Introduction
Active Learning (AL) is gaining popularity all over the world, even though giving up the ineffective traditional methods of education proves to be a prolonged process (Aliakbari, Parvin, Heidari, & Haghani, 2015). Moreover, AL is being actively promoted in nursing, midwifery, and other educational environments (Herinckx, Munkvold, Winter, & Tanner, 2014, p. 31). The approach is “democratic” in ensuring the participation and active engagement of students, which appears to correspond to modern trends, but to understand the reasons for its popularity, more extensive research into its theory, practice, and context is required.
Literature Review
Definitions
Modern health professional education (HE) can be defined as a “broad and complex set of events, processes and influences, both deliberate and unplanned” that surround the aspiring medical specialist since the beginning of studying and until the final day of practice (Mann, 2010, p. 61). Indeed, nowadays, healthcare professionals are expected to improve their skills continuously; apart from that, medical competence is now considered to be the “professional identity” of a person (Mann, 2010, p. 61). This identity includes the profession-related skills and knowledge but is not limited to them: the requirements of the profession include cognitive and communicative skills, self-awareness, self-improvement, self-assessment, and others (Mann, 2010, p. 62). As a result of these changes, lecturing has stopped being the key or the most effective way of teaching (Kroning, 2014). Traditional education is hardly capable of producing such an outcome, but new approaches, especially AL is technically geared towards achieving it.
AL is any “engaging activity other than that of passively listening to teachers lecture” (Kroning, 2014, p. 448). This definition is very generic, but it is understandable since the means of engaging students are numerous. In this paper, several approaches that can be used in classroom settings will be presented to illustrate the notion.
Active Learning Approaches
To better understand the notion of AL, its specific approaches should be considered. Classroom diversity implies that the varied methods based on these approaches can be suitable for or preferred by a particular part of the learning cohort. As a result, the use of various techniques may be preferable and should be introduced in every particular classroom (Boctor, 2013; Cubas et al., 2015; Moore, 2012; Robb, 2013).
Problem-Based Learning
Problem-based learning (PBL) is an AL approach that “uses authentic artifacts reflecting real-world situations for students to practice problem-solving skills through collaboration with their peers” (Martyn, Terwijn, Kek, & Huijser, 2014, p. 829). Thus, apart from providing the profession-related knowledge, it is aimed at the formation of cognitive and communication skills; besides, this approach qualifies as a self-directed one. It is widely used in nursing and midwifery since problem-solving skills are of especial importance for their future professions (Choi, Lindquist, & Song, 2014). As a result, the approach has proved to be useful for the training of nursing and midwifery students in pre-and post-graduate programs, especially when compared to traditional lecture-based methods (Martyn et al., 2014; Choi et al., 2014).
Team-Based Learning
Team-based learning is a very popular means of teaching nowadays that has also been proved to be effective in HE (Clark, Nguyen, Bray, & Levine, 2008; Maslakpak, Parizad, & Zareie, 2015). It improves engagement, provides the training related to interpersonal skills, and most often is also geared towards the development of other skills, for example, cognitive ones (Lubeck, Tschetter, & Mennenga, 2013). A type of team-based learning is the “near-peer” one that is particularly useful for nursing and can also be combined with simulation experience (Owen & Ward-Smith, 2014). For example, the near-peers (who are the upper-level students) can play the role of patients and mentors. As a result, not only profession-related, collaborative, and communicative skills of the students were trained; for the upper-level student, leadership and teaching ones were also being developed.
Hands-on Learning
The hands-on learning approach offers the students the opportunity to apply what they learn through “physical demonstration” (Robb, 2013, p. 304). It reinforces knowledge, improves the students’ confidence, and helps them to determine and deal with difficulties. An example of such an approach is simulations.
Simulations are concerned with creating an experience that is matching reality to some degree and is meant to recreate a real situation but is not real (Moyer, 2016). Both low- and high-fidelity simulations have been proved to help students organize their knowledge and apply it in the course of such a “practice.” At the same time, low-fidelity simulations are much more feasible and easier to arrange, which is a plus in classroom settings (Moyer, 2016, p. 68). In nursing and midwifery, simulations can be created with the help of software (even in virtual classrooms) or mannequins and actors (McAllister, Searl, & Davis, 2013).
