The MBBS curriculum review coincides with a college-wide review of all taught programmes – MBBS, BSc, MSc, MRes. The college is dedicating resources to a learning and teaching strategy, with buy-out of academics’ time to plan their reviews, grants for new teaching initiatives, a promise to reward good teachers in promotion rounds, a seminar series on approaches to teaching, curriculum review workshops, and a heightened status for the Education Development Unit as a centre for research into teaching and learning. There are ambitious plans to encourage the diffusion of learning technologies throughout our programmes. For a research-based university, there is a surprising level of chatter about teaching, together with chances to influence (and be influenced by) the renewed emphasis on education. If you don’t know what I’m talking about, see the Learning and Teaching Strategy.
Dr Jo Harris, in her undergraduate curriculum review article, has written about the reformed syllabus of the MBBS, and the intended outcomes for graduates – their knowledge, skills and behaviours. Between these two poles of syllabus and outcomes lies all the teaching we do, and the various styles of teacher Jo calls for. We could carry on teaching as we did before, and the students would emerge with the same knowledge as graduates in former years. The intended skills and behaviours, on the other hand, which are driven in part by changes in the profession, in technology and in society, are not a straightforward emergent property of the taught programme. By the time young doctors are called on to exercise them ‘on the job’ they might have spent years neglecting these attributes, or learning in a way that actually undermines them. The same is true, of course, of basic scientists and engineers, whether they leave with a BSc or a Master’s degree. This is why there is renewed interest across the college in how we teach, and how students learn.
I am not going to make the case that students can never learn by facing the front (it worked for me), or that Problem Based Learning is superior to all other approaches (we’ve come out of the other side of that trend in medical education). I am going to focus instead on the classroom experience of teachers themselves. If you are a practitioner or a biomedical researcher or a skilled facilitator, do you want to spend class time with UG or PG students rehearsing Key Facts that they could have learned in their own time? Far better to direct the students to the preparatory study, and then bring your own expertise into the class session.
How might this work? Here is one instance, but many other implementations are possible. Suppose that the students have taught themselves the textbook facts about angiotensin, from a book or review or video you have directed them to. They are now primed to work in class on more exploratory tasks in circulation, pharmacology, therapeutics. This gives them the chance to discuss concepts with each other, and with you, to exercise thinking skills, to integrate evidence of different types, and to identify unmet clinical needs and knowledge gaps. Someone has to devise these class activities – but for a specialist, it is quicker to come up with two or three under-determined or open-ended scenarios that make the students think, than to write or revise a 40-slide Powerpoint show (how many hours do we waste embellishing these lectures?) And when you are talking in class, you will be interacting with students and making use of your expertise, rather than rehearsing key facts which they will probably have to re-learn inefficiently after class in any case.
The scene I have described is an example of Active Learning. The students spend class time ‘on task’. That’s the Active part. But are they Learning? You can find this out by asking them to hand in a worksheet or a paragraph of free writing, or post their conclusions to a shared document, or by hosting a wash-up session towards the end of the class. In the view of teachers who use Active Learning approaches, students more readily acquire habits of thinking, inquiry and problem-posing when they work in this way. There are incidental gains in communicating, justifying, persuading, understanding other viewpoints, sharing competencies with other team members. The focus is no longer ‘the naming of parts’ but the cognitive, behavioural and attitudinal approaches of a doctor or bioscientist. The eventual assessment should probe these same attributes. The learning outcome is no longer to ‘understand the control of vasoconstriction’ (can we really test their understanding?) but perhaps to ‘assess the prospects for improved cardioprotection with currently available drugs’. An imaginative and authentic assessment of this outcome might be to ‘advise a supposed patient on the treatment options following a heart attack.’
Active learning, measurable outcomes, authentic assessment (AMA) are the three pillars of student-centred learning. Many of you are doing it already, before you knew the name for it. Some of you are less convinced, and you’re sure the students would hate it. Some of you, I know, lack confidence in running a session like this, in case it flies off into directions you are unfamiliar with. I favour the approach because it develops higher-order learning far beyond memorising and describing (which is sometimes all we require them to do in parts of our jam-packed curricula). Handling uncertainty, and making decisions in the face of incomplete evidence, is one of the traits that biomedics and doctors are often called on to make use of.
Active learning can also promote engagement with research, society or enterprise, one aim of the Imperial College Teaching and Learning Strategy. The main attraction for me, though, is the experience of the teacher. If I’ve spent 10 years researching or treating pain, or epilepsy, or cognitive decline, I can do less work and have more fun teaching neuroscience 101 through the prism of my research interest. Here’s a family with an inherited deficit in pain sensation… what is going on in their spinal cord? How do we know? Why can’t we treat it? How would you tackle it? Is this rat model useful? On the other hand, I could scroll through my slides. Here they are, an extruded textbook. A neuron… a synapse… a neurotransmitter… a dendrite… we’ll never get round to pain at this rate. But we’re all getting numb.
You can get in touch with the Curriculum Review team on firstname.lastname@example.org. You can keep up with all the developments in the Review on the web pages, and for staff with Imperial login details, you can see the wider College Curriculum Review resources here.