The concept of transformative learning and my teaching experience

The impact of educational theory on teaching practice must not be underestimated. During module one I learnt about the concept of transformative learning for the first time. Some elements of transformative learning theory I have encountered in my teaching in the past without truly being aware of it, but the application of it’s principles to my future practice will be invaluable.

In this assignment I would like to focus on how transformative learning has and will shape my approach to group learning and personal tutoring.

The key principle underpinning transformative education is critical self-reflection on our own assumptions and expectations when faced with a ‘ disorienting dilemma’ in which an experience does not fit with our own view of the world. Sociologist Jack Mezirow described this as ‘ learning that transforms problematic frames of reference to make them more inclusive, discriminating, reflective, open, and emotionally able to change’ (1).

Currently the vast majority of teaching I do is small group teaching to medical students on hospital placements. It is often opportunistic bedside teaching on the ward.

Teaching medical students I often find that they have fixed assumptions and expectations of what the role of a doctor is, namely a diagnostician and healer. These ideas become problematic for students when they start clinical placements as they do not match up with the full reality of life as a clinician. I also had these assumptions when I started medical school.

The image of a doctor who instantly knows the diagnosis and saves lives in heroic ways is perpetuated culturally and socially in the media. In reality there is a lot of uncertainty in medicine and often we do not know the exact diagnosis of a patient. Similarly the fixed idea of the doctor as a healer-saviour quickly becomes undone as students see patients die and treatments fail.

The doctors role is multi-faceted and itself transformative. These frames of reference shift during these group teaching sessions away from the one dimensional doctor as a healer, to the doctor as a communicator, listener, thinker and feeler.

Reflecting on my early teaching at medical school I can see how the assumptions I made about medicine and the role of the physician had to change and adapt as I gained more exposure to the field and this is an ongoing process through my career the more I experience, learn and reflect.

Learning about transformative education has forced me to question my own assumptions about the students I teach and the impact this has on teaching sessions. For example, teaching clinical skills to small groups often involves intimate examinations, such as breast, genital and rectal. When teaching these examinations it is easy to assume that the learners have the same experience and attitude as me. When reflecting on my last session, the male genital examination, I had a range of students from different cultural, ethnic and social backgrounds. One student was clearly uncomfortable but I did not appreciate or acknowledge this at the time. I did not address her discomfort or seek to understand why. This undoubtedly impacted her learning in a negative way.

Transformative learning can be applied to both the teacher and learner. Being more mindful of transformative learning in action I want to apply this through my small group teaching to enable students to challenge their own way of thinking, the same way I have been challenged during module 1.

Another area of education I am involved in is personal tutoring and supervision. Through this module I have become aware of the assumptions I make about my students particularly in regards to their motivation to be at medical school and their previous experiences which I assume are the same as mine. I expect a degree of self-motivation from them and take for granted that they will be comfortable with me as a supervisor. A young Asian man, however, might not feel I am best placed to understand his viewpoint.

Reflecting on transformative education in regards to personal tutoring has made me realise I need to appreciate how my experience of the world has biased me and to become more open and inclusive as a result. My experience as a white, British, woman from a working class background is very different to that of most of the students I tutor. In ‘ Re-thinking work with multicultural populations’, Casimir and Morrison argue that we should endeavour to understand the point of view and reference points of health service users to provide better care (2). I think this can be extrapolated to teaching and supervision too. St George’s University is a diverse institution with a large number of international students from all over the world. In addition there are a high number of graduate students coming back to university later in life, some with families and children and different priorities to my own. Student will have different needs and in order to understand these and be a better personal tutor I need to reflect on what their experience and reference points are.

Putting transformative education into practice during module one has helped me improve my relationship with students. For example I tutored a student who had grown up and studied in India and was struggling on a clinical placement. In the UK we have a very patient-centred healthcare system where management plan is often a discourse between doctor and patient. This particular student was finding this hard to relate to as the Indian healthcare system is more traditionally paternalistic and dictatorial. Acknowledging his view point helped us develop a relationship and make a plan of action to help him overcome his difficulties.

Transformative learning is a continuous process over time. It is dynamic with constantly shifting frames of reference in both teacher and student. This module has made me appreciate that I have ideas about the world which impact on my teaching as I encounter views different to my own.

To help incorporate transformative learning in adult education, Cranton set out guidelines based on it’s principles. This includes promoting rational discourse, encouraging equal participation, developing group facilitation skills and encouraging decision making and independent self-reflection through various teaching strategies. It is these principles I want to take forward into module 2 so I can a better teacher, but also a better learner too.