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Planning and conducting an educational programme

3.05

The tasks involved in planning and conducting an educational programme can be classified into four major types, namely:

deciding on the objectives;
selecting learning experiences that will contribute to the objectives;
organizing the learning experiences to maximize their cumulative effect; and
evaluating the effectiveness of the educational programme in attaining its objectives through appraising the educational progress of the students.

Education is a process for changing the behaviour of students in desired directions. The term “behaviour” is used in the broad sense and includes thinking, feeling, and acting. When a student is educated he has acquired ideas, habits, attitudes, interests, ways of thinking, and professional skills which he did not have before he went to school; his behaviour has changed.

From this definition of education it is clear that the educational objectives are the behaviour patterns that the school tries to develop in the student. The knowledge, the skills, and the ways of thinking that the student is expected to acquire are examples of these objectives. The task of deciding on objectives is an important one because these are the aims and purposes which can and should be used to guide the entire educational programme. The only rational basis for selecting learning experiences and devising evaluation procedures is in terms of their relation to the educational objectives.

The second major task of education is to select learning experiences that will contribute to the objectives. This raises a previous question: how do people acquire these desired changes in behaviour patterns? “People acquire them by practising them” is a simple but fairly accurate answer. Getting students to practise the desired behaviour, however, is not the easiest thing in the world.

A student develops understanding by recalling ideas, by explaining them in his own words, and by finding illustrations of them. Skill in ways of thinking is developed by practising problem-solving again and again. Manual skills and habits are also acquired by practice. An attitude is acquired as the student looks repeatedly at the phenomenon from a new perspective. Interests are acquired by getting satisfaction from certain kinds of experiences so that the experiences become increasingly satisfying. For all of these kinds of behaviour, students acquire new behaviour patterns by practising them.

One fact clearly emerges from this analysis - the teacher cannot learn for the student. Whether or not the student develops an understanding will depend upon what is going on in his mind, not what is going on in the teacher's mind. To plan learning experiences is to outline the activities that will give the students a chance to practise the behaviour implied by the objectives. Thus, planning a particular course will mean providing situations in which students will encounter problems to solve so that they can gain understanding and develop critical thinking. Planning may also involve providing tasks which require the students to practise manual and intellectual skills and habits, and so on.

The third major task in education is to organize the learning experiences to maximize their cumulative effect. We can increase the cumulative effect of learning experiences in two ways: through sequential organization and through integration. When learning experiences are arranged so that the students begin with simpler concepts and skills and go on to broader and deeper applications, far greater learning results than with a random arrangement of learning. This is sequential organization. Integration involves relating what is taught in one part of the educational programme to what is taught in another part. Effective organization of learning experiences involves planning both for sequence and for integration.

The fourth major task in education is to evaluate the effectiveness of the educational programme in attaining its objectives, through appraising the educational progress of the students. This requires evidence of changes in students' behaviour during the time they are taking part in the educational programme. It means appraisal early in the course as well as near the end. It involves evidence relating to all of the important objectives which will help us to identify those aspects of the curriculum that are effective and those that need improving.

With this brief review of the essential characteristics of a profession and the major tasks in planning and conducting an educational programme, we can identify more easily the distinctive attributes of education for the professions.

Objectives of professional education

The existence of principles and of a code of ethics in a profession points to several kinds of educational objectives which are important in educating for a profession. The development of an ethical practitioner who has an adequate understanding of the ethical code of the profession, who applies the ethical principles intelligently to the varied particular instances that arise, and who is sincerely committed to the highest ends of the profession, requires an education programme which consciously aims at several major types of objectives.

In terms of knowledge and understanding, a programme of professional education needs to develop in students a broad and clear concept of the social role of their profession. This includes understanding of the social functions the profession serves and how these functions are related to the total functioning of society and to the functions of other major specialized groups. It also includes an understanding of the various kinds of relations which exist between the profession and society at large and between the profession and other specialized groups, including the expectations which these groups hold regarding the members of the profession.

Also, in terms of knowledge and understanding, professional education aims at developing a deep understanding of the persons to whom the professional service is rendered, including particularly insight into personal motivations, feelings, needs, and the interrelation of physical, psychological, social, and emotional aspects of human behaviour. Furthermore, professional education needs to include among its objectives the development of self-understanding in the students. Obviously, in no sense can complete self-understanding be attained by the time of graduation from the professional school, but a sufficient beginning can have been achieved to provide for continued development as he pursues his professional career.

In terms of effective thinking or problem-solving, the objectives of professional education which are derived from the importance of ethics include the ability to recognize ethical problems, the ability to identify the ethical principles at issue, and the ability to work out appropriate courses of action in terms of ethical principles.

In terms of attitudes, education for the professions aims at developing loyalty to the social well-being of the persons who are served by the profession, concern for a truly social role on the part of the profession, a sense of self-respect for the social contributions of his profession and of his own work, and a warm, accepting, yet objective attitude towards his clients. This involves developing in professional students a considerable degree of emotional maturity so that they are free to express and receive emotionally charged communication and at the same time can act intelligently as new problems arise.

The foregoing objectives clearly represent a large task for professional education, but these are not all the important objectives. The requirement that the professional practitioner operate on the basis of principles rather than rules implies certain additional objectives if the educational programme is to aim consciously to develop students who can operate in this fashion. Some of the purposes outlined above contribute to the performance of professional duties in terms of principles. In addition, in terms of knowledge and understanding there is need to understand the structure and functioning of the institution in which the profession operates, whether this be a school, church, hospital, court, or other institution. Only with such a broad view can a professional practitioner operate with intelligence and on the basis of principles adequate to produce desired consequences.

Finally, of course, every professional school needs to aim consciously to develop any understanding of those principles, concepts, facts, and procedures which are basic to professional operations. In medicine these include principles of physiology, anatomy, chemistry, physics, bacteriology, and psychology. The tendency, however, is to limit these basic principles too narrowly. In a very real sense, doctors deal with problems in their normal professional work which are psychological and require an understanding of relevant psychological principles if they are to operate intelligently.

In terms of effective thinking and problem-solving, it is clear that the foregoing objectives involving knowledge imply the development of some skill in recognizing professional problems, in analysing the problems in terms of the relevant principles, and in working out courses of action by applying these principles.

In terms of attitudes, the use of principles, rather than rules, in a profession requires as objectives in professional education the development of broad, rather than narrow interests in the fields on which the profession draws, and the development of the student's interest in continuing his own learning long after graduation from a professional school.

Planning learning experiences

The previous section outlines characteristic objectives of professional education. What about the learning experiences which the professional may use to attain these objectives?

The most common problems in professional schools in connection with the learning experiences used are:

the failure to select learning experiences in terms of the objectives to be attained;
the failure to utilize consciously appropriate learning procedures for developing problem-solving skills, attitudes, and interests; and
the failure to develop effective motivation for learning.

These are serious deficiencies.

