Antecedentes de investigaciones sobre educación secundaria de adultos

Placements are considered to be the interface between the classroom and the realities of practice, providing an opportunity for students to acquire and place theoretical knowledge in context (Cohn and Crist 1995, Alsop and Ryan 1996, Tompson and Ryan 1996a). However, I would argue that the notion of acquisition and transference of knowledge that is implicit in this assumption is too simplistic and that placements present students with a much wider stimulus for learning and opportunity for personal and professional growth and development. Jarvis (2010, p78) suggests that as students enter a new practice setting they are having, for the first time, “a primary experience of practice” that presents them with an array of opportunities for new learning and development. It is this notion of experiential learning that is now explored. Consideration is then given to the way in which behaviourist, cognitive, humanistic, sociocultural and lifeworld learning theories have influenced practice education.

Dewey (1938) was the first educational theorist to give centrality to personal experience (cited in Jarvis 2010, Merriam et al 2007) and much of the adult learning literature builds on his ideas as shown in the work of authors such as Kolb (1984), Schon (1987), Knowles et al (2005), Boud et al (2008) and Mezirow et al (2009). From this perspective, learning is considered to be an intrinsic need, core to our being as humans, which results from everyday experiences, although it is recognised that without reflection not all experiences are educative (Kolb 1984, Jarvis 2010, Merriam et al 2007, Mezirow et al 2009).

Kolb’s (1984) theory of experiential learning is one that has become increasingly popular in higher education (Jarvis 2010) and has relevance to practice education. Here, learning is viewed as a four-stage cycle where learners are actively engaged in a ‘concrete experience’, observe and reflect on their experiences from various perspectives during a stage of ‘reflective observation’, formulate their ideas and integrate their observations and reflections into theories during ‘abstract conceptualisation’ and finally test out their theories and ideas

through ‘active experimentation’ (Kolb 1984, Evans et al 2010). Such a cycle of learning can be applied to students on placement as they engage in hands-on activities, reflect on their experiences both individually and with their educators and start to generate ideas and concepts that they are then able to test out and refine. It is suggested that using such a cycle helps educators to assess where students may be blocked in their leaning and create experiences that can move students forward in their development (Cross et al 2006).

Jarvis (2010) however suggests that Kolb’s theory of learning does not convey the complexity of the adult learning process and, drawing on the experiences and reflections of his own adult learners, Jarvis constructed a learning theory that takes as its central focus the notion of disjuncture. This is defined as the gap between a person’s perception of an experience (based on their previous experiences) and the actual reality of the encounter and suggests that where these two start to significantly separate then questioning begins and conscious learning starts to take place (Jarvis 2010). Learning is thought to have occurred when an individual is able to resolve the disjuncture (which can occur cognitively, emotionally and / or practically) by giving new meaning to experiences or generating new understandings, knowledge and skills. As a result, the learner becomes changed or transformed by their experience (Merriam et al 2007, Jarvis 2010).

Links have been made to phenomenology where the focus of concern is on the experiences of everyday life and the sense that individuals make of these experiences (van Manen 2007, Jarvis 2010). However, social learning theorists would argue that learning is more than phenomenal, emphasizing the social context in which learning takes place (Lave and Wenger 2003, Wenger 2006). This phenomenological perspective is discussed in more detail shortly when consideration is given to conceptualising learning as a process of becoming.

Whilst most definitions of learning include some reference to change in an individual, how such changes occur appears a matter of debate. A wide variety of learning theories exist, taking behaviourist, humanist, cognitive and social learning perspectives (Merriam et al 2007, Jarvis 2010). More recently authors have argued that a lifeworld perspective on learning should be adopted in helping to understand learning, and in particular professional development, as a process of becoming (Dall’Alba 2009a, Dall’Alba 2009b, Hagar and Hodkinson 2011, Scanlon 2011, Vu and Dall’Alba 2011). Whilst it is not possible to cover all

the various learning theories in detail in this thesis, it is useful to consider some of the key concepts that appear to have influenced thinking in relation to practice education.

