aprendizagem significativa e metodologias ativas em educação médica

Aprendizagem Significativa

e Metodologias Ativas em Educação Médica

Stewart Mennin

Stewart Mennin 2009 Frontiers in Medical Education

Overview:

• Theories of active learning• Complicate - complex

• Methods, applications & implications

• Frontiers in research


Teaching & Learning

• Teaching rests on particular beliefs about learning

• We all work from particular theories (ways of seeing)

Stewart Mennin 2009 Frontieras da Educacao

History of Technology & Learning Theory

• Catapults• Hydraulics• Telegraphs• Telephone

switchboard’s• Computers• Cell phones


Thinking About Education

• Essential elements

• Theory of knowledge• What is learned

• Theory of learning• How it is learned


Essential Ingredients of Education

• Information• Context• Experience• Interaction, transaction• Transformation - X∆• Reflection - intention


What Is Information?

• Differences, variations, edges, irregularities

• Impinge on senses• Patterns


Patterns Matter

Edges Are Information

Edges, Boundaries, Patterns

• Choices

• Categories

• Context

Learning is Context Dependent

Learned on land

Learnedunderwater

0

5

10

15

20

25

30

35

40

45

50

% W

ord

s R

ecal

led

Recalled on land

Recalled underwater

Godden & Baddeley, 1975


Reflection & Feedback

•Mutually agreed upon •Timely•Constructive - useful•Results in a plan for action•Supportive•Improves learning •Improves memory

Complicated & Complex Theories of Learning


Com plicae – to fold, enfold

Com plex – to weave

TheoriesKnowledge (Knowing)~ Learning


Knowledge independent of learner


Knowledge in the mind constructed by learner


Knowing as emerging from self-organization

Theories of Knowledge

Complicated Theories of Learning

•Behaviorism•Mentalism• Complex

• Constructivism• Individual• Social • Ecological

• Self-Organization


Behaviorism

• Thought is internal• Observable stimulus-behavior is most

important• Feedback and reward affect learning• Learning is linear and cumulative

• Cause and effect

• Behavioral objectives, goals, structured courses, programmed learning

• Thought and action as “mechanical”


Mentalism• Knowledge exists outside of knowing

agents (objective)• Learning is a matter of representing &

internalizing knowledge (subjective)• Knowledge is something to be acquired,

grasped, held, possessed, exchanged, managed

• Learning is about connecting external to internal

• Role of teacher to present information


Computer Metaphors in Cognition

•Learning as acquiring & inputting data

•Learning difficulties as problems with brain wiring

•Communication as transmission & interfacing


Computer Metaphors

•Thinking as processing and compiling information

•Memorizing as storing

•Remembering as retrieving and outputting


Complex Theories of Learning

• Complicated • Behaviorism• Mentalism

• Constructivism•Individual•Social

• Self-Organization


Constructivism

• Personal & collective knowledge derives from experience in the world

• Teachers as guide, facilitator • Teachers provide experiences to expose

gaps between old & new experiences• Teachers engage students in active ways,

using problems & groups• Sufficient time for in-depth examination

of new experiences• Reflection


Embodied Perception

• Sensing & perceptions are active

• History imposes expectations

• Perception & conception are inseparable

• Information is variation, difference, edge


Stewart Mennin 2009 Frontieras da EducacaoWikibooks, 2009

Where Do New Patterns Come From?

• Connections, exchanges & inter-actions

• Adaptive variable iterations

• Simple Rules• Self-organization

Stewart Mennin, 2009

Demonstration of Self-Organization


15 volunteers

EXAMPLES OF SELF-ORGANIZATION & EMERGENT

PATTERNS

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SELF-ORGANIZATION

29

Origin of Patterns

Stewart Mennin 2009

Olson & Eoyang, 2001Frontieras da Educacao

CONDITIONS FOR SELF-ORGANIZATION

• Gradients–gaps–fuzzy boundaries• N2K Need to know

• Multiple diverse agents • X∆, co-evolution

• Dynamical, far from equilibrium• Recursive (multiple

short-loops)

