Sus beneficios y costos médicos como miembro del plan

For the purpose of this thesis, learning is to be defined as acquiring new knowledge that is constructed by overwriting the old knowledge, which will be modified as a result of gaining new experience. The interaction between the old and new knowledge should form an entirely new understanding (current knowledge) until the learner adjusts it by acquiring newer knowledge.

Before relating the above definition of learning, which is offered by this thesis, to learning perspectives, it is essential to describe three different perspectives of learning: associationist, cognitive and situative (Greeno, et al., 1996).

Behaviourists, such as Tolman (1932), Guthrie (1935), Skinner (1938), and Hull (1943), cited in (Greeno, et al., 1996), developed the associationist perspective. According to Jessel (2013), this perspective places an increased emphasis on the idea of association and repetition. The associationist perspective shapes learning as the gradual process of building patterns, associations and skill elements (Beetham & Sharpe, 2007).

In this perspective, learning takes place by linking behavioural units through a series of activities followed by immediate feedback. Associationist approach requires the subject material to be analysed as particular associations, displayed as behavioural objectives; this type of analysis was suggested by Gagné (1985). Based on the task’s analysis, units of knowledge need to be sequenced in terms of complexity, simpler components as prerequisites for the more complicated tasks (Koedinger, et al., 2012).

Gagné (1985) described the principle of Instructional Systems Design (ISD) as a recursive breakdown of knowledge and skills into small units. The fundamental principle of ISD states that the complex tasks need to be built step by step, starting from more simplistic units of knowledge. According to Gagné (1985), cited in (Mayes & Freitas, 2007, p. 15), ISD comprises three steps:

ii. Sequence the units so that a combination of units is not taught until its component units are grasped individually.

iii. Design an instructional approach for each unit in the sequence."

Gagne’s approach "was reflected in the technology of the time: teaching machines were developed that were based upon learning principles such as simple repetition, feedback and reinforcement through external reward. The assumption was that learning was a matter of building on earlier behaviours” (Jessel, 2013, p. 16). The

repetition of the simple units to those of increasing complexity, bottom-up fashion, reshape student's behaviour gradually. Joining this fashion with immediate feedback provides students with various paths to a successful completion where each learner is given access to the next problem contingent on their answer to the former one, “this process is suited to automation through simple technology” (Mayes & Freitas, 2007, p. 16).

Many researchers criticised the associationist perspective, see, for example, Nunes & McPherson, (2003) as it does not promote higher-order thinking skills. This claim is backed by Jessel (2013, p. 16), who stated that this pedagogy is “essentially didactic with the learner regarded as passive recipient of knowledge that is transmitted”. Thus, there was a need to move to a new view of learning, cognitive perspective, which focuses on the mechanism of processing and constructing the knowledge rather than being delivered and memorised. In other words, it encourages higher-order thinking skills. According to the cognitive perspective, knowledge acquisition is regarded as the adjustment of current schema, including concepts and understanding. Such development arises from active interaction of new experiences and the existing schemes (Jessel, 2013).

While cognitive theory suggested by Piaget is concerned with the individual's development and achievement, Vygotsky (1978; 1934/1986) shifts the emphasis towards a social context where individuals work together to build their knowledge (Cole, 1991). Vygotsky's contribution goes in line with the sociocultural theory, which reveals how a community contributes to an individual's growth, the interaction between a learner and the culture is addressed in this theory as well. In the cognitive perspective, students need to be active participants in learning, emphasise understanding, analysing and application of critical thinking rather than memorisation and repetition. These claims are

supported by Jessel (2013, p. 17), who stated that “ a cognitive perspective is concerned with inner mental functioning of a higher order such as thinking and reasoning and representation in memory”.

This perspective of learning allows students to develop current schemes by constructing new knowledge. Schallert and Martin (2003) suggested that teachers, in this perspective, are no longer considered the only providers of knowledge, but facilitators for students’ learning. According to this perspective, students learn through mental activities, such as reasoning and challenging tasks, rather than being offered the knowledge through instruction (Jessel, 2013; Brown, et al., 1989).

The possibility of building new knowledge through activities led to the development of a new approach, the constructivist perspective (Brown, et al., 1989). Learners are encouraged to develop their understanding “through self-directed activities, including problem-solving and experimentation” (Jessel, 2013, p. 17). Such developments require learners to interact with environments related to real-life applications. Constructivism promotes higher-order thinking skills. For instance, learners raise questions, look for answers by building a reasonable hypothesis, test their hypothesis and based on their findings; learners draw conclusions. For further information about constructivism, please refer to section 2.3.5

Finally, situated learning is an instructional method promoted by Jean Lave and Etienne Wenger in the early 1990s (Heick, 2019). This perspective follows the work of Vygotsky, who stated that students are more willing to learn through experience (Clancey, 1995). Stein (1998) stated that situated learning is related to creating an experience from authentic contexts or activities linked to real-world. According to Jessel

(2013), since situated learning occurs in an authentic setting, it can be contradicted with other approaches to learning that are based on abstract principles isolated from a context of use.

