October 12, 2010

Learning Through Teaching

By Rachel M. Kruer, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Hospital
As pharmacy students and residents we often wonder why we are required to give frequent presentations and lead numerous topic discussions.  I have found myself wondering why it is that I am presenting a topic to my preceptor on subject matter for which she is viewed as the house-wide expert.  She obviously already knows the material.  For example, why lead a topic discussion on rapid sequence intubation to an audience of emergency department pharmacists?  Then it hit me!  After reading the material, I had a basic understanding of the mechanisms of pre-induction and induction agents.  I understood the kinetics of neuromuscular blockers.  However, it was not until I was asked to explain the sequence of drug administration and answer questions regarding the most appropriate agents for a patient with a specific injury, that I truly understood rapid sequence intubation. 
Heidi G. Elmendorf explained this phenomena quite nicely in her essay entitled “Learning through Teaching:  A New Perspective on Entering a Discipline.”   In her essay, Elmendorf describes an introductory level biology course she taught at Georgetown University targeted to non-science majors.   During a volunteer project, one of Elmendorf’s students found herself in charge of an elementary class.  The student did a quick mental scan for topics she could present to these children that would peak their interest.  In Elmendorf’s course, the student had been learning about childhood vaccinations, so she decided to lead a discussion with the elementary class on the basic scientific principles of vaccines and their use.  While teaching the subject matter she had recently learned, the student became more engaged in the material of her biology course.  When returning to Elmendorf’s course, she asked thoughtful questions so that she would be better prepared to answer the questions of others, including her elementary class students.  Elmendorf writes of her student, “Her experience spoke to the educational power of the intersection between the metacognitive engagement stimulated by the creative construction of knowledge and the affective impact of communicating that knowledge to a group eager to learn.”1    
The essay reminds us of a supposition previously proposed by David Perkins, that learning facts is not equivalent to learning for understanding.2  Elmendorf describes a three-fold theory of understanding.  The first step is basal understanding of fundamentals. Next is structured understanding of the organization of ideas into a larger conceptual framework and how ideas from other disciplines are connected.  The final step is translational understanding in which the learner is able to move fluidly between organizational levels of information.  It is not until the third step is reached that one becomes fluent in a content area.  These steps in understanding correlate with the educational theories discussed in our course.  Behaviorists help us to understand the formation of a solid foundation of knowledge, while constructivists describe the mechanisms by which knowledge is internalized and organized.
Elmendorf believes that by teaching, students re-learn basic concepts in a way that deepens previous superficial understanding.  Learning through teaching has certainly been helpful in my practice thus far.  I often feel that my knowledge of a topic is superficial at best, until I really dig in and prepare a presentation or topic discussion in such a manner that I feel comfortable (well, as comfortable as possible) answering questions from the content experts.  It seems as though this concept of teaching through learning is used widely in the development of pharmacy residents.  It is also employed when we counsel patients.  We often ask patients to repeat back how they are going to take a given medication.  This model may be further utilized by asking patients to teach us how to take a medication, or use an inhaler, for example. 
Additionally, this model could be explored to a greater extent in formal pharmacy education.  Students are often asked to prepare presentations and topic discussions during their experiential rotations, however, this model could prove to be beneficial as a part of didactic teaching and learning.  Perhaps students would have a deeper knowledge of disease states after being required to teach the topic to others, whether that be students or content experts, prior to going on advanced experiential rotations.   The take home message from the Elmendorf essay reveals “that casting students in the role of teacher is a remarkably powerful way of making visible, to both the students and their instructors, some invisible shortcomings of traditional educational approaches.”

1. Elmendorf, Heidi G. “Learning Through Teaching: A New Perspective on Entering a Discipline”, Change: The Magazine of Higher Learning 2006; 38: 6, 36 — 41.

2. Perkins, David, “What is Understanding,” in Teaching for Understanding: Linking Research with Practice, M. Wiske, ed., San Francisco: Jossey-Bass, 1997.

[Editor's Commentary:  Research has shown that deep learning is facilitated when the learner articulates and expresses his / her understanding of the material.  This can be accomplished through writing about the subject, answering questions about the subject, or giving an oral presentation about the subject.  Teaching others typically requires the learner to do all three.  It is through these forms of expression - by explaining one's thoughts -  that a learner begins to solidify mental schema, organizational structures, and inter-relationships with prior knowledge.  Teaching requires thoughtful preparation.  The learner has to decide what information is most critical to convey, how to organize and sequence the material, as well as create visuals (or stories or analogies) that convey important concepts.  Moreover, teaching is a public activity - one that has potential consequences for those being taught.  So the incentives are strong and the stakes are high.  A learner who is teaching others is highly motivated to do a "good job" explaining the material.  The old adage "see one, do one, teach one" rings true.  So rather than giving your students a dull lecture on some topic ... ask them to teach you instead! - S.H.]

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