Since learning is an active process, in which the learner himself is definitively involved, motivation is essential. Since the learner learns more than knowledge of content, and he actually learns what he is doing, what he is feeling, what he is thinking, it is important to make conscious plans for students to learn to solve problems, to develop attitudes and interests. Since objectives represent the aims of the professional school and learning experiences are the means of reaching educational aims, the latter should be planned in terms of these aims.

An essential factor in planning learning experiences in terms of the objectives sought is to have clearly in mind what the objectives imply, both as regards behaviour to be developed and content involved. For example, if the objective “understanding the social functions the profession serves and how these functions are related to the total functioning of society and to the functions of other major specialized groups” is to serve as a guide for planning learning, we must have a clear idea of what is meant by “understanding” as a type of behaviour to be developed and what content is included in the phrase beginning “the social functions the profession serves”. Most instructors who have sought to define “understanding” indicate that it is a mental process that is more active than memorization, since it involves not only remembering but also the ability to explain the concept or principle in one's own words, the ability to interpret, to illustrate, and to compare and contrast it to related ideas. Such a definition clarifies the behaviour that the student is expected to develop and, as pointed out earlier, it suggests the kind of learning experiences that are required to attain the objective. These would be learning experiences which give the student opportunity to explain, to interpret, to illustrate, and to compare and contrast it to related ideas. By defining the content implied by the phrase beginning “the social functions the profession serves”, we are able to identify what the principles and concepts are which the students will be given opportunity to explain, to interpret, to illustrate and to compare and contrast with related ideas.

Correspondingly, as we define each objective in terms of the behaviour and content implied, it is a much easier step to select learning experiences that give students a chance to practise the behaviour involved and to utilize the relevant content. In this way, learning experiences are planned in terms of the objectives sought.

The fairly common practice in professional schools of giving almost exclusive attention to knowledge and to technical skills may be partly due to the failure to recognize that effective thinking, attitudes and interests are also learned and can be consciously developed in programmes of professional education. Skills in ways of thinking are acquired by practice in solving problems. A new attitude is acquired by repeatedly observing and reacting to certain phenomena from a new perspective. Interests in certain kinds of activities are developed as the student gains satisfaction from participating in these activities. For each of these types of objectives, definite learning experience can be provided so that students are practising problem-solving, they are projected into situations from a new perspective, they are able to gain satisfaction from certain kinds of activities. In short, professional schools can plan learning experiences for developing effective thinking, attitudes and interests.

This leads to consideration of the primary significance of motivation. Since the learner learns through his reactions, unless he can be involved in the situation, unless he can be guided to think, feel, and act in ways appropriate to the situation, it is not possible for him to learn. Practice alone, even when carried to unusual limits, does not take the place of the learner's being involved in what he is doing.

Organizing learning experiences

There are not only problems involved in the selection of learning experiences but also in their organisation. As the programmes of professional education have become more complex and involved larger staffs, they have become more disintegrated. Yet significant changes in behaviour, that is, fundamental learnings, require a long time to develop. It is necessary that what is learned this term builds upon what was learned last term, that what will be learned next year builds upon what is learned this year. This is sequence learning.

However, effective sequence is not simply a series of repetitions from one year to another. Rather, it includes variety in the learning experiences, so that each subsequent term emphasises the main things to be learned, but in varied contexts. In this way, ever broader and deeper learnings are achieved.

Furthermore, effective organization provides for relating one course to another and one field to another, which reinforces the learning in each course or field. This is done both by helping the student to use things learned in one course or field in another, and by helping him to perceive differences as well as similarities in the concepts, principles, attitudes and skills utilized in the various courses and fields. This is called curriculum integration.

Sequence and integration are essential to programmes of professional education, but because of the tendency towards specialization and separation, conscious efforts are required to plan for and develop effective organization.

One significant development in working out a better-organized curriculum is the building of a closer and more appropriate connection between theory and practice, between the art and the science of the profession. Many institutions are not only teaching general principles but also helping students to apply these principles to particular cases so that it is possible for them in practice to use the principles as they deal with particular cases. Effective professional education requires this close connection between theory and practice. Without theory, practice becomes chaotic, merely a collection of isolated, individual cases. Theory gives meaning and unity to what would otherwise be specific and isolated cases.

On the other hand, without practice, theory becomes mere speculation. The realities of practice provide a check upon pure speculation, a test of the adequacy of theory; and practice provides the problems which must be dealt with by any comprehensive theory. Hence these efforts to connect theory and practice more closely are important contributions to professional education.

Another illustration of this development is the increasing use of the case method. The case method involves the student in the study of a concrete and particular case. However, for him to understand this case and deal with it effectively, he must bring to bear the theory, the concepts and the principles that are basic to the issues raised by the case. The internship provides concrete experiences which are interpreted in terms of basic theory in the accompanying seminars. This shuttling back and forth between general and specific aspects of a profession helps to build an increasingly adequate context of concepts and principles by which a member of the profession can understand the operations to be performed in relation to the values to be attained. An adequate theory helps him to relate particular activities in an individual case to the larger social issues, to see the connection between the activities of the daily operations of the profession and the welfare of society generally.

However, for these types of educational programmes to be effective, more than superficial experience and explanation must be provided. The student needs many opportunities to deal with situations on the basis of a careful analysis of them, to identify the values and principles involved, and through practice to develop artistry in devising means to deal with the situation in order to preserve these values. This is the aim of efforts to knit theory and practice more closely together.

Another effort at extending the sequential organization of professional education is the working out of definite plans for continuing education after the member of the profession has completed pre-service training and has been inducted into the initial activities of his work. Fifty years ago medical schools felt that their work had been done when their graduates had been admitted to initial professional activity. As the years went by it became increasingly clear that many members of the profession did not grow after they began their work and that in some cases the older practitioner was much less competent than those currently beginning their profession. Few doctors made any effort to continue their education after graduation.

Now there is a marked tendency for professional schools to develop programmes of continuing education, in some cases bringing the work of the school to the practitioner in the field, in other cases setting up short courses, institutes, or long-term seminars for practitioners to take on the campus.

Evaluating effectiveness of educational programmes

The final attributes of professional education are those involved in the task of evaluating the effectiveness of the educational programme in attaining its objectives, through appraising the educational progress of the students. Four important attributes are too often neglected in current educational programmes.

The first of these is conducting an appraisal in terms of all of the important educational objectives of the professional school. The common practice is to appraise the knowledge of the students and certain of their technical skills. In addition, many professional schools appraise the students' ability to solve problems as these are presented in verbal form. Few institutions provide for careful, systematic appraisal of problem-solving in the professional situation, and appraisal of professional interests and attitudes. Hence the school does not have a comprehensive picture of the achievements of its students in terms of its own purposes.

A second attribute, often neglected, may partly account for the shortcomings in the first. A comprehensive programme of evaluation uses varied devices for obtaining evidence regarding the educational progress of students. These devices include not only written tests and examinations, useful as they are, but also observations, interviews, questionnaires, reports from the field and samples of the students' work; in short, any device which gives valid evidence regarding the significant behaviour of the students. Few professional schools consistently evaluate their effectiveness in such varied ways. They tend to limit their appraisal to written examinations and to rating forms. This does not provide adequate means for comprehensive evaluation.

