Lenses for learning

“information is an undigested burden unless it is understood. It is knowledge only as its material is comprehended. And understanding, comprehension, means that the various parts of the information acquired are grasped in their relations to one another — a result that is attained only when acquisition is accompanied by constant reflection upon the meaning of what is studied.“ (Dewey, 1933, p.78)

Learning by reflection

Experience or provision of information are thus not enough to learn. Information including un-reflected experiences as an undigested burden is a challenge, for us, our students, and patients. Dewey [1] emphasized the importance of reflection to comprehend and learn. I believe we all need to take the time to share reflected insights in ways that may promote a ripple effect of knowledge building, reducing the undigested burden. Reading analyses by others may promote our internal reflection and thus learning.

Research plays an important role as a source of information to support our professional educational endeavor, but also research have the risk of being looked at as information sharing only. As teachers, clinical supervisors, and researchers in education, we are invited to reflect on the research results in relation to our own context and experiences.

To make our reflections more complex, we may also consider the lenses used for the information collection. As I have been wearing glasses almost all my life, I’m quite aware of the impact the use of different lenses has on information gathering (such as using reading glasses or regular glasses will dramatically change what I see from the same outlook). I think this also applies to our interpretation of research. Which lens we use when addressing a question will impact our reflections and understanding. Therefore, it is valuable that researchers provide us with information using various lenses.

In the current issue, researchers in physiotherapy education help us by their use of different lenses, inviting us to gain a richer picture of learning and education.

Lenses for learning

Looking through the lens of the curriculum

Which learning spaces are we using? We have probably all experienced that the pandemic led to a shift in using more digital resources in education. Now is the time to reflect on what did work and should be maintained and in which areas are the digitalization not as well developed for our purposes. In an umbrella review Connelly Ortega et al. [2] assessed systematic reviews about digital and blended curriculum in health professions education. These findings may have implication for future digitalization of our educational programs.

What’s on the schedule? From a curricular point we also need to address which topics are included and how. The topic of international global health has gained attention and Felter et al. [3] did a review on education initiatives to further our insights into what kind of learning activities have been explored to promote student learning. In times of a pandemic, it is even more important to consider how it can be implemented and how activities should be designed for students to encounter the area of international global health.

Looking through the lens of the learner

What are student experiences when they get the chance to elaborate beyond what we find in regular course evaluations and rather taking a programmatic perspective? Listening to the students may guide us in their understanding of our efforts and how a curriculum can be enhanced from the students’ point of view. We are here introduced to papers addressing students’ perspective on emerging areas such as person-centered approach [4], palliative care [5] as well as the anatomy [6], the latter being a well-established topic, yet the same concern still needs to be addressed: which learning activities are suitable for long term learning and translation to practice. In addition to exploring the students’ opinions, though the lens of the learner the test performance is also an important outcome measure to investigate [7], to improve our teaching practice for long term learning.

Killingback et al. [4] explored students’ experiences in studies relating to teaching person-centred practice in physiotherapy. One important take home message is the value of persistence. Working person-centred is as much about professional attitude and values as having the knowledge. Developing professional attitudes takes time and the topic should be addressed throughout the program. They conclude that further research is needed on how person-centred learning activities translates to changed behaviour in clinical practice. I hope someone will pick up this research area and explore how it may translate to extended benefits.

As health care evolve, how can we keep up with integrating new topics students need to be familiar with? One important emerging example is palliative care. The sparse number of papers on this topic indicates that it is a new area in physiotherapy education. Cabrini-Back & Clark [5] explored the impact on education about palliative care on students’ attitudes and beliefs. This may give us inspiration on activities that could be implemented, but also in this area I hope we will see more research in the future.

A challenge we encounter from a curricular perspective is that we cannot fit everything ‘new’ and ‘old’ into the curriculum. It has to be a balance between established topics and emerging areas. For the curriculum development, which learning activities are used and their impact also needs to be addressed. This leads us to the papers addressing the impact of different learning activities [6,7].

Even though anatomy is well established as a corner stone in physiotherapy education, it is still a topic of concern with the challenge to facilitate translation of theory into practice. To further understand the students’ perspective on the learning activities Ojukwu et al. [6] inquired students about their perception of the current anatomy education in Nigeria. Their findings of low commitment when class size is large or having a low degree of supervision, is important and probably also translatable to other topics as we can see how that resonates to the finding in the other studies presented here.

Then, moving from what the students say to what they do, Hasan & Makary [7] explored the use of quizzes to promote learning. They concluded that quizzes were useful to trace learning in relation to lectures, but high performance on quizzes did not predict high grades on exam. It would be interesting to follow up asking students about their experiences on how they used their results from the quizzes. Did it have any influence to identify knowledge gaps? Did it influence their study strategies for the exam? It would also be interesting to follow up this and the other papers addressing students’ perspectives, by exploring the teachers’ perspective. Such as, could the teachers use the information from the quizzes to improve their lectures?

Looking through the lens of our teacher colleagues

After addressing what can be done in education such as adding new topics or learning activities, we also need to address the teachers’ perspective on their readiness for being a teacher. What do teachers need to act as competent teachers in their learning environment? Are you prepared to be a qualified teacher just because you have a higher education yourself? The teachers’ perspective was addressed in two papers [8,9]. Snook et al. explored the teacher identify formation based on the literature [8]. They concluded that is seemed desirable to promote a merged identity between being a teacher and physical therapist and that there is a need for education for teachers, through faculty development initiatives. This was further addressed in the second paper. Based on a survey, Snook et al. [9] explored Icelandic clinical teachers’ and classroom teachers’ perceived needs of education, in their teaching role, through faculty development activities. They found that the needs were context specific, but both clinical and classroom teachers perceived a need for faculty development initiatives to support their role.

How can the teachers’ need be met to enable the curriculum development we may desire? Faculty development is often a small unit, and it will be a challenge to locally meet various specific needs. I believe – thinking back on the paper about areas of successful digitalization [2] that digitalization in faculty development may be a future way for making it possible to meet specific needs, by international collaboration and exchange across faculty development initiatives. This is another area to be explored in future research.

Lenses for reflection

A lens does not provide reflection, it is just a prism bring attention to specific perspectives to reflect on. Given the various lenses provided in the papers, I want to invite you for summative reflections with a systems approach on learning – considering the whole curriculum with various topics and learning activities, the learning spaces, the student attitudes, and the teachers’ perceived preparedness.

Looking through our own lenses

I hope you will use the various lenses for reflection after going through this special issue and move beyond information as an undigested burden. What did you find valuable for your learning? In what way may it impact your practice? What is your next step? I hope that it may lead to furthering evidence informed education and research projects that we eventually may publish here. Learning from each other and publishing our experiences are important to promote the best education possible for our upcoming colleagues and for the long-term goal of good health and well-being in society.

Christina Gummesson
Faculty of Medicine, Lund University, Sweden;
Faculty of Odontology, Malmö University, Sweden
[email protected]