2010 Pauline Cerasoli Lecture: Rhetoric and Responsibility in Physical Therapy Education

Abstract

INTRODUCTION I want to thank the Awards Committee and Education Section for this tremendous honor. I am truly humbled to have been recognized in this way. And I want to thank Polly's family for establishing this lectureship. I knew Polly only a little, but I respected her wisdom a lot. When I was informed of this lectureship, I was told to talk about anything I wanted related to professional education, so I decided that I would like to be a bit heretical. Early in my research career, I published papers that challenged some of our cherished clinical beliefs. Today, I would like to reflect a bit on some of our cherished educational beliefs. For some time, I have been struggling with the popular concept of student-centered learning and whether an inaccurate understanding of such a model could actually encourage inappropriate student behavior. This lectureship offers me an opportunity to try to get those thoughts to coalesce and to talk about some of the challenges our educational methods pose as we prepare our future colleagues. Let me say at the start that I do not mean to disavow student-centered learning, which is well supported by research. GOALS FOR STUDENT LEARNING Based on APTAs Core Values,1 Vision 2020,2 and the Generic Abilities,3 1 think we would agree that our goals for our students include some of those listed in Table 1, which is not an exhaustive list. We all want our students to develop the background knowledge and skills to be scholarly practitioners. We want them to use the best evidence available to strive to achieve the most positive patient outcomes.4 We want them to be prepared for lifelong learning and professional development.5 In addition, we want them to understand the culture of the profession and practice in a manner that upholds it. As part of the professional culture, we expect certain professional behaviors1,5,6 that reflect the core values of our profession1 as well as respectful interaction with others,6 critical thinking,5 critical self reflection,7,8 and personal balance.5 These goals will be difficult to achieve if students are not exposed to learning environments in which they have the opportunity and latitude to develop them. The studentcentered learning model is a popular effort to provide such a learning environment. This model is somewhat broader than student-directed learning or student-regulated learning, which I believe are included within student-centered learning. So, although there are some differences between these various models, I will refer to the more global model as student-centered learning. DEFINITION OF STUDENT-CENTERED LEARNING Beginning with the learning theory behind student-centered learning, constructivism9 is learner-centered, and, according to Baviskar and colleagues,10 there are 4 essential elements. First, knowledge is constructed based on existing mental models or prior knowledge. Second, these existing mental models are challenged by new information that creates a cognitive dissonance and stimulates learners to construct new mental models.10 The new knowledge is connected in the brain to the existing knowledge, not simply stored.11 The third element is that the new learning must then be applied, with feedback If students do not actually use information, they cannot remember it They learn to use information by trying to solve problems about which they care.11 Finally, there must be reflection on the learning process.10 Student-centered learning as a curricular model has grown out of constructivism. There are many definitions of student-centered learning, but they all have some common themes. First, it is learner-centered, as distinguished from teacher-centered. In teacher-centered models, the teacher is the sage on the stage, and student learning is assumed. Teachers have no sense of variation among students. Student failures are attributed to lack of motivation, attention, or ability.12 In contrast, in student-centered learning, it is the responsibility of the student to learn. …