Appraisal of the progress of students toward the objectives of professional education requires evaluation at several points in their career. This is a third essential attribute. To get evidence of progress requires at least three appraisals, one early in attendance at the professional school, one near graduation, and one after several years of service in the profession. Some schools attempt annual appraisals during the students' enrolment. The changes made while in the school throw light on the immediate effectiveness of the school's educational programme, while the appraisal after the students have spent several years in the profession provides evidence of the permanence of learning and the extent to which it has achieved some continuity with professional experience. Unfortunately these studies of progress are quite rare. This may be partly due to the lack of appreciation of the way in which systematic sampling of students and alumni is small enough to permit the use of individual interviews yet at the same time sufficiently representative to permit valid generalizations regarding the populations from which the samples were drawn.

The last attribute to be mentioned here is the use of evaluation in improving the educational programme as well as in providing information to guide work with individual students. Too often, what little appraisal of student achievement is conducted results only in grades for the students. Actually an evaluation programme can serve as a helpful means for continued improvement and development of the professional school. The results of appraisal indicate the respects in which students are making substantial progress and the respects in which expected development is not taking place. These suggest aspects of the educational programme which need re-thinking and re-planning to provide for improvement. Furthermore, as revisions are made in the programme, subsequent evaluation indicates the relative effectiveness of these revisions. Hence, appraisal provides a sound basis for planning.

The evaluation data also indicate the progress made by individual students and bring to attention both their strength and their difficulties. This information thus provides a sound basis for the guidance of individuals and gives a more substantial foundation for the individual student's continued planning of his own education.

In summary, the distinctive characteristics of a profession, namely its ethical code and its operating basis on principles, suggest the distinctive attributes of education for the profession. From these characteristics, important educational objectives can be derived. Because these objectives are complex and involve understanding, problem-solving, attitudes and skills, they require clear definition in order to develop effective methods for their attainment. The difficulty of attaining the goals of professional education makes motivation of prime importance and effective organization of learning experience a necessity. Finally, a comprehensive evaluation programme is required to guide the continued development and improvement of the educational programme and to provide information for constructive work with individual students. The building of an effective programme of education for a profession is not easy but when attacked intelligently, systematically, and enthusiastically, it can be done.

The author of the preceding pages* is Ralph W. Tyler. He obtained his doctor's degree from the University of Chicago in 1927... over 60 years ago! He wrote these lines in 1951... nearly half a century ago! yet his vision is still valid today and still remains to be acted upon.
For those concerned in curriculum planning this clearly means that the order of the day is patience and perseverance.

* The paper was presented on 30 January 1952, in New York at the Annual Meeting of the American Association of Schools of Social Work and printed in the Social Work Journal, April 1952.

A programme describes

3.11

a series of planned educational activities a student is to go through with the assistance of teachers

Integration (of a curriculum)

coordination of different teaching/learning activities to ensure the harmonious functioning of the educational process for more effective training

The four c's of curriculum planning

3.12

cooperative

A programme prepared jointly by a group of persons will be less liable to error than one prepared by a single person.

continuous

The preparation of a programme is not a one-shot operation. In planning it, provision should be made for its continuing revision.

comprehensive

In an approach which accepts the interaction of all the programme components, each must be defined with the requisite precision.

concrete

General and abstract considerations are not a sufficient basis for drawing up a programme. Concrete professional tasks must constitute the essential structure of a relevant programme.

adapted from E. Krug

Plan of action for preparation of an educational programme

3.13

Chronological order

Definition of objective

Executing body

Advisory body

1

Prospective study to evaluate the country's requirements (quantitative and qualitative) in respect of health personnel, taking into account what is available and can be absorbed

Ministries of Planning, Health, Education, etc.

University staff, national and international experts

2

Definition of the educational objectives of the school of health sciences in accordance with the tasks to be accomplished by each professional health worker (professional profile)

Ministries of Education and Health

Special commission of educators and practitioners

3

Organization of an information group on education planning for health sciences

Faculty staff

Faculty of Education, education consultant

4

Acceptance by the faculty staff of the goals established in the light of the country's requirements; training of teachers in education planning

5

Development of a system of evaluation:
formative and certifying evaluation;
programme evaluation;
evaluation of human resources and learning materials.

Evaluation committee

Department of Education, education consultant

6

Modification of programme and selection of methods by which to attain the goals

Programme committee

Faculty of Education, education consultant

7

Organization of a group for research in education

Faculty staff

Faculty of Education

8

Periodic re-evaluation of goals and methods in response to changes in the country's needs and in the light of evaluation

Ministries of Planning, Health, Education, etc.

University staff, national and international experts

Personal notes

3.14

Diagram showing factors influencing curriculum design

3.15

The purpose of teaching is to facilitate learning1

¹ Adapted from Norman Mackenzie et al. Teaching and learning. Paris, UNESCO, 1970, pp. 44-50.

3.16

The literature on the philosophy of education is rich in theories, which tell a story of timid steps forward, backward leaps and rediscoveries. It would be very gratifying to have a reliable general theory, firmly seated on a scientific basis and making proper allowance for social variables, which could serve as a guide for every teacher and enable him to resolve the “real” problems of teaching the health professions. Unfortunately, such a universally satisfactory general theory does not exist. On the other hand, by means of the systematic approach suggested, hypotheses can be formulated regarding the process of acquiring a satisfactory level of performance that can be evaluated empirically and the choice of learning activities facilitated.

The contemporary trend is to stress the “teaching-learning system” as opposed to the preponderance previously given to teaching alone. There is a tendency to be interested less in teaching than in learning, less in what the teacher presents and more in what the student learns. Lawrence M. Stolurow has criticized what he calls the “communication-learning fallacy” which assumes that the information transmitted to the student is always learned. This is obviously fallacious, and known to be so when it is expressed so crudely, but discussions of teaching methods are often still inspired by it and it has even been carried over into the initial stages of research into new methods. Much of this research, by concentrating on problems of the presentation of stimulating materials and utilizing some of the more rudimentary concepts of communications theory, dealt too much with the manner in which information was transmitted to the student without investigating very closely what was learned and by whom, at what speed and, in particular, for what purpose. Understandably, this approach led to a passive attitude towards students' response; the student was seen in a dependent situation, relying upon information directed at him, whether through modern audiovisual communication techniques or the more traditional forms of the lecture and the textbook.

Learning, however, is a dynamic and interactive process in which the behaviour and experience of the student are vital components; the student must not only receive but also contribute; his perception of what is happening is just as important as the perception of his teachers and the assessment he makes of the value of a learning activity may be more relevant than that of his examiners. Good conventional teaching, of course, has always sought to take account of the learner, but its structure and methods have greatly inhibited it. The rigid style imposed by large numbers, timetable requirements and the availability of teaching space, by the conventional practices in designing courses and by teaching conforming to an accepted academic discipline, have led to the “teaching” aspect again dominating over the “learning” aspect. If it is accepted that the starting-point must be the acquisition of knowledge rather than its communication then we must ask some different questions and intensify our investigation of non-directive methods. Using the same approach as Jerome S. Bruner we can consider what experiences will motivate the student and enable him to learn, in what ways knowledge can best be structured for a given student or group of students, what sequence and in what form the material can be presented most effectively, what should be the nature and the frequency of rewards or penalties, and how we can gradually lead a student to give less thought to extrinsic rewards than to the personal satisfaction of having achieved a desired degree of skill.