Situated learning proposes that learning occurs through social relationships between learners, previous knowledge and authentic environment (Besar, 2018). According to Mayes and Freitas (2007, p. 19), "There are perhaps three levels at which it is useful to think of learning being situated". The first level represents the cultural perspective that highlights the necessity to learn in order to accomplish the desired participation in a broader community. The second level of situatedness is related to the learning group. At this level, learning is experienced in a social context, such as students

in the classroom or students enrolled in a virtual learning platform computer-mediated communication. In such groups, students are keen to participate as active members. Finally, learning through individual relationships. This level emphasises that learning is mediated through the relationships with different members of a community. Fowler and Mayes (1999) stated that these relationships vary according to the characteristics of the community, the circumstances within which individuals work and the strength of the relationships.

The definition of learning offered by this thesis, strongly agrees with the cognitive constructivism and social constructivism perspectives, that are based on the work of Jean Piaget and Lev Vygotsky, as well as the situated learning. Constructing new knowledge and adjusting the old schemes through the interaction with the environment are critical elements in the presented definition of learning.

The definition of learning offered by the thesis is formed of three interrelated elements:

Firstly, acquiring new knowledge. The analysis of this element shows that it consists of the first part of the adaptation process (refer to section 2.3.5), which is the assimilation process (Ginsburg & Opper, 2016). Piaget explained the assimilation process as the process where a person uses existing schemes to interpret the newly gained knowledge (Littlefield Cook & Cook, 2005).

The interaction between organisms and the environment forms (assimilates) new knowledge or behaviour. The assimilated knowledge has to be discussed internally (internal mind) to check its compatibility with the existing set of behaviours and schemes. If these schemes fail to understand the external examples or the newly acquired knowledge, then new schemes need to be developed through the second phase of constructivism, the accommodation process, see the second element below.

Secondly, overwriting the old knowledge through the interaction between the old and new knowledge to form an entirely new understanding, after which it will be considered current knowledge.

The term overwriting indicates that an old item disappears and new emerges (Oxford dictionaries, 2005, p. 1085). This statement leads to connect this element with the second part of the adaptation process, which is the accommodation process. The accommodation takes place when the previous knowledge or schemes do not work or

are insufficient to understand the external examples, which causes cognitive disequilibrium. In this case, the existing schemes must be overwritten and modified to be compatible with the newly gained experience. This implies that there will be an interaction between the external elements, those that can be seen externally (the environment), and the existing experience (AIU, 2018; vonGlasersfeld, 1982). As such, the newly formed schemes are sufficient to understand the new experience. In other words, new schemes will be developed; previous schemes are overwritten. Consequentially, new knowledge will be accommodated. Therefore, cognitive equilibrium is back again.

Finally, adjusting the current knowledge by acquiring newer experience (the current knowledge being re-challenged).

Reading through this element, show that it is linked with the second primary phase of the intellectual growth; the organisation process. Ginsburg and Opper (2016, p. 57) defined this process by "the tendency to form increasingly coherent and integrated structures". In other words, it is the process of seeking the perfect equilibrium (perfect understanding), which will never be fully achieved, as always there are new ideas to examine. Because of this tendency, people are never satisfied with the current equilibrium as they are looking for a deeper understanding of the known "We stretch and extend our cognitive structures by assimilating new and challenging information" (Ginsburg & Opper, 2016, p. 57). Piaget claimed, “the normal state of mind is one of disequilibrium—or rather a state of ‘moving equilibrium” (Beilin, 1994, cited in (Ginsburg & Opper, 2016, p. 58).

The newly accommodated knowledge will be considered as learner's current knowledge until new assimilation (experience) re-challenges the last formed schemes (the current ones) (AIU, 2018; Littlefield Cook & Cook, 2005). Hence, the process of constructivism, including all stages; assimilation, adaptation and organisation, will be repeated to form again another current knowledge, including the cognitive equilibrium. Therefore, using the constructivist approach, I would summarise my definition of

learning by stating, it is the dynamic interaction between the old and new knowledge to form the current knowledge.

I would argue that the offered definition of learning by this thesis is also related to Vygotsky’s perspective of constructivism, the social constructivism, and situated learning as well. The presented definition stated, constructing new knowledge and

adjusting the old schemes will be achieved through the interaction with the environment. However, the definition did not specify if this knowledge will be constructed individually, as Piaget suggested, or in a social context, where individual's work together to build their knowledge, as suggested by Vygotsky.

Moreover, the presented definition of learning did not specify the nature of the environment, if it is an authentic or merely abstract principle isolated from the context of use. This might be considered as limitations in the offered definition. Even though the above elements discussed the proposed definition in relation to Piaget’s view only, considering the collaboration and scaffolding between students to build new knowledge

in an authentic environment, creates the connection between the offered definition of learning and both perspectives, the social constructivism, and situated learning.

Lave and Wenger (1991) claimed that situated learning promotes collaboration between students in an authentic setting. Besar (2018) claimed that situated learning occurs through social relationships between learners, participation, previous knowledge and authentic environment. Thus, including the social context and an authentic environment in the offered definition by this thesis would support my argument that this definition is related to both perspectives, social constructivism of Vygotsky and situated learning, in addition to the cognitive constructivism of Piaget.

2.2 THE NOTION OF TECHNOLOGY AND THE ENTRANCE