Frontieras da Educacao


• Learning is more about a reaching out than taking in

• It is a participation – an exchange

• It is a process of re-membering, of

pulling together - connecting

Stewart Mennin 2009 Frontieras da EducacaoDavis, Sumara, Luce-Kapler, 2000


• Not about acquiring or accumulating information

• A matter of keeping pace with one’s evolving circumstances

• A constant revision of memories, capacity for action, and ranges of possibilities


Learning Is:

Davis, Sumara, Luce-Kapler, 2000


“What an agent knows is inseparable from what that agent does, which is in turn inseparable from what or who that agent is. Knowing is doing is being”

Stewart Mennin 2009 Frontieras da EducacaoDavis, Sumara, Luce-Kapler, 2000

Becoming

Adult Learners• Safe effective

learning climate• Involved in mutual

planning of relevant methods & curricular content

• Involved in diagnosing own needs—helps motivation

Stewart Mennin 2009 Frontieras da EducacaoMalcolm Knowles, 1984

Adult Learners• Encouraged to identify

resources & devise strategies to achieve goals

• Support in carrying out learning plans

• Involve in evaluating own learning—

Stewart Mennin 2009 Frontieras da Educacao Malcolm Knowles, 1984

Activity Is Necessary & Not Sufficient

• Action –recursion• Transaction• Transformation• Co-evolution



Dr. Al-Eraky, M.International Medical Center, Jeddah, Saudi Arabia


Caring

Learning How to

Learn

Foundati

onal

Know

ledge

Application

Integration

Significant

Learning

L.Dee Fink, 2003

LEARNING FOR UNDERSTANDING REQUIRES

• Adequate time• Deliberate practice • Multiple

experiences over time• Variable Iteration • Test for

understanding

• Questioning, disagreeing, choosing


Instructional Time

% Rote Learning in Medical School


Problem Solving


Approaches to Interactive Transformative

Learning Approaches


Teaching Skills for Interactive Learning

• Degree of directedness & responsibility

• Liberating constraints • Draw out and work with

learners’ experience• In-depth exploration,

multiple examples• Reflection on & in

action



MAKING UNDERSTANDING VISIBLETeaching Skills

•Consult your colleague

•Reciprocal teaching•Polling the class•Frequent formative assessments

•Explore understanding

•Cases/problems•Prototypes

•Questioning

Forms of “Interactive” Learning

• Groups with cases, problems• Problematization• Problem-based

learning (PBL)• Team-based

learning (TBL)• Case-based

learning (CBL)• Community-based

learning (CBME)



Dynamics of Interaction, History & Reflection

•New knowledge emerges from enacting with the world

•History shapes receptivity to information & action in context

•Teachers help to frame subjects

•Teachers need to know about & stimulate students’ knowing (history)

FOCUS ON PROCESS OF KNOWING


IMPLICATIONS FOR TEACHERS

•Create situations (activities) to make understanding visible (accessible)

•Stimulate exploration & reflection

•Foster self-organization in new situations

IMPLICATIONS FOR MEDICAL EDUCATION

• Integration - Promote connectivity, time for exchange of differences

• Recursion, variable iteration• Re-vision, Re-member• In-formation

• More time to reflect

51

TASKS OF TEACHERS

• Value traditional and contemporary ideas about teaching/learning

• Identify activities that enhance teacher effectiveness

• Generate appropriate teaching/learning activities

• Show synergy between three elements of active learning• Information & application of ideas• Experience with continuity• Reflection & recursion


53

ACTIVE LEARNING METHODSClassroom

• Think, Pair, Share

• Problem-solving exercises

• Plus/Delta• Matrix compare

& contrast

• Find primary data, original sources

• Concept maps• Team-based

learning

54

ACTIVE LEARNING METHODSSMALL GROUPS

• Clinical Scenarios/experience• Problematization• Reflective discourse• Simulations• Case studies• Team-based learning• Problem-based learning