The body of knowledge possessed by a group of teachers or set out in a series of authoritative volumes is the fruit of intense intellectual activity. Teaching a so-called basic science is not a matter of getting the student to memorize it, but rather of helping him to participate in a process that renders the acquisition of a body of knowledge possible. A subject is taught not to produce little living libraries on that subject but rather to get the student to think for himself in accordance with the laws of physics, to consider problems from the same angle as the biologist and to assimilate the process of acquiring knowledge. Knowing is a process, not a product.

If the revision and renewal of the programme are regarded as part of the teaching-learning process, a change must also occur in the roles and interrelationships of teachers, students and others who are concerned. The system becomes much more complex than the conventional linear model and it demands much more from those who have to design, manage and operate it. To put it epigrammatically, the teacher becomes a learner himself, and the learner undertakes some part of the teaching role. This is because the teacher learns more about teaching and the student begins to assume a greater responsibility for his own progress. The roles of other participants also change and new roles must be added to the old. Some of the new methods at present under trial, for instance, not only require librarians to emerge from their traditional sphere into a more dynamic type of activity; they also call for the services of highly qualified personnel, such as artists, photographers and technicians, as well as educational technologists and psychologists. In fact, the ecology of a teaching institution changes once its primary function is redefined, namely to facilitate the acquisition of competence by the student.

In the following pages a certain number of definitions, epigrams and lists are proposed whose aim is to serve, where appropriate, as a starting-point for reflections or discussions on the methodology of education. These elementary concepts are derived from various systems, and none of them is regarded as embodying an absolute and final truth.

Always assume that a teaching activity is ineffective unless there is evidence to the contrary.
Adapted from A.L. Cochrane

Teaching

3.18

Interactions between teacher and student under the teacher's responsibility in order to bring about expected changes in the student's behaviour.

Purposes of teaching

3.19

to help students to

acquire, retain and be able to use knowledge
understand, analyse, synthesize and evaluate
achieve skills
establish habits
develop attitudes

all of which correspond to the
Professional Profile

teaching approaches

3.20

talk to students
talk with students
have them talk together
show students how
supervise them
provide opportunities for practice

S. Abrahamson

Teaching methods which place the student in an active situation for learning are more likely to be effective than those which do not.
G.E. Miller
3.21

The activities composing a training programme must be organized so that students can acquire their professional skills under conditions similar to those in which they will later practise.
3.22

If only ideal or model learning situations are used, the student will be deprived of the stimulus of having to face realities and will have less opportunity to propose improvements with the help of his fellow students and his teachers.

Learning is both an emotional and an intellectual process.

Learning
A process resulting in some modification, relatively permanent, of the way of thinking, feeling, doing, of the learner.
3.23

The characteristics of learning

3.24

learning is

producing a behavioural change in the learner
leading to a relatively permanent change that is also gradual, adaptable and selective
resulting from practice, repetitions and experience
not directly observable

Some principles of learning

3.25

learning is individual
motivation is the key
relevance of learning experience should be clear to the student¹
“feedback” to learner is important

¹ See paragraph 2, page 2.13.

Conditions to facilitate learning

3.26

An atmosphere which

encourages people to be active
emphasizes the personal nature of learning
accepts that difference is desirable
recognizes people's right to make mistakes
tolerates imperfection
encourages openness of mind and trust in self
makes people feel respected and accepted
facilitates discovery
puts emphasis on self-evaluation in cooperation
permits confrontation of ideas

Pine, G.J. & Horne, P.J. Principles and Conditions for Learning in Adult Education - Adult Leadership. October, 1969.

Learning

3.27

is primarily controlled by the learner¹
is unique and individual
is affected by the total state of the learner
is cooperative and collaborative
is an evolutionary process
is a consequence of experience
is not directly observable

¹ Teachers are sometimes heard to say that young students lack the necessary maturity to take on this responsibility. They might be reminded that these “young” students are legally adults, even if many adults lack the “necessary” maturity.

Pine, G.J. & Home, P.J. (ibid.)

They might also be reminded of article 12 of the United Nations Convention on the Rights of the Child: “States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child... [and]... the opportunity to be heard in any judicial and administrative proceedings affecting the child”.

... so, why should a student be treated less well?

Personal notes

3.28

Almost everything that any health professional will have to learn in the forty years or more of professional life after initial training will be learned by self-learning.

EXERCISE

3.29

1. Complete in less than five lines the following sentence:

“I learn best when I ________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________”

2. Ask several of your colleagues to do the same exercise; make a list of all the situations.¹

¹ Compare your list with the list on the next page.

3. Note the diversity of situations and compare it with those provided for students by the educational institution to which you belong.

In the educational institution to which I belong, the following learning situations are provided for students:
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________

4. If the comparison shows that changes are needed in your institution, read the following pages which describe the teacher's functions, and do the exercise on page 3.37.

I learn best when I...

3.30

- know what my goals are
- am motivated by the relevance of these goals to my personal/professional needs
- work in a small tutorial group
- can alternate between personal study and work in a small tutorial group
- am in an active situation, with responsibility and a specific objective
- am in a good environment (calm, good staff/student relations, competent teaching staff, lively atmosphere)
- am able to work at my own pace
- am able to put what I have just learned into practice (repetition)
- team by the problem-based method
- have opportunities for formative self-evaluation and critical review by others (peer criticism)
- am exposed to different types of stimulation (visual, extended listening summary review)
- face the challenge of (valid) certifying evaluation
- know that I shall have to inform/instruct others
- am able to have outside contacts (travel, congresses, etc.)

List made by participants in workshops.

Teaching: a complex but challenging task

3.31

The teaching of health personnel has become more complex than it used to be, especially if it is accepted that the teacher should consider the benefit of the learner and not only his own satisfaction. More than a dozen of the teacher's functions are described below. A teacher should feel satisfied if he fulfils only a few of them, because the present educational environment does not greatly help him along this road. Nevertheless, he will do well to improve his performance by training as an educator.

It is sometimes thought that a teacher's activities are so intricately related to the local culture in which he functions that the description of his tasks should differ if he teaches in Antwerp, Dar-es-Salaam or Moscow. However, there is no support for this concept in reality. Data concerning teachers' behaviour during teacher training workshops organized by the World Health Organization over the last 10 years with participants from a great variety of geographical or sociopolitical backgrounds clearly indicate that teachers are more like each other than they are like the people of the community to which they belong. The worldwide academic community seems to be one cohesive entity modelled on nineteenth century western European concepts of academic freedom, exclusiveness and detachment.

