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.