I was a keen participant,2 although I am aware now that behaviourism was obviously playing a part in my development as I responded to positive and negative reinforcement.3 At a pre-operational level my education was always very learner-centred and I can remember finding it quite difficult to move into a primary school environment where I was unable to dictate any of my learning goals. I found the personal model4 was often favoured by teachers, which often created difficulties when the teacher could not accept that I might have different values or needs. I remember a particular incident in primary school where a teacher insisted that we should all have handwriting identical to hers and spent many days getting us to relearn the way we shaped our letters to be identical to hers in spite of the fact that at 10 years of age I had developed my own (legible and competent) handwriting.
At secondary school I became a very competitive learner.2 Many of my subjects were taught in mixed ability groups and I have to admit that I was rarely patient or accepting of other pupils who struggled to understand the subject matter. I found collaboration very difficult in my early secondary school years, partly, I think, because I found it difficult to understand the differences between sharing knowledge and cheating.
I found computer studies especially challenging. I could not understand binary and saw no relevance in what I was supposed to be learning. I was hopeless at art and was constantly filled with a sense of failure. Sadly the concept of self-efficacy5 was never explored in these subjects, I accept that I will probably never be able to draw but I think that had my computer studies teacher been clearer and better at providing ‘guided practice with corrective feedback’ I might have gained something from my lessons other than a sense of total failure.
Little Miss Why was still present — I struggled to engage with the surface approach to learning.6 I found Latin a challenge and clearly remember my teacher shouting repeatedly ‘a gerund is a passive verbal adjective’ over and over again totally unable to comprehend that fact that I had not understood this explanation the first time and no amount of shouting was going to help.
I was inspired by some excellent teachers who managed to focus on a syllabus while allowing some creativity and learner input. This was especially apparent during my English Literature A level where I was introduced to a facilitated small group learning environment. My gap year in Malaysia required a lot of self-directed learning. I worked in a children's home where few of the staff or children spoke English and I quickly picked up the local language. I was entirely self-directed and I learned quickly because it was so relevant to my life — my first foray into truly adult learning.7
Medical school was quite a shock. There seemed to be no set curriculum. Perhaps this was drawing on principles of constructivism,8 but I found it very challenging to prepare for examinations without any guidance on the subject matter. Most of the pre-clinical teaching was in a lecture format with ‘expert’ and ‘formal authority’ figures. I found it difficult at first to adapt to the change from small group learning. I began to develop an achieving approach to some of my learning, accepting that at times surface learning6 can be useful. I started to collaborate, working with a friend before exam time. As I progressed through the course and my clinical skills developed I became more confident and more able to try different approaches to learning. I will admit that I remain competitive not least around exam times and was rewarded with an undergraduate prize.
Postgraduate training has changed my attitudes and approach further. I am much more self-directed. I found the apprenticeship model of being a GP registrar very helpful, I was introduced to the concept of reflective practice9 and started to keep a learning journal. My trainer helped me to become autonomous10 and encouraged me to develop for myself a ‘curriculum customised to [my] prior knowledge’.8 I found it enlightening to be learning in context and to set my own goals. I started to work in a study group for the MRCGP and I still meet with the group for ongoing CPD. I still find some subjects difficult to engage with or to take an interest in but I find the PUN/DEN approach helpful to guide my work and to help me continue to practice reflectively.
As a educator I am conscious that there are a wide variety of different styles of teaching each of which has its place. I try to be adaptable in my approach,11 however I try hard not to match my teaching style to the students' preferred style every time, not least because I am aware that some mismatch will promote deeper understanding.12 I am very conscious that it took me a long time to develop as an adult learner. I try to introduce the students to the concept of reflective practice. In one of the modules I teach at Sheffield University each tutorial begins with a significant-event analysis where I try to get them to work through Kolb and Fry's Learning Cycle13 and we also talk about Schon's9 concepts of ‘reflection in action’ and ‘reflection on action’ and I introduce the ideas of PUNs and DENs.
I mainly teach small groups in a seminar style setting. I tend to use different approaches in one-to-one teaching. Sometimes when I have someone sat in my surgery with me (for example, a nurse or registrar) I will use a ‘mini-lecture’ as a quick method of delivering information appropriate to the immediate setting. I remember being irritated by tutors telling me to ‘go home and read about it yourself’ and so I try to support my students while still trying to encourage them to be self directed.
I accept that just before examinations students will often switch to a surface approach6 in their learning, I try to encourage students to take a deep approach and to understand what they are doing and to try to work from principles. I do think that reward often stimulates learning; the reward can vary from student to student whether it is passing an exam, getting a job or simply learning for one's own enjoyment. I am conscious that I have always been very competitive and I make great efforts to ensure that I do not stray too far into a Socratic method11 and risk humiliating my students.
- © British Journal of General Practice, 2009.