Most teachers in schools for health personnel conduct scientific research, write reports and articles, plan and supervise laboratory or clinical units and, finally, teach, in that order of priority. To teach means, in most instances, to prepare and deliver lectures, to supervise students during laboratory and clinical work, to decide which questions should be asked at examinations, and to score papers and oral examinations. Added to all this is attendance at numerous scientific or administrative meetings.

Instructional duties are sometimes called “teaching load”, an expression which clearly conveys the attitude to that function. Teaching staff are jokingly depicted as secretly believing that academic life would be much easier if there were no students. As in all jokes, there is much truth in this.

Some teachers are seldom seen by students while others spend many pleasant hours in stimulating discussion with their students.

Rather than pursue this description, in which no teacher would ever want to recognize himself, let us consider what are the teacher's functions in the light of present-day educational concepts.

1. To be available

The teacher should be available to give students constructive criticism of their working objectives and methods. The key-word here is “available”. It constrasts sharply with the habit of the traditional academician who proclaims “I am always happy to meet students ... my door is always open”, but who, in fact, is so rarely in his office that only very stubborn and highly motivated students manage to catch him once he has left the lecture hall. Really available is the professor who has a notice on his office door saying “I am at the disposal of students in this office every Tuesday and Friday from 10 a.m. to 12 a.m.”, and who is actually there at those times.

2. To provide constructive criticism of the student's learning objectives and working methods

It is of the utmost importance that the student's working objectives and methods should be exposed to constructive criticism as, after training, health personnel should be able to relate their own professional goals to the organized system of health care, and to develop their own tactics for achieving those goals.

It is also important to develop the student's desire to seek criticism, supervision and advice from teachers and fellow-students.

3. To analyse and evaluate health problems

Generally speaking, clinical teachers are able to guide students in solving patients' particular problems, but students should also collect and use relevant information for the solution of community health problems. It is less certain that all teachers have enough understanding of epidemiology and of health manpower planning principles and methods to assist students in that respect. This is especially true of teachers of the so-called basic science subjects.

It would be an advantage if all teachers had sufficient competence to ensure that whatever they teach is relevant to the community. The teacher should be able to analyse and evaluate health problems raised by students, as well as proposed solutions.

4. To define learning objectives

The teacher should be able to define the abilities that students need to acquire in order to solve a given health problem. For example, a teacher should be able to define explicit and relevant learning objectives so as to help students to understand a problem. Moreover, when programmes are being constructed, it is preferable to indicate clearly the standard of performance to be acquired by students than to state only the amount of time to be spent teaching the subject. It is well known that the time needed to master a subject varies from student to student depending on ability, motivation and drive, and on the availability of teachers and educational facilities. What is important for the average person is not the length of time during which teachers teach or students learn, but the ability of the person providing health care to perform a given task. If my son needs a hernia operation, I do not wish to be told that the surgeon has graduated from a six-year course in an institution in the World Directory of Medical Schools. What I want to know is whether he is competent to perform that operation in the best and safest way. As for the nurse who will comfort him in this strange and frightening hospital world, I do not care whether she has had 72 hours in a psychology course as long as she is able to give him the reassurance he may need.

5. To assess students' work

The teacher should be able to define criteria for assessing students' work and measuring their abilities. Such criteria need to be carefully drawn up, and teachers should share the task of preparing them with their students. The sad state of most examination systems in faculties and schools is largely the result of the absence of such criteria, which could serve not only for certification purposes but also in guiding the students' learning, a point that is certainly no less important. Everybody in the health professions should cultivate this ability to define criteria, as it is essential that they should be able to audit their own performance and that of their colleagues.

6. To prepare learning aids

The teacher should prepare learning aids and materials, provide information that will facilitate students' independent work, and evaluate the usefulness of such materials. Most of what is usually transmitted by traditional lecture courses could be better acquired by students working independently and studying books, scientific journals and duplicated texts in self-learning format, with or without audiovisual aids. In such cases, students should be aware of related learning objectives, and feedback evaluation exercises, based on those objectives, should be available.

The preparation of such materials may well be a joint effort among colleagues from several faculties. It calls for a lot of work, but may be considered as an investment that will pay off during several years through setting up banks. It should help to eliminate passive learning which is often all that is required of students. The assessment of the usefulness of such materials, which requires a level of educational competence some teachers do not yet have, may call for the collaboration of specialists in education.

7. To select professional activities for students

The teacher should select professional activities of graded difficulty appropriate to the student's level of progress during the whole of his learning curriculum. There is agreement among professional educators that students should acquire professional competence through the practice of real (or, if that is not possible, simulated) professional activities. Even students fresh from secondary school are perfectly capable of drawing valuable lessons from the study of real cases.

8. To confront students with new problems

The teacher should confront students with a diversity of new problems in order to help them define the terms of the problems and find solutions to them. If it is true that the estimated half-life of medical knowledge is about five years, and it is slowly but constantly shrinking, it is essential that today's graduates, among whom are tomorrow's leaders of health services, should be able to solve the new problems that arise in new situations. It is here that the basic sciences have an important role to play as they can help the student to acquire a scientific method of inquiry. Such an approach is essential to keep knowledge and skills up to date. The fact that the graduate will have to replace much of what he knows is the least part of the problem; the main difficulty is that we, the teachers, do not know which half.

9. To develop problem-solving skills

The teacher should facilitate students' learning by asking questions requiring problem-solving skills rather than simple recall of facts. Even the most traditional teacher will agree that students must acquire basic skills, either manual (e.g. inserting an intravenous drip) or intellectual (e.g. taking a history), should behave in an appropriate manner with the patient and his family, and should not merely possess theoretical knowledge.

In spite of this, whenever the final examinations used in faculties and schools are analysed, it is found that a majority of the questions test only simple recall and not the intellectual skill of interpreting data and solving problems. No attempt is made to measure practical skills and attitudes. The fact that most examinations require students to recall facts without recourse to books is highly significant. Of course, health personnel must possess a large amount of knowledge that they can call upon without reference to books, otherwise their usefulness in an emergency situation would be seriously impaired.

Teachers should therefore test students on their ability to recall those facts that will be needed immediately in emergencies and have been clearly specified as such from the start. Apart from this, examinations should confront students with typical individual or community health problems and allow them access to books, in accordance with the sound practice adopted in everyday professional life.

10. To aid the understanding of basic scientific principles

The teacher should endeavour to ensure that students understand the basic principles underlying the activities and tasks they are learning to master. Factual details can be readily added to an understanding of basic principles and concepts, but such principles are not easily derived from a mass of facts. Students usually learn the so-called basic sciences early in the curriculum before they have met the real-life problems which require an understanding of those subjects. They are thus poorly motivated and soon forget what they have learned. It has repeatedly been found that students tested 18 to 24 months after having followed a basic sciences course answered at random, just as if they had never studied the subject.

11. To supervise the student's progress

The teacher should check each step the student takes in solving health problems in order to discover the areas where he fails to take account of the relevant basic scientific principles. This role follows naturally from the previous one. As mentioned above, in the traditional curriculum, students are taught basic sciences in the first two or three years. Ideally, a student should be helped to reach an acceptable solution to problems through his understanding of the principles of the basic sciences and by adopting a scientific approach. One of the persons best qualified to judge whether the student is thinking in a scientific manner is the basic sciences teacher. In the training of a nurse or of a general practitioner, for example, the role of the basic sciences teacher is not to instruct in a given subject but to ensure that the nurse and the physician are capable of applying basic scientific principles in their daily work.