Games
Learning games can also be mentioned as a technique that is particularly approved by a large number of students (Boctor, 2013, p. 96). It is especially good at attracting attention and making students curious, which is one of the goals of AL (Kroning, 2014). From the point of view of the teacher, the specific outcomes may vary. The game described by Boctor (2013), for example, mimicked the “Jeopardy” game and included nursing questions, answering which brought a team “money.” It was aimed at reviewing and learning new knowledge and collaboration. Also, games produce immediate feedback in the form of scores.
Justifying AL
The reasons for the popularity of AL and its promotion in nursing and midwifery education are numerous. First of all, it is admittedly more innovative and suitable for the modern kind of HE than the traditional approach (Herinckx et al., 2014). Besides, AL has been suggested as a more appropriate model of learning for Millennial students: for example, by Robb (2013), Kroning (2014), Welch (2013). Therefore, it is a timely approach suitable for modern students. Moreover, nursing students have reported preferring AL: in other words, it contributes to their satisfaction, which is essential for engagement (Boctor, 2013, p. 96).
The shift towards AL is of particular importance for the classroom settings that are typically concerned with the acquisition of knowledge. Modern opportunities (for example, simulations) have started to blur the line between classroom and clinical settings, though, but it is still apparent that AL is in the process of dramatically changing the former (Fahlberg, Rice, Muehrer, & Brey, 2014; Moyer, 2016). Indeed, AL challenges the classic means of passing the knowledge, which makes the application of its theory to the classroom setting particularly timely. It is also noteworthy that the classroom and clinic settings should not be considered completely detached from each other: in reality, the two need to be collaboratively used to ensure that students use their classroom knowledge in the clinical environment (Po-Han, Hwang, Liang-Hao, & Yueh-Min, 2012). AL is capable of affecting both settings and assisting in uniting them (Dewing, 2010; Wonder & Otte, 2015). Still, they both have their specifics that need to be taken into account, and here, the focus will be on the classroom settings.
AL is still being developed. Its introduction into nursing and midwifery is a new tendency, which means that there is still much room for experiment, research, and improvement (Welch, 2013; Moyer, 2016). Still, its effectiveness in the development of varied skills (problem-solving, reflection, communication) and expanding and organizing knowledge, improving psychomotor skills have been studied and proved to an extent (Moyer, 2016). Therefore, the study of AL in the classroom teaching environment for nurses and midwives is justified, and this paper attempts to provide insights into this topic.
Theories of Learning and Teaching that Inform an Active Learning Approach
The approaches of AL are based on and reflect the theory of learning and teaching. The key learning theories that have had an impact on HE and AL are behaviorism, cognitivism, social, and humanistic learning (Hoy, Davis & Anderman, 2013).
Behaviourism
Behaviourism was the first theory that managed to explain learning from the scientific point of view (Kay & Kibble, 2016). This approach emphasizes the role of the environment (stimuli and consequences) in learning and human behavior in general (Mann, 2010). This theory of learning is well-established, and its methods (positive and negative reinforcement) are very often used in teaching to shape the desired behavior.
Clearly, behaviorism emphasizes the role of the teacher as the environmental agent that produces the stimuli and controls the consequences, but it still contributes to the AL, for example, in the form of incentives and rewards as well as the role of repetition (Kay & Kibble, 2016). Another significant aspect of behaviorism is feedback: according to Mann (2010), behaviorist theory gave rise to this phenomenon (p. 62). In other words, AL uses elements proposed by behaviorism.
Cognitivism
In contrast to behaviorism, cognitivism focuses on the unobservable processes that allow learning to happen: it studied the memory, organization and storing of knowledge, experience processing, decision-making, clinical reasoning, expertise development, and so on (Kaylor, 2014; Aliakbari et al., 2015). Unlike the behavioral theory, this one focuses on the learners and considered them to be active agents who are also unique from the point of view of their pre-existing knowledge, skills, and general ability (Kay & Kibble, 2016). From the point of view of AL, the theory has had an impact on PBL (Mann, 2010). Many memory-enhancing techniques (for example, reviewing, notes, distinguishing crucial knowledge) that are of interest for AL have also been based on the information gained by this theory (Kaylor, 2014).