Merriam et al (2007) and Jarvis (2010) provide useful summaries of behaviourist theorists whose underlying assumptions are that observable behaviour rather than internal thought should be the focus of study. From this perspective learning is seen through a change in behaviour, the locus of control over learning lies with the environment that shapes behaviour, proximity of events encourages connections to be formed and reinforcement encourages repeat behaviour (Merriam et al 2007, Jarvis 2010). Imitation, in particular, is considered important in enabling individuals to learn how to behave and carry out accepted practices within cultural groups (Jarvis 2010). Such principles appear evident in adult education where behaviourist techniques such as feedback, modelling and practising of activities are used to enhance a student’s development on placement (Tompson and Ryan 1996a, Tompson and Ryan 1996b). However, such theories appear limited in the extent to which they acknowledge the individual agency of the learner or social context of learning. Behaviourist theorists view the learner as separate from their world and consider knowledge to be something that can be learnt and applied as required. This would appear to lead to a risk that students simply learn how to ‘do’ or perform occupational therapy without gaining a rich understanding of their practice. This understanding, Dall’Alba and Sandberg (2010) suggest, is the difference between learning through practice (as evident in behaviourist approaches) and learning about practice.

It is possible that the current emphasis given to knowledge, skills and competency frameworks places increasing demand on practice educators to adopt behaviourist approaches in order to reinforce and assess students’ knowledge, skills and behaviours on placements. Indeed many placement assessment/evaluation forms appear to encourage this approach, consisting of tick boxes and pass / fail criteria that seek quantifiable outcomes of learning. It is likely that this will encourage students to develop professional identities and ways of enacting practice that reflect those of their educators and are not of their own making. I suggest that placements should not simply be concerned with the acquisition of particular skills, behaviours or actions and that a more holistic approach to learning is required that allows for the development of an authentic professional identity. Authors argue that such an identity, or ‘professional-way-of-being’, combined with knowledge, skills, actions and personal and professional attributes, leads to more competent skilful practice (Duke 2004,

Murphy and Calway 2007, Barnett 2007, Dall’Alba 2009a, Dall’Alba 2009b, Dall’Alba and Sandberg 2010).

A cognitive approach to learning, advocated by Mezirow et al (2009), highlights the importance of critical reflection in transformative learning. Here, learning is viewed as a process of meaning making, suggesting that through reflection and self-exploration learners may come to fundamentally change their points of view (immediate beliefs, feelings, attitudes and judgements) and habits of mind (broader perspectives, assumptions and world views) that influence the way they interpret and make sense of their experiences (Merriam et al 2007, Mezirow et al 2009, Jarvis 2010). Individual constructions of reality are transformed by reflecting on experiences and elaborating existing, or learning new, frames of reference and strategies for living (Jarvis 2010).

Such transformative learning is considered emancipatory in allowing learners to develop as autonomous thinkers. Rather than simply enacting the beliefs, values and world views of others, which leads to reproduction of the status quo, it is suggested that students come to develop their own understandings and ways of thinking (Merriam et al 2007, Mezirow et al 2009, Jarvis 2010). This has similarities to the work of Billett (2010) who makes the distinction between mastery (the superficial acceptance of knowledge and the ability to achieve standards required for public performance) and appropriation (active engagement in what is being learnt and a desire to integrate this as part of their being) of knowledge. Appropriation is also a key idea of developmental psychologist Vygotsky (1978) in which the ability to take a piece of knowledge and internalise this into a way of ‘knowing how’ allows an individual to use this in their own unique way and prevents them from being so reliant on the ways of others.

In relation to placements, Webb et al (2009) suggest that appropriation is the highest level of identity formation as students come to construct their own ideas about practice and to test out their knowledge and understandings in practice. Links can be made here to literature on the development of practice knowledge where distinction is made between propositional knowledge that arises from learning facts or theories in the classroom (‘knowing that’) and the more tacit non-propositional knowledge generated by students as a result of practical, professional and life experience (knowing how) (Gustavsson 2004, Dall’Alba and Sandberg 2006). The integration of these types of knowledge are reflected in Schon’s (1987, p25)

notion of “knowing-in-action” where the importance of learning by doing is highlighted in order to give students experiences that allow them to understand what professional practice means. Here, the relevance for students on placement would appear to be the extent to which they are able to move away from learning simply how to carry out or ‘do’ occupational therapy for the purposes of passing their assessment, or uncritically replicating theories learnt on campus, towards activities that allow them to gain a richer understanding of what it means to ‘be’ an occupational therapist and to develop an embodied sense of professional self.