A physiologist could spend two hours a week in a ward or an outpatient clinic with his students, going through the medical records of current patients to check whether basic principles had been adhered to, and draw the students' attention to unsatisfactory examples. Such an association between basic sciences and clinical activities would be of greater value than the present so-called integrated forms of teaching in which teams or panels of teachers endeavour to teach in a coordinated manner.

12. To identify the factors underlying health problems

The teacher should make sure that the student identifies and takes account of the psychological, cultural and socioeconomic factors underlying the health problems with which he deals.

In practice, there is no natural frontier between the physical sciences and the humanities, nor between sciences and art in the broadest sense of the words. Giving courses in the humanities and the behavioural sciences does not automatically ensure that future health workers will be able to relate their daily activity to the culture to which they belong. They are more likely to do so if they are required in practice to define the patient's social and psychological problems in relation to his health problems, and to seek solutions, with the help of suitable specialists.

13. To encourage intellectual discipline

The teacher should encourage intellectual discipline by observing students' work and evaluating their activities in relation to defined standards of quality of care.

Both teachers and students pass much time, more or less usefully, in large lecture halls. A better distribution and use of teachers' time, and the practice of peer-teaching to enliven the course, could improve both the quantity and the quality of the instruction given and allow for more individualized supervision.

The quality and satisfactory performance of learning should be the only yardstick or criterion used by the teacher, to the exclusion of the time constant (“the duration of the curriculum is six academic years”). What should vary is the number of different types of task that any given kind of health professional can perform. Every member of the health team, and the physician most of all, is a potent therapeutic agent but a poorly tested one. The least toxic medication listed in The International Pharmacopoeia has undergone more thorough double-blind testing than any health professional anywhere, at any time. Cigarettes are sold with a printed health warning. Does not the university have a social duty to protect all citizens from the potential danger that physicians and the other members of the health team may represent?

14. To set an example

Finally, the teacher should serve as a model of professional conscientiousness, reliability, analytical sense and efficiency. We have all met such people in the course of our studies. We have also met the other kind. We tried to imitate the former and sometimes despised the latter. In connection with students' values and personality, the following quotation from the American Association of Medical Colleges Longitudinal Study, reported by E.B. Hutchins (1964), should be remembered. Describing the effects on students of their years of study, Hutchins says “... the interest in understanding how others feel about problems or the need to place one's self in another's shoes ... has, on the average, decreased”. To a potential patient, this statement is very disturbing. If it reflects a widespread reality, the cause could lie in the example that has been set.

Conclusions

Nostalgic remarks are often heard about the good old days before professional educators had begun to invade the educational black box. One could then lecture and enjoy the feeling of satisfaction any good teacher has the right to expect. Nowadays, teaching is somewhat more complex, especially if the idea is accepted that it should be for the benefit of the learner and not only for the satisfaction of the teacher. Some teachers have already undertaken some of the functions described in this paper. They may feel satisfied even if they fulfil only a few, as the present educational environment is of no great help to their efforts in that direction. The conclusion must be that, despite all that has been achieved in the field of teacher training, much still remains to be done. Some have more gift for teaching than others, but all have the possibility of improving their performance by training as educators, even though such courses are still too seldom sought after and too seldom available.

How many teachers are really prepared to have students reach conclusions different from their own, giving first consideration to the logic of reasoning rather than the ability to arrive at a predetermined solution?
The student body represents the largest untapped educational resource in most schools.
G.E. Miller (1977)

Personal notes

EXERCISE

3.37

Read, or reread, carefully the description of the teacher's function (pp. 3.31-3.35) and circle the numbers of those that you believe yourself able to perform in your present situation taking into account the university regulations and any other local constraints. For each function, describe the precise activities that you personally will be able to start or continue during the 12 months to come.

Function no.

Description of precise activities for each function

Teaching techniques

3.39

The Handbook does not give detailed descriptions of the different teaching techniques employed in centres for training health personnel. This is intentional, for an abundant literature is available on these subjects to which the reader is referred (see references). Another reason is that the main purpose has been to stress the relevant aim of the teaching (whence the almost obsessional insistence on the need to define relevant educational objectives-) (chapter 1) and on the means for checking if and how these aims have been achieved (chapters 2 and 4). The problem is not merely one of communicating better (this is the subject of chapter 3) but of better communicating a relevant message.

For details concerning teaching techniques, lectures, seminars, tutorials, practicals, programmed learning, etc., the reader should refer to the specialized publications (see bibliography, page 7.01). The following are also suggested as useful reference documents:

The lecture method of instruction - Eileen Bughman, Public Health Papers No. 52, WHO, pp. 57 - 63.

Audiovisual aids to learning - E.B. Penta and T.V. Telder, Public Health Papers No. 52, WHO, pp. 40 - 51.

The selection of teaching/learning materials in health sciences education. WHO Technical Report Series, No. 538.

Audiovisual media in medical teaching - M.A.C. Dowling, Public Health Papers No. 47, WHO, pp. 53 - 78.

Group techniques in education, UNESCO, Educational Studies and Documents Series, No. 24, Paris, 1977.

As a teaching technique workshops are certainly very useful and efficient. For details see chapter 5.

The teacher's role is to encourage the desire to learn rather than the desire to know.

Advantages and disadvantages of certain teaching methods and of different educational media

3.40

Advantages

Disadvantages

1. Lectures

1. Apparent saving of time (for the teacher) and resources.
2. Presence of the teacher (showmanship).
3. Covers a large group of students.
4. Gives a feeling of security.

1. Keeps the student in a passive situation.
2. Does not facilitate learning how to solve problems.
3. Offers hardly any possibility of checking learning progress.
4. Does not allow for individual pace of learning.
5. Low receptivity.

2. Small group activities and workshops (see also Chapter 5)

1. Permits a teacher/student dialogue (thanks to the availability of the teacher).
2. Facilitates evaluation.

1. High costs in personnel and time (unless peer-teaching is used).

3. Demonstrations

1. The teacher is present (showmanship).
2. Gives a feeling of security.
3. Develops the quality of observation.
4. Ensures closer contact with concrete problems.
5. Facilitates the acquisition of practical, intellectual and communication skills.
6. Presents reality, not substitutes.
7. Enables logical step-by-step presentation.
8. Is attention-catching.
9. Demonstrates the right way of doing a (complex) task.
10. Presented facing the audience.
11. Allows students to ask questions.
12. Limits damage to equipment and material when students do practical work afterwards.

1. Number of students is limited.
2. Keeps the students in a passive situation (except for observation).
3. Offers little possibility of checking the learning process.
4. Does not allow for individual paces of learning.
5. High cost in personnel and time.
6. Difficulty in repeating the demonstration in order to acquire competence.