55

TEAM-BASED LEARNING

Team Learning Phases

Preparation(pre-class)

Phase 1

Readiness Assurance

Phase 2

Application of Course Concepts

Phase 3

Individual Test

Individual Study

Group TestWritten Group Appeals

Instructor FeedbackSmall-group Assignments

Thompson et al., 2007

Team-Based Learning

• Increased student engagement,• Higher-quality communication

processes• Increased NBME shelf-exam scores• Increase application time• Teacher controls content• Teacher as expert & facilitator

Stewart Mennin 2009 Frontiers in Medical EducationThompson et al., 2007

Uses of Cases & Problems


Add Relevence

Test(ProblemSolving)

Problem-BasedLearning

Lec-PROBLEMPROBLEM-ture

Programmed Learning

PROBLEMPROBLEM

PROBLEMPROBLEM

InquiryStrategy

Learning(Learner – Centered)

THE CASE

Identify Problem

Learning Issues

EXISTING

KNOWLEDGE

Independent Study

Generate/Rank Hypotheses

Explain Thinking

Ask Questions

Get New Information

DecisionDx & Rx

PBL

Mennin, 2005

Problem-Based Learning

• Increased motivation for & enjoyment of learning

• Learning for understanding• Teamwork• Improved clinical skills• Equal or better knowledge

performance• Mixed vs blocked study improves

diagnostic accuracy Stewart Mennin 2009 Frontiers in Medical Education

Norman & Schmidt, 2000

Activity: Lecture, PBL, TBL


Kelly et al., 2005; TLM 17

Prepare to do well on MCQ tests, individual & teams

Need to know, self-directed learning, essay tests

To do well on tests, usually MCQ

Incentives

Motivation

Teacher identifies content, students come prepared, take tests, in groups apply knowledge to teacher problems

Sequential cases, explore, hyp, question, LOs, self-direct study, group work apply knowledge

Teacher-Centered

Notes, exams, assign

Instruction Methods

Learning Sequence

Teacher-directed, apply specific info to problems in lecture hall, work in teams to solve problems, use info, rapid feedback

Teachers write cases, students choose LIs, Pre-existing knowl.,

Deep learning, Feedback

Transmission, notes, examination, surface learning

Principles & Assumptions about Learning

TBLPBLLectureConstruct

Independent study outside class, team work, discuss, present

ID problems, hypothesize, pre-exist know, LOs, apply, discuss, group, assess

Attend class, study notes, prepare for exams

Role of Student

As teacher, provide content, opportunity to apply concepts, solve problems

Facilit group, individ learn process, assess, feedback, xample

As teacher, provide content, examples

Role of Expert

Set objectives, select content, resources, exams,

Facilitate group, examples, feedback, assessment

Do objectives, content, tests, material, learning aids

Role of Teacher in

Learning

Achieve objectives, apply content, solve problems, reason, groups

Deep understanding, reason, evidence, context

Content acquisition, conceptual understanding

Desired Outcomes

TBLPBLLectureConstruct

TRANSFORMATIVE EDUCATIONAL STRATEGIES

• Learning is an emergent property• Experiential, elaborative • Social (small-groups), self-directed• Early authentic experience

• Networks• Capability building• Feedback, recursion, variability• Metastability


“…formal efforts to educate have to do with prompting learners to notice certain aspects of their worlds and to interpret those elements in particular ways.

Or in other words,

formal education has to do with one group’s desires - conscious or unconscious – to have another group see things in the same way.”

Education


RESEARCH• Discovery-

• new understanding

• Testing hypothesis• Structural Equations

Modelding

• Explanation• Application –

outcome• Synthesis


If learning is regarded not as the acquisition of information, but as a search for meaning and coherence in one’s life and, if an emphasis is placed on what is learned and its personal significance to the learner, rather than how much is learned, researchers would gain valuable new insights into both the mechanisms of learning and the relative advantages of teacher-controlled and learner-controlled modes of learning.

Stewart Mennin 2009 Frontieras da EducacaoPhilip Candy, 1991

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