Social Constructivism and Sociocultural Approach
Based on Vygotsky’s work in many ways, social constructivism focuses on the social and cultural aspects of learning (Hoy et al., 2013). Here, the knowledge is divided into that existing at interpersonal and intrapersonal levels, the latter being a consequence of coming into contact with the former with the help of “semiotic mechanisms” – tools, maps, technology, language, and so on (Kay & Kibble, 2016, p. 22). This theory promotes learning that advances the development of a particular student, and the levels of development are naturally diverse among the learning cohort. The performance here has lesser importance for the theory. The sociocultural approach effectively promotes collaboration, participation, and engagement, which are some of the pillars of the AL (Aliakbari et al., 2015).
Humanistic Approach
The humanist approach (HA) to learning is focused on the concept of self-actualization (Mann, 2010). According to HA, people inherently want to learn and develop. The approach unites theories related to motivation, “self-regulation and self-directed lifelong learning” (Mann, 2010, p. 63). The latter is the goal of ME; apart from that, these theories have contributed to the development of PBL. The teacher is expected to be a facilitator rather than the provider of the knowledge, which is a relatively new and underdeveloped role that contrasts the traditional one (Aliakbari et al., 2015). A drawback of HA is an excessive idealization of human nature (Mann, 2010). Still, the key elements and beliefs of the approach are indeed useful for the development of a professional identity rather than just a set of skills.
Social Cognitive Theory
The social cognitive theory (SCT) basically “incorporates the behavioral, cognitivist and humanist perspective” within the field of social learning theory (Mann, 2010, p. 63). In other words, it admits that the environment and the learner both have an impact on the learning process and the outcomes; it also focuses on the behavior itself and the way cognition mediates it. This approach favors observation as a learning method, which corresponds to role models in HE. Similarly, the simulation approach is based on this comprehensive theory, in particular on the humanistic contribution of self-reflection (Burke & Mancuso, 2012). SCT is aimed at uniting the valid points of all of the previous approaches and attempting to eliminate their limitations (Kay & Kibble, 2016). Indeed, the key theories all have advantages and disadvantages; as a result, the approaches that are used by the practitioners of education can be based on a mixture of the elements from these theories resulting in a blend that is best suited for their students (Hoy et al., 2013; Moore, 2012).
Considerations
With the development of the notion of AL, the whole concept of education has been and is still being reconsidered. For example, some researchers believe that the new approach demands a new environment. The AL classroom needs to be organized differently from that meant for lectures: it needs to be more suitable for engagement and avoid discriminating students depending on the position of their seat (Park & Choi, 2014). Similarly, it needs to be equipped with necessary or recommended tools (for example, classroom response technologies or those aimed at simulation and other virtual experiences) (Welch, 2013; O’Flaherty & Laws, 2014). The integration of up-to-date technology is bordering on a must. Modern students practically grew up with it; moreover, operating contemporary devices is a skill that they are likely to need in the future. This technology also has a great potential for enhancing learning, and it can and should be used during lessons (Kroning, 2014).
Not all the considerations are as easily defined and foreshadowed. AL is more challenging from the point of view of the teacher: it requires the development of non-traditional roles, innovation, out-of-the-box thinking (Kroning, 2014; Walters, 2014). The fact that it is a challenging task is proven by the research devoted to the effectiveness of the approach. The students who were engaged in AL report feeling more confident and satisfied with their results (Everly, 2013; Fahlberg et al., 2014). However, the assessment of the actual effectiveness (end test performance) of the approach brings mixed results (Waltz, Jenkins, & Han, 2014). According to Waltz et al. (2014), the inconsistency might be connected to the fact that the studies offer varied and often incomplete definitions of AL and choose not to use randomized designs. In general, more consistent research is needed to evaluate those methods. It is also noteworthy that the standardized test maybe not sufficient to assess the outcomes of AL that are often concerned with communication skills, or, for example, general development concerning one’s level (Aliakbari et al., 2015). Still, the issue might also be connected to the mentioned difficulties of the role of the teacher in an AL classroom that the educators need to be prepared to.
Conclusion
AL is likely to be described as the educational approach of the future. It has absorbed the elements of the key educational theories and uses varied approaches, all of which are aimed at engaging students and helping them to learn to study, communicate, think, and work to develop their competency. AL is noticeably more challenging than the traditional lecture approach, but it is also more suitable for the development of the professional identity that is demanded from the modern HE. As a result, the AL approach is perfectly applicable to the nursing and midwifery classroom, and by combining the numerous methods and tools and aligning them with the theory of learning, teachers are capable of bringing the education in the field to a new, modern level.
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