4. Practical work 5. Bedside teaching 6. Field work

1. Puts the student in an active situation.
2. Permits evaluation of degree to which educational objectives (practical and communication skills) have been attained.
3. Develops qualities of observation and decision-taking.
4. Ensures closer contact with reality (professional, health situation of country, colleagues and teachers).
5. Permits comparison between practice and theory.
6. Enables student to develop self-confidence.
7. Increases diversity.

1. High personnel, transport and material costs.
2. Covers a limited group of students.
3. Sometimes puts the patient in a difficult situation.
4. Poor standardization.
5. Narrow limits of utilization, therefore requiring careful planning.

7. Books, handouts, programmed learning from books, and simulation (self-learning packages).

1. Enables student to work at his own pace.
2. Facilitates self-evaluation.
3. Makes mass teaching possible with high efficiency.
4. High availability.
5. Facilitates decision-taking (solution of complex problems).
6. Reduces risks (for patient or society).
7. Avoids bias transmitted by “bad teachers”.
8. Allows a good teacher to save time that can then be spent on more complex activities such as interpersonal relations.
9. Can be kept up to date with new scientific developments and contain references to other documents.

1. Necessitates special educational competence.
2. High additional investment costs (in teachers' time and money).
3. No group dynamics.

8. Role playing

1. Students have an opportunity, in a controlled situation, to develop real communication skills and obtain constructive feedback from peers and teachers.
2. Helps students through emotion-laden situations. Provides them with opportunity to be in somebody else's role and develop empathy and understanding.

1. Time-consuming and strongly dependent on student's imagination.

9. Real objects and specimens

1. Presents reality, not substitutes.
2. Three-dimensional.
3. Permits use of all senses in study.

1. May not be easily obtainable.
2. Inconvenience of size - danger in use.
3. Costly or not expendable.
4. Usually only usable in small groups.
5. Sometimes easily damaged.
6. Problems of storage.

10. Models and simulation devices

1. Three-dimensional; concept of reality.
2. Size allows close examination.
3. Good for magnified situation. (e.g. middle ear mechanism).
4. Can be used to demonstrate function as well as construction.
5. Can permit learning and practice of different technique.
6. Some can be made with local material.

1. Craftsmanship required for local construction.
2. Simulation models often expensive.
3. Usable for small groups.
4. Models often easily damaged.
5. Never same as performing technique on a patient. Beware of faulty learning.

11. Graphics (charts, diagrams, schematic drawings), posters, paintings, photographic prints

1. Promotes correlation of information.
2. Assists organization of material.
3. Photographs nearer to reality than drawings, but association often valuable.
4. Usually easily produced and duplicated (black and white photos).
5. Easy to store, catalogue and retrieve.

1. For small audiences only (unless projected with epidiascope).
2. For effective use, good duplicating equipment and trained staff needed.

12. Blackboard or flipchart

1. Inexpensive, can be made locally.
2. Usable for wide range of graphic representation.
3. Allows step-by-step build up, or organization of structure or concept.

1. Back to audience.
2. Audience limited to 50 or so.
3. Careful drawings erased, not preserved for future use, except in the case of flipcharts.
4. Considerable skill required for effective use (rarely taught to teachers).

13. Flannelboard (flannelgraph) and magnetic board

1. May be used repeatedly.
2. Usually preparable from locally available materials.
3. Good for showing changing relationships.
4. Holds attention if well used.
5. Very suitable for group participation.

1. For limited audience only (25).
2. The instructor needs good skills to use this technique convincingly.

14. Visualized discussion (on cards)

1. Helps to visualize the opinions of a large group of persons.
2. Gives everyone an equal chance to present a point of view.
3. Provides anonymity and is “democratic”.
4. Facilitates the grouping together of opinions.
5. Encourages explicitness and conciseness.

1. Requires specific equipment.
2. Considerable skills required from instructor for effective use.

Projectable Media

15. Still pictures - opaque projection (epidiascope)

1. Enlargement of drawn or printed materials for large audiences.
2. No need for producing slides and transparencies.
3. Enlarged image may be transferred to chart or blackboard for copying.
4. Small objects and specimens may be projected.

1. Demands total darkness for clear projection (except with very expensive models).
2. Bulky machine, difficult to transport.
3. Electricity required.

16. Transparencies for overhead projection

1. Projectable in full daylight to large audiences.
2. Presented facing audience.
3. Relatively easy to prepare with local materials.
4. Subjects can be drawn in advance or developed by stages with the group.
5. Can demonstrate movements, processes, etc. with transparent or coloured perspex models.

1. Electricity required.
2. Equipment and materials for making sophisticated transparencies expensive.
3. Not usually suitable for photographic material due to cost (although adaptor available to take 35 mm slides).
4. Usually restricted to teacher use, as it is not easy to adapt for the learner to use.

17. Slides and Filmstrips

1. Suitable for large audiences.
2. Relatively easy production and (in black and white) reproduction.
3. Cheapest current forms of visual medium.
4. Easily adaptable to self-learning packages.
5. Equipment available for viewing or projection without electricity source (battery only).

1. Fixed order of frames in filmstrip restrictive in use.
2. Need partial darkness for viewing unless rear screen or daylight screen used.
3. Duplication of colour slides expensive (even impossible in many countries).

18. Microfiches

1. Easy storage and cataloguing of large numbers of visuals.
2. Exchange of information on available collections.
3. Very cheap per image if projection can be assured for large groups.
4. Small and light for easy despatch.

1. Too small for clear naked-eye viewing.
2. Although inexpensive equipment available for individual use, large group projection equipment not readily available.

19. Films (8 mm and 16 mm)

1. Close to reality with movement and sound.
2. Suitable for large audiences (16 mm); for small groups only (8 mm).
3. Compression of time and space.
4. Emotive, can develop attitudes, pose problems, demonstrate skills.
5. 8 mm loops useful for individual instruction.
6. Good learning source if preceded by teacher's introduction and followed by discussion.

1. Does not permit self-pacing.
2. Films costly and difficult to produce.
3. Individual films relatively expensive.
4. Electricity required.
5. Equipment difficult to transport.
6. Darkness needed for viewing (except rear screen use).
7. Imported film may contain inappropriate information (see item in advantage 6).

20. Open-circuit television

1. Adaptable to large and small audiences in widely distributed area.
2. Capable of gaining and maintaining attention.
3. Can stimulate emotions, build attitudes and develop problems.
4. Can conserve resources of instructors by simultaneous broadcast to many classes.

1. Programme expensive to produce and demands highly skilled staff.
2. Receiving equipment expensive and difficult to maintain.
3. Electricity required.
4. No immediate interaction or feedback.
5. Learner must adapt to a set programme with no possibility of repeats

21. Closed-circuit television and videotapes (including videocassettes and videodiscs)

1. Adaptable to medium and small audiences.
2. Videotape repeatable to fit learning schedules.
3. Film advantages 1, 3 and 4 apply (see above).
4. Valuable for magnification of image, recording intimate situations, micro-teaching, recording of developments in clinical syndromes or in scientific experiments “bringing the village into the classroom”, recording emergencies, etc.
5. Portable equipment can function on battery for field recording.

