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MEDICAL SCIENCE EDUCATOR The Journal of the International Association of Medical Science Educators Med Sci Educ 2012; 22(4S): 264-266 KEYNOTE LECTURE The Learner-Teacher Relationship Steven L. Kanter, Victoria Groce & Eliza Beth Littleton University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Abstract The relationship between learner and teacher is fundamental to medical education, yet there has been limited research on the subject. We explore how analogies to theories from two other fields—evolutionary biology and social theory—may help us understand some of the tensions in this relationship and may offer guidance on how to solve problems between learners and teachers. The Learner-Teacher Relationship The learner-teacher relationship (LTR) is as central to medical education as is the patient-doctor relationship to medical care. Educators make important decisions about curricular structure, facilities, and instructional methods, but in the end, their success hinges on the interaction of each student with his or her teachers, and on each teacher with his or her students. Aside from the excellent chapter by Richard Tiberius and collaborators, little has been written about the nature of the learner-teacher relationship in the context of medical education. 2 Since there is little guidance in the literature, we will explore the LTR through the lens of two theories from the fields of evolutionary biology and social theory. We will pursue a thought experiment to see whether these theories, from fields not typically associated with medical education, can help us learn where we might be able to strengthen LTRs, or to raise concerns that may have been overlooked heretofore. In a biological niche, organisms can interact in symbiotic relationships that are beneficial, harmful, or neutral to one another. The same can be true in our medical schools, and indeed in any situation where humans interact. Cooperation is defined as a situation in which two individuals interact such that each has a beneficial effect on the other. Facilitation is the situation in which one individual has a beneficial effect on the other, but the latter has no Corresponding author: Steven L. Kanter, MD, Vice Dean, University of Pittsburgh School of Medicine, M-240 Scaife Hall Terrace and DeSoto Streets, Pittsburgh, PA 15261 Tel: +1-412- 648-9000; Fax: +1-412)-648-9065 email: kanter@pitt.edu effect (neither beneficial nor harmful) on the former. Assuming a cooperative (i.e., mutually helpful) LTR, we would expect learners and teachers to each contribute to and benefit from the relationship. Table 1 operationalizes this notion in a 2X2 table with cells representing what the learner gives to and receives from the relationship, and what the teacher gives to and receives from the relationship. For example, in traditional lecture-based teaching, teachers may provide information, context, and perspective for that information; learners may receive (or construct knowledge around) the information they need to master the subject matter. Perhaps less obvious—but no less important—are what students give and teachers receive. The learners' attention, feedback, and time can provide teachers with valuable information, and students' questions and new insights can help both learner and teacher refine their knowledge and understanding. In addition, teachers often can benefit from the internal rewards of teaching. In situations in which learners and teachers give and receive in equal measure, a positive feedback loop can emerge, making the educational transaction worthwhile for all concerned and helping to strengthen a useful alliance between teacher and student. This operationalization of the LTR, based on the evolutionary biology theory of cooperation, can provide a framework for analyzing one’s own teaching settings or for comparing teaching under different conditions. For example, one could explore what points each cell in Table 1 would contain if Medical Science Educator © IAMSE 2012 Volume 22(4S) 264
applied to a lecture versus a small group setting versus team-based learning. Learner Teacher Table 1 Gives Receives Another application of Table 1 would be to use it to analyze the difference between a traditional lecture setting (that is not audio- or videotaped) and a lecture that is recorded and posted on a web site for later viewing (i.e., podcasting). It is well known that, while video streaming of lectures may still provide the knowledge and context that students need, it also may lower physical attendance in the classroom. Although it is common for teachers to focus on the lack of student attendance, Table 1 might reveal that the fundamental problem lies in the lower right-hand cell – i.e., that, under conditions in which lectures are taped and available on the Internet, teachers do not receive the attention and feedback on which they rely both for calibrating their teaching to students' needs and for internal reward. This realization could lead to better solutions than would a narrow focus on lack of attendance. Another framework through which to view the LTR is the social theory of Max Weber, one of the founders of the modern discipline of sociology. 1 Weber developed a theory of “ideal types,” stating that "An ideal type is formed by the one-sided accentuation of one or more points of view and by the synthesis of a great many diffuse, discrete, more or less present and occasionally absent concrete individual phenomena, which are arranged according to those one-sidedly emphasized viewpoints into a unified analytical construct." 3 If we apply Weber’s theory to the LTR, it helps illuminate different characteristics of “idealized” learner-teacher relationships and reveals how different types of LTRs may exist along a continuum. (See Table 2) In this application of Weber’s theory to the LTR, paternalistic and cooperative LTR types lie at two ends of a continuum. In accordance with Weber’s theory, no individual LTR needs to fit all of the characteristics of one type, and a given LTR may exist somewhere in between the two defined models. For purposes of completeness, it is worth mentioning that theoretically, another LTR “ideal type” — perhaps it would be labeled “anarchic” — may exist further to the right of the collaborative type defined in Table 2. This “anarchic LTR” would be one in which the student is in full command of the learning environment and the teacher functions strictly as a resource to be used at the student's behest. For some time now, medical education has been evolving from a paternalistic ideal type to a more collaborative ideal type. We can use these ideal types, as defined in Table 2, as a lens through which to view the problem mentioned above – that technological delivery methods for lectures might lower learner attendance, and might therefore compromise teachers' experience in the classroom. Conception of Teacher Task of Teacher Conception of Learner Task of Learner Paternalistic …* Collaborative Expert, authority figure Provide information Blank slate Acquire knowledge Control Teacher … Shared Stress on student Teacher view of student Warrant student competence Relatively lower A dependent child Teacher … … … … … … … Expert, coach, guide, facilitator Design experience to foster understanding Primed slate (prior experience and knowledge provide context) Construction of meaning Relatively higher An independent adult Faculty member who does not teach in the course/unit Table 2: Paternalistic & Collaborative Ideal Types of Learner- Teacher Relationships *The ellipsis indicates that the “paternalistic” and “collaborative” types lie at each end of a continuum. In the context of a paternalistic LTR, one can imagine the teacher simply requiring that students be physically present at lectures. (After all, by definition, the focus of a paternalistic LTR is on the transmission of information, and podcasting accomplishes that goal quite well. So, either the teacher could eliminate podcasting or require attendance.) However, a collaborative LTR fosters a broader approach to considering potential solutions to the “podcasting” problem. For example, since a Medical Science Educator © IAMSE 2012 Volume 22(4S) 265
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Page 8 and 9: main focus of the collaborative LTR
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Page 34 and 35: METHODS The new curriculum began to
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Page 52 and 53: CONCLUSIONS Requiring students to a
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Programmes, Non Governmental organi
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METHODS Literature search was condu
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member's change with the patient's
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graduates recognized the availabili
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CONCLUSIONS This rubric will provid
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RESULTS The TBL results, examinatio
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etween pre-test and post-test mean
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students, audio-recording their dis
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Individual Journal Subscriptions Av
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MEDICAL SCIENCE EDUCATOR The Journa
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