In this extra post, Dr Adan Chew, Dr Jess Gurney, and Dr Magdalena Cerbin-Koczorowska, from Edinburgh Medical School, explore the concept of student-centred education through the lens of medical education and clinical practice. In considering different learning theories, they foreground the importance of social and cultural influences, and the uniqueness of the individual, on learning.
A superficial understanding of a student-centred approach to education may falsely lead to the belief that standardisation of teaching activities can become a source of high-quality education.
The concept of student-centred education (SCE) has existed in literature for many years. It entails a shift in focus of the educational process from the teacher to the student. Higher education institutions have to find their place in the commercial and competitive market of educational services. which can result in a risk of misinterpretation and a superficial understanding of the SCE approach (Fawns et al., 2021; Trinidad, 2020).
Identifying a ‘competent student’ as a product of robust teaching activities without acknowledging the philosophy behind it, the power of the student-teacher relationship, and the nature of the learning process, may falsely lead to the belief that the standardisation and detailed evaluation of teaching activities leads to outstanding education (Trinidad, 2020). On the contrary, it has the potential to negatively affect teachers’ creativity and self-esteem (Fawns et al., 2021). Additionally, this belief opposes the concept of students as co-creators, which has been suggested as a future direction for higher education (Bovill, 2020; Stoddard et al., 2024).
At the decision-makers’ level, a superficial approach could be adopted due to a misunderstanding of the concept of standardisation as promoted by the World Health Organization and the World Federation of Medical Education (Weisz & Nannestad, 2021). The movement toward the “market model of the university” results in higher education institutions imitating behaviours and elements of organisational culture from large corporations (Jongbloed, 2003). Although standardised measurements of students’ knowledge and clinical competencies are seen as a driver for high-quality medical education (Scoville & Bisson, 2018), some institutions have attempted to standardise the delivery of educational interventions in response to the challenges of mass education (Mierzwa & Mierzwa, 2020).
This approach seems to contradict what is understood about learning. As we outline here, an exploration of the predominant learning theories demonstrates that not only should each learner be treated as an individual with their unique learning readiness and abilities, but the dynamic and multifactorial nature of the educational environment cannot be ignored.
Starting from the behaviourist approach, which suggests that learning is underpinned by habit formation, the response to a standardised stimulus will differ across individuals (Hull, 1943). The response is shaped by learners’ unique biological features (such as the number and sensitivity of receptors) and previous experiences which shape neural structures and cognitive abilities. Even if it could be widely agreed on how one defined the intended effect, the type of reinforcements and punishments considered more or less effective and the time of stimulation needed to achieve the intended effect will vary across learners.
Analysing the nature of learning through the lens of constructivism requires considering the importance of prior knowledge and existing mental frameworks. As these vary among our learners, the same information is perceived differently based on aspects such as cultural background and prior learning experiences. Clinical practice is varied and uncertain, meaning each learning event is a unique experience. Moreover, learner motivation to reflect upon experiences and actively construct their own understanding might differ based on temporary psychosomatic conditions, which in turn impact factors that affect intrinsic motivation, such as perceived control and task value (Eccles & Wigfield, 2002). This ultimately influences how learning messages are interpreted.
Finally, the social aspect of learning cannot be omitted. Clinical practice and training often occur in various learning settings, with different mentors and peers, forming communities of practice (Lave & Wenger, 1991). Furthermore, learners assume different identities – some are mentors themselves, or some may be guided to different extents by teaching fellows, professors or clinical supervisors. This in turn brings their unique experiences and cognition perception into the shared repertoire in varying settings.
Indeed, this is also dependent on the extent of engagement learners have integrated with their respective communities of practice (ibid.), coined by Lave and Wenger as “peripheral participation” (1991). It is simply too easy for standardised educational practices to disregard the multifaceted aspect of learners’ experiences. Since each learner has unique interactions and interpersonal experiences, the learning process becomes personalised and distinct for each individual.
Considering the above models that foreground the importance of social and cultural influences on learning, the pursuit of standardising the delivery of teaching activities may not only fail to bring the intended results but is also literally impossible. This is especially the case for a clinical teaching environment, where the social aspect is even more dynamic.
Finally, keeping in mind the above-mentioned importance of observational learning, we need to be aware that how different members of higher education institutions approach various aspects of the educational process may stimulate but also distort its true nurturing value. Bates et al. (2019) state that, “The inevitable diversity of contexts for learning and practice renders any absolute standardisation of programs, experiences, or outcomes an impossibility.”
There is simply no ‘one size fits all’ approach to student-centred education. Even though, as humans, we strive to minimise uncertainty by categorising our observations and generalising them, educators (including decision-makers) must acknowledge and become equipped to deal with this uncertainty. Instead of confining teaching activities to uniform and limited parameters, utilising pedagogical expertise in combination with creativity and courage allows us to embrace the precious uniqueness of learning.
References
Bates, J., Schrewe, B., Ellaway, R. H., Teunissen, P. W., & Watling, C. (2019). Embracing standardisation and contextualisation in medical education. Medical Education, 53(1), 15–24. https://doi.org/10.1111/medu.13740
Bovill, C. (2020). Co-creating learning and teaching: towards relational pedagogy in higher education. Critical Publishing.
Eccles, J. S., & Wigfield, A. (2002). Motivational beliefs, values, and goals. Annual Review of Psychology, 53(1), 109–132. https://doi.org/10.1146/annurev.psych.53.100901.135153
Fawns, T., Aitken, G., & Jones, D. (2021). Ecological Teaching Evaluation vs the Datafication of Quality: Understanding Education with, and Around, Data. Postdigital Science and Education, 3(1), 65–82. https://doi.org/10.1007/s42438-020-00109-4
Hull, C. L. (1943). Principles of behavior: An introduction to behavior theory. Appleton-Century.
Jongbloed, B. (2003). Marketisation in Higher Education, Clark’s Triangle and the Essential Ingredients of Markets. Higher Education Quarterly, 57(2), 110–135. https://doi.org/10.1111/1468-2273.00238
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press.
Mierzwa, D., & Mierzwa, D. (2020). Organisational culture of higher education institutions in the process of implementing changes–case study. Journal of Decision Systems, 29(sup1), 190–203. https://doi.org/10.1080/12460125.2020.1848377
Scoville, J. P., & Bisson, E. F. (2018). Quality and standardization of medical education. In Quality Spine Care: Healthcare Systems, Quality Reporting, and Risk Adjustment (pp. 15–28). Springer International Publishing. https://doi.org/10.1007/978-3-319-97990-8_2
Stoddard, H. A., Lee, A. C., & Gooding, H. C. (2024). Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory. Teaching and Learning in Medicine. https://doi.org/10.1080/10401334.2024.2313212
Trinidad, J. E. (2020). Understanding student-centred learning in higher education: students’ and teachers’ perceptions, challenges, and cognitive gaps. Journal of Further and Higher Education, 44(8), 1013–1023. https://doi.org/10.1080/0309877X.2019.1636214
Adan Chew
Dr Adan Chew is an academic foundation doctor and a student in the MSc Clinical Education Programme at Edinburgh Medical School. She has a keen interest in medical education, and also enjoys hiking and running in her spare time.
Magdalena Cerbin-Koczorowska
Dr Magdalena Cerbin-Koczorowska directs the MSc Clinical Education Programme at Edinburgh Medical School.
Jess Gurney
Dr Jess Gurney is a Lecturer on the MSc Clinical Education, and works clinically as a doctor in Medicine of the Elderly.