1. High initial cost of production equipment, and requirement of trained staff.
2. Electricity required. Although portable equipment works off battery, this needs charging from power source.
3. Receivers are expensive and require maintenance.

Sound media

22. Radio broadcasts

1. Adaptable to large and small audiences in widely separated areas.
2. Conserves resources of instructors by broadcasting simultaneously to many classes.
3. Capable of gaining and maintaining attention.
4. Reception equipment relatively cheap and will function on batteries.
5. If combined with prepared materials (radiovision) can be improved learning tool.

1. Special studio facilities and staff required for broadcast (less expensive and complex than television).
2. Learners must adapt to fixed schedule, not other way round.
3. No immediate feedback and no audience interaction.

23. Sound recordings

1. Adaptable to any size of audience.
2. Especially suited to individual and small group learning.
3. Because of stop and playback facilities of tape, can be student-paced.
4. Cheap, battery-operated cassette players available, and cassettes relatively cheap.
5. Many uses - to provide sound for slide sequences, for micro-teaching, heart sounds, for posing problems, etc.

1. Use for individual learning demands many playback units.
2. Good quality recording demands studio facilities.

Computers

24. Computer-assisted education

1. Large amounts of educational materials can be stored in a highly concentrated form.
2. Interactive retrieval and use of information.
3. Particularly suitable for problem-solving and programmed examination.
4. Allows students to learn at their own pace.
5. May be adapted for both individual and group learning.

1. Preparation of the programme is time-consuming and sometimes expensive.
2. Microcomputers are expensive to buy, use and maintain.
3. Electricity required.

... and do not forget that formative evaluation is also a teaching method.

... and of course the INTERNET! (Unfortunately the author is of the wrong age group to help you with this; better ask your children.)

Certain pages of the Handbook are printed in large type and can be used as matrices if you should wish to make your own transparencies for projection using an overhead projector. There are different methods, depending on the photocopying equipment available. In general, all you need to do is to place a sheet of transparent, thermosensitive acetate film on top of the Handbook matrix¹ and put the whole in the photocopying machine. In a few seconds you will have a transparency ready to be projected on your overhead projector.
Please follow the instructions applying to the particular photocopying machine available to you.

¹ You can obtain them by removing the binding from the Handbook and placing the sheets in a ring file.

Why problem-based learning (PBL)?

3.47

If we look at what happens in most of the institutions that train health personnel, the main feature seems to be large groups of students (more than 30 and sometimes several hundred) under the authority of a teacher who transmits information to them orally on a particular discipline; the students are in a passive situation, their only activity being to take notes, the quality of which is only indirectly verified by the teachers through examinations where the students are usually required to set down in writing, for each different discipline, the information that has been transmitted to them by the teachers.

If we look at the health professions, however, they are characterized by their complexity and require practical skills, dialogue in a climate of confidence and respect, and the integrated application of different types of information and knowledge from many different disciplines, while all health professionals often have to find solutions to health problems that require the collaboration of other health personnel.

We also know that advances in science are expanding the scope of knowledge at an ever-increasing pace, so that it is no longer possible to teach everything or learn everything; we therefore need to learn how to learn what we need in order to deal with each problem as it appears.

Society thus needs to be able to count on successive generations of graduates who have acquired the skills to find and implement solutions to unforeseen and often complex problems with which they are not familiar, and are able to assemble and make effective use of the resources that are needed to resolve them.

Throughout the educational programme, the role of teachers must therefore be to encourage students to find and make effective use of the resources they need to carry out their professional tasks, in order to resolve the health problems of the individuals and groups of the community they will be serving as members of the health professions.

The aim to be achieved is to help students in the course of their studies to become the architects of their own education, which will enable them to go on learning through out the 30 or 40 years of their professional life so as to continue to be able to resolve health problems effectively.

A problem to be resolved is not really a problem until a health worker does not have the competence to cope with it, starting with the ability to formulate the problem; formulation is the first and fundamental step in the overall process of problem-solving.

The role of teachers is therefore to plan learning activities so as to give students the opportunity and desire to formulate the problems identified from different health situations.

Thus it will not suffice to give students pre-constructed problems and/or problems selected by the teachers and to ask them to solve them with the help of whatever basic sciences have been judged to be important and taught by the teachers of the various disciplines. But this is what is being done in most establishments. One reason for this is that the new approach advocated would be too time-consuming, eludes any traditional form of control and raises all the worries of uncertainty: “God only knows what kind of problems students would formulate if left to themselves”.

But there is no question of students being left to themselves during the period of their training, even though they are indeed going to be left to themselves afterwards, and for very much longer.

The argument that it would take too long would be true if every student were to formulate all the problems it is possible to formulate today. But as it is not possible to teach everything (which is admitted by teachers, even though they regret this so much that they still try to do so), teachers must help students to master the ability to formulate a problem. This is a constant among the aims to be achieved, whereas the timing and content of knowledge can only be variables.

We must once again stress that it is the role of teachers to ensure that students are given the opportunities to identify the health problems that are important, to develop explicit objectives (professional profile), and to formulate problems and resolve them successfully.

Programmes of study should therefore set aside sufficient time for personal study to enable students to prepare themselves through observation, reflection and reading to meet with tutors in small groups to continue their analysis of problems of common interest. The role of the tutor is not then to be an expert on the problem of the day, but to facilitate discussion and promote interaction within the group. At the outset of their studies, as students have been conditioned by the traditional approach to wait upon the wisdom of their teachers, the tutor's role will be to ensure, by asking questions and not by giving answers, that the students explore the areas of knowledge relevant to the problem selected. As the programme proceeds (and experience shows that this stage is soon reached), the students become capable of identifying the information they need more or less unaided. The evaluation process allows this to be verified.

With the help of the teachers and a method of work that teaches them to learn how to learn, the students thus arrive at an active and responsible attitude based on the confidence that they will be able to rely on their own resources to resolve the health problems they will encounter in the course of their professional life.

There are certain fundamental principles that are essential to this approach.

One of these principles is “learner-centred education” (refer back to definition on page 1.79).

Learner-centred education¹

¹ Adapted from Barrows, H.S. & Tamblyn, R.M. (1980) Problem-based learning: an approach to medical education. New York, Springer.

3.49

According to this principle, although teachers still have considerable responsibility at the outset for helping students to acquire the experience they need, students are ultimately expected to assume the entire responsibility for what they learn. The emphasis is on the active acquisition by students of information and skills, and this will depend on their ability to determine their own educational needs, the best ways to set about learning, the speed at which they are able to work and their ability to evaluate their own knowledge. The teachers are there to give them the advice they need until they have learned to work completely independently. The teachers still retain full responsibility for certifying evaluation.

In the methods in which the emphasis is on learning, as in those where the stress is on teaching, teachers should define what they consider to be appropriate learning objectives, identify relevant sources of information and develop means of evaluation that will not only reflect their own experience and knowledge, but more specifically the health needs of the community. With the teaching-centred approach, these materials will result in rigid prescription of what the st