Kieran Walsh: What if everything you knew about medical education was wrong?

Learners have to be active. This is something that I have heard a lot and also said a lot in the years I have been involved medical education. The idea that learners have to be active has driven educators to set up small group teaching, problem based learning, interactive educational resources, and a range of other teaching formats. It seems to be a widely-held truth that learners have to be active. But what if it was wrong? Or what if we were interpreting this idea in the wrong way?

BMJ Learning is the online learning service of the BMJ. At BMJ Learning we continuously look at what modules people are doing. And we see that they are doing a wide range of different types of modules. Some users like text, some like audio, and some like video. When I ask users what they like, or why they like or don’t like different types of content, they come up with a range of answers.

For example some say they like video resources. But some say that they don’t like them—because their mind wanders off and they stop listening. They say that the modules are “passive.”

What about those who do like them—why do they like them? I have heard a range of reasons. Some say that they like listening. Some say they like taking notes, and so they take notes as they listen. Some say that they multitask—they listen and watch a bit, do the housework, and scribble some notes as they go.  Some watch at their desktop and then send us their reflections on what they thought of the content. In doing so they are articulating and recording their reflections. Some go back over bits that they missed. Some read the transcript after listening. Some tell others about the module if they think it was good. Some tag the module and put it in a particular category in their online portfolio. Some think hard about applying what they have learned. Some even go so far as applying what they have learned.

All this has led me to think that a learning resource is not active or passive in itself. Rather the concept of active or passive is related to how we use it. Sometimes when we see people sitting quietly at a lecture, we think that is bad—they are being passive. But learning is not something that you can see—there may be a lot going on in their heads. David Didau expands on this idea in his book What if everything you knew about education was wrong. He says that “because we can’t see anything happening, we assume nothing is happening.” So in a desire to make everyone active learners, we get them running around and “slapping sticky notes on every available surface.”

So do learners have to be active? I think sometimes yes and sometimes no. But as educators we need to rethink what we mean when we say active. Sitting and listening can be active too.

Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology.

Competing interests: KW works for BMJ, which produces BMJ Best Practice—an evidence-based clinical decision support tool.

  • Jean Mckendree

    Hello Keiran. A nice article, but something that cognitive scientists have known and written about for a long time. I don’t really agree that you can learn if you are not active. “Activity” is in the mind. Sitting and listening can be very active. (I often listen to lectures – or politicians – where I am frantically debating what is being said!) I have wriitten about “vicarious learning” where students can learn by watching other learners – something that people have sometimes called “passive learning”. But to work, it is not at all passive. Studies find that vicarious learning works when the observer is actively thinking about goals, what they might do next or do differently, or when they are discussing what they are seeing with someone else. (See studies by Michelene Chi and others.) So, I think I would say that all learning is active, requiring connection and integration. Anyone who is truly passive, I would say, would learn little or nothing. The reason that PBL works (or doesn’t) is that when it is done properly, the students are very much driving the discussion, processing and transforming the information through explanation and debate, and applying what they have read very actively with the facilitator pushing and challenging them to go further, not supplying anwers or mini-lectures, as I have seen happen too often.

  • Kieran Walsh

    Thanks Jean for your reply. Re studies by Michelene Chi: are these the ones that you mean?

    Active-constructive-interactive: a conceptual framework for differentiating learning activities.
    Chi MT.
    Top Cogn Sci. 2009 Jan;1(1):73-105.
    https://www.ncbi.nlm.nih.gov/pubmed/25164801

    Observing tutorial dialogues collaboratively: insights about human tutoring effectiveness from vicarious learning.
    Chi MT, Roy M, Hausmann RG.
    Cogn Sci. 2008 Mar;32(2):301-41.
    https://www.ncbi.nlm.nih.gov/pubmed/21635338

  • Jean Mckendree

    Those are a couple, but she has written many more. If you go to her home page, there is a list. There is a PDF of an interesting paper about ICAP which summarises a lot of her research. It’s called “The ICAP framework: Linking cognitive engagement to active learning outcomes”

    http://chilab.asu.edu/publish.html