Critique of cognitive learning theories include their focus on the individual and the fact that they centre on cognition at the expense of physical, practical and emotional aspects of learning (Merriam et al 2007, Hodkinson et al 2008, Jarvis 2010). Hodkinson et al (2008) also highlight that cognitive approaches tend to decontextualise learning and ignore the social context in which learning takes place. Cognitive approaches view the individual as occupying a context rather than being an inter-related part of it, running the risk that learners are unable to transfer the knowledge they have created from one context to another. Nevertheless, as will be discussed shortly, cognitive influences such as reflective practice remain an important concept in student development and practice education literature (Andrews 2000, Stockhausen 2005, Zimmerman 2007, Owen and Stupans 2009).

A cognitive constructivist approach that seeks to address the issue of decontextualised learning is problem-based learning (PBL). Here, students work together in small groups, under the guidance of a facilitator, to explore real-life cases and scenarios with the aim of activating, exploring and building on previous knowledge. This, it is suggested, facilitates cognitive changes in learners that are transferable across practice contexts (Scaffa and Wooster 2004, Schmidt et al 2011). The PBL process involves students being presented with a case, or ‘problem’, and through discussion and problem analysis they identify what they already know and the gaps in their knowledge. Students generate questions that they feel will help them further their understandings and knowledge base in relation to the case. Students each take a particular question and engage in self-directed learning to seek out and make sense of the required knowledge. This is then shared with the rest of the group with the aim of working together to create an end product, for example an assessment or treatment plan (Tavakol and Reicherter 2003, Schmidt et al 2011). Research suggests that students’ reasoning, problem-solving and self-directed learning skills, developed through this process, prepare them for placements and life-long learning in professional practice (Hammel et al

1998, Tavakol and Reicherter 2003, Lindstrom-Hazel and West-Frasier 2004, Sadlo 2004, Scaffa and Wooster 2004, Schmidt et al 2011).

First developed in the mid 1960’s for medical education, PBL is increasingly being used within occupational therapy education in the UK and internationally, with literature advocating benefits such as increased clinical reasoning, problem solving, critical thinking, team working and communication skills (Sadlo 1994, Hammel et al 1998, Lindstrom-Hazel and West-Frasier 2004, Scaffa and Wooster 2004, Davys and Pope 2006, Halliwell 2008). However, in contrast to the field of medicine, studies into the effectiveness of PBL within occupational therapy are small in number. Evaluations are also made more difficult by the variation in the way that PBL is applied by different institutions, for example PBL being used for a particular module compared to a fully integrated PBL curriculum (Lindstrom-Hazel and West-Frasier 2004).

Davys and Pope (2006) highlight positive and negative effects of using PBL within an occupational therapy programme at one British university. This is not a research paper but the authors state that the effects discussed in the paper are a reflection of student module evaluations, statements made by students in tutorial session and staff comments. Ethically, it is not clear whether students and staff were aware that such evaluations and discussions would be used for this paper. Positive effects identified were a deeper and more holistic level of learning, enhanced clinical reasoning and interpersonal skills. Negative effects included student anxiety about setting their own learning outcomes, group dynamics and gaps in knowledge in relation to anatomy and physiology. This has similarities to the findings of an earlier American study by Hammel et al (1998) where the perspectives of 154 students were gathered using focus groups over 2 years. Benefits of PBL included enhanced clinical reasoning, information management, interpersonal and team-working skills. Concerns were raised about access to resources, coping with the ambiguity of knowledge and conflict between tutor and student expectations.

