This is the third in a series about the evolution of
prosthetics education in the United States. The first article
offered a brief history of the formation of orthotics and prosthetics
educational institutions, beginning in the 1950s. The last article was my
perspective at Northwestern University about how student learners and teaching
practices have evolved over the last 20 years.
This article is a brief history of the teaching strategies that were
used at Northwestern in the early days, leading to the blended learning format
that is currently used at Northwestern. I will explain the effective teaching
strategies utilized by many educational institutions to enhance the clinical
thinking process that residents need for success in the profession as we move
to a higher level of education.
First, let’s take a trip back in time. Most of us remember going
to school as children and sitting in the classroom while our teacher would
stand at the front of the class and teach from a book while we would listen and
take notes. This style of learning is referred by Paulo Freire as the
“banking style of learning,” because the students are considered
banks and the teacher deposits the information in their heads. Throughout
history this is how schools taught, perhaps by design. The purpose of the
banking style of learning is to produce good workers who learn to follow
directions but who do not necessarily think on their own. Even today, many
institutions — including Northwestern — still use this design, but we
try to minimize the amount of banking style lectures. These lectures are useful
to introduce the learner to the subject matter but for a deeper understanding,
other designs may be used.
Different teaching styles
Teachers tried to improve on the lecture style and have discussion
sessions or case methods to allow the student to engage in the learning process
with the hope of improving comprehension and recall. In addition to discussions
or case methods, the teachers sometimes would require writing a paper to
enhance learning subject matter.
Even meeting presentations have changed to improve attendee
comprehension. Why do you think the talks are shorter in time and workshops
arranged alongside the scientific session? The hope is to maintain the
attention span of the participant, but also to allow the individual to provide
