From Bedside to Brain: The Science and Art of Good Teaching

By: Susan Gross Forneris and Mary Kohl Fey

“The important thing is not to stop questioning. Curiosity has its own reason for existing.”

Albert Einstein (1955)

We teach the way we were taught. Where has that left us? As nurse educators we often believe the misconception that our learners are empty vessels into which our expertise — the content —can be poured. We mistakenly believe that everything learners need to know can come from the expertly prepared lecture, delivered by an experienced nurse. After all, lectures are safe, self-contained; a lecture has intentional boundaries between delivery and questions.

Devoid of curiosity — that has been the practice. Our responsibility as educators has been seen as: Get through the content and teach everything needed to function at the bedside. The brain will magically know how to apply that knowledge in context. But content, in and of itself, is the beginning of learning; content that is not applied in the real world of nursing practice has little value. True learning happens when learners have  opportunities to apply content knowledge and then reflect on the experience.

What if curiosity — at the bedside — became the driver of clinical teaching? A curious educator, seeking to understand the learner’s perspectives, can then guide the learning using strategies that build cognitive muscles so the brain can perform immediately — at the bedside. EUREKA!

In our volume 2 monograph, Critical Conversations: Moving from Monologue to Dialogue, we take educators through a neuroscience journey to explore key strategies from the education discipline that enhance critical thinking. We believe that dialogue is the foundational thread, and that curiosity underpins these neuroscience strategies. In this monograph, we weave together the latest in neuroscience teaching and learning strategies with the art of dialogue. Let’s explore a few ideas.

Context

Creating a context for learning — a space in which learners can take risks while learning, including the risk of failure, without fear of shame or humiliation — is job #1 for educators. This learning space invites reflection and open dialogue. The first steps in creating this space begin in the mind of the educator. As educators, we must embrace errors as unavoidable and welcome steps in the process of learning. Seen through this lens, errors become a mystery to be solved instead of a crime to be punished.

How do we create this space? By clearly framing the learning encounter; sharing the plan for the experience; being transparent about the benchmarks for success; and norming the material within the context of a developmental journey. Importantly, the educator discusses strategies to manage the challenges. As we frame and norm the context, we also guide learners to retrieve prior knowledge that can be applied and built on for the current learning challenge. Retrieval builds confidence through repeated use of existing knoweldge — the beginning step in building cognitive muscle (Forneris & Fey, 2020; Weidman & Baker, 2015).  

Content

Content represents the heart of the learning experience — it is the knowledge that the learner puts into action. Curiosity about how our learners piece together and use their knowledge is the starting point for the teacher-learner encounter. Only when learners use the content, and we observe them as they apply it, can we come to understand the connections they are and are not making. By paying close attention to this, we are able to examine learning needs and gaps and see how learners’ knowledge, assumptions, perspectives, impressions, and past experiences inform their understanding and decision-making. Dialogue is key to this process: We observe, we question, they reflect and explain their thinking, we co-create new knowledge. As we model curiosity, we hope to instill that in our learners as well, as we guide them in reflecting on their use of knowledge to make clinical decisions.  

There are several neuroscience-based learning techniques at the educator’s disposal. Two strategies that guide educators in effective content immersion are chunking of content and checking in for understanding. Both consider the amount of cognitive lift (or cognitive load) being required by our learners: Too much and they are overwhelmed; too little and we lose them to boredom. With just enough of a challenge, our learners practice at the edge of their expertise, and we have them in a powerful learning moment (Josephen, 2015; Meguerdichian et al., 2016; Sweller, 1994; Van Merriënboer & Sweller, 2010). While navigating the learning experience, the educator looks for key opportunities to support the learner through the use of various scaffolding techniques. Among these are reflective questions, use of cognitive aids, and the previously mentioned techniques of retrieving prior knowledge and chunking information. 

Course

What good is content if we can’t assure that learners carry it forward into new and different contexts? Helping learners see how content mastered in one situation can apply to others in the future creates durable, flexible learning. This where the bedside meets the brain. A variety of teaching and learning strategies are available to help our learners connect concepts and ideas within a domain of learning. The educator’s ability to move fluidly between Content and Courseconstitutes the dynamic and critical nature of the learning space dialogue. Metacognitive dialogue, collaborative cognition, and analogical transfer are key to engaging learners in conversations that help them navigate between what they know and how that knowledge can be applied to future, similar situations. This is an important dynamic that leads to solid learning now, and a likelihood that learners will be able to successfully use the learning in future contexts (Kirschner et al., 2018; Weidman & Baker, 2015).

We are excited to bring you the second volume in our critical conversation series: Critical Conversations: Moving from Monologue to Dialogue. This volume curates the best evidence in neuroscience-based teaching and learning strategies. Tables highlighting points of dialogue illustrate how to immerse your learners, keeping them at the center of the learning encounter. We invite you to explore how to build on to your repertoire of teaching and learning strategies as you develop your expertise and begin to transform the learning space. Additionally, please join us for our recorded webinar – Bedside to Brain: The Science and Art of Good Teaching where we dove into these techniques and shared more about the use of neuroscience teaching strategies in nursing education.


References

Forneris, S. G., & Fey, M. (2020). Critical conversations (Vol. 2): Moving from monologue to dialogue. National League for Nursing.

Josephsen, J. (2015). Cognitive load theory and nursing simulation: An integrative review. Clinical Simulation in Nursing, 11(5), 259-267.

Kirschner, P.A., Sweller, J., Kirschner, F., Zambrano, J.R. (2018). From cognitive load theory to collaborative cognitive load theory. International Journal of Computer Supported Collaborative Learning, 13, 213-233. https://doi.org/10.1007/s11412-018-9277-y

Meguerdichian, M., Walker K., & Bajaj, K. (2016).  Working memory is limited: Improving knowledge transfer by optimizing simulation through cognitive load theory. BMJ Simulation & Technology Enhanced Learning, 2(4),131-138.

Sweller, J. (1994).  Cognitive load theory, learning difficulty, and instructional design. Learning and Instruction. 4(4), 295-312.

Van Merriënboer, J.J., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Educator, 44(1),85-93.

Weidman, J., & Baker, K. (2015). The cognitive science of learning: Concepts and strategies for the educator and learner. Anesthesia & Analgesia, 121(6), 1586-1599.

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