Scaffe and Wooster (2004) carried out a quasi-experimental pre-post test study of 48 occupational therapy students to explore the effect of PBL on clinical reasoning skills following a 5 week 30 hour intensive PBL course. They concluded that PBL had a statistically significant effect on students’ clinical reasoning skills. This conclusion was based on improvements made in 11 of the 26 items that made up the Self-Assessment of Clinical

Reflection and Reasoning tool that was used to measure this effect. Areas of improvement included using theories to understand treatment techniques, seeking alternative viewpoints, contrasting information about client’s problems and proposed solutions. No consideration, however, was given to the lack of statistical difference in the other 15 items, including aspects of clinical reasoning that would appear particularly important such as questioning why they do things in practice and clearly identifying the occupational problems prior to planning intervention. In contrast to this study, McCarran and D’Amico (2002) found no significant difference in the clinical reasoning of 22 occupational therapy students that had completed either a traditional teaching and learning or PBL approach for a specific module. However, data was collected using a non-standardised tool which may have affected the validity and reliability of the findings. Whilst such studies highlight the variations of opinion regarding the effectiveness of PBL, general reviews of literature indicate that it is increasingly becoming the preferred model of teaching and learning within medial and allied health education and that the benefits outweigh the limitations (Tavakol and Reicherter 2003, Schmidt et al 2011).

Through its use of real cases, it is an approach that contextualises learning, helps students to link theory to practice and facilitates critical thinking and self-directed learning. It would appear that there are links here to Mezirow et al’s (2009) transformative learning through the facilitation of autonomous thinking and changes in students’ habits of mind and ways of thinking. Whilst there appears to be a paucity of research that explores the use of PBL on placements, it would appear to be an approach that could prove particularly useful for role- emerging placements: assisting students in their self-directed learning, helping them to identify their learning needs and facilitating development of clinical reasoning, problem solving and autonomous working skills in the absence of an on-site professional educator.

PBL appears to be influenced by humanistic theories of learning, evident in its use of self- directed learning, recognition of the motivation of the learner and focus on self-development. Humanist approaches to learning consider learning from the perspective of the human potential for growth (Merriam et al 2007), recognising the intrinsic motivation of learners and the free will and responsibility of individuals to become what they are capable of becoming. Such ideas can be seen in the work of Maslow (1987) whose hierarchy of needs moved from physiological needs, through stages of safety, love, belonging and self-esteem to self- actualisation. Similarly, the writings of Carl Rogers have been influential in advancing

humanist perspectives of adult education, in particular the emphasis placed on self- development, direction and maturity as the goal of education (Merriam et al 2007).

The influence of humanistic theories can be seen in Knowles et al’s (2005) learner-centred model of androgogy (adult learning) which rests on the principles that adults have an intrinsic motivation or readiness to learn when activities are meaningful and directly related to their life tasks or when they perceive a need to know something. This model asserts that adults have a self-concept of being capable of taking responsibility for their own decisions and that they learn more effectively from task-centred or problem-based approaches (Knowles et al 2005, Cross et al 2006, Biggerstaff and Thompson 2008). Furthermore, as adults, learners come to a new learning experience with previous experiences which are recognised as a resource for applying and making sense of new learning (Knowles et al 2005). This view is supported by Boud et al (2008) who suggest that learning is always related to past experience and without this connection new experiences exist as abstractions and have no meaning.

Billett (2010, p72) suggests that it is this personal and cultural history, or personal “ontogenies” (the values, beliefs and ways of knowing based on past experiences) that influence an individual’s engagement in workplace activities and learning. This view is also advocated by Boud et al (2008) who highlight in particular the way that previous educative experiences, which have resulted in positive or negative effects, have the potential to stimulate or suppress new learning and as such cannot be ignored. Similarly, other authors suggest that personal histories and learning dispositions form the basis of the learner’s frames of reference, identity and way of being (Claxton and Carr 2004, Barnett 2007, Hodkinson et al 2008, Webb et al 2009, Jarvis 2010). Here, links can be made to the philosophical writings of Heidegger (1973/ 1927) who argues that our experiences and engagement with the world are always interpreted based on ‘fore-conceptions’ or ‘historicality’ (for example, previous experiences, values, understandings and background) and that some events, interactions and experiences therefore have more meaning and purpose to us than others (Finlay 1999, Smith et al 2009). In relation to placements, recognition of students’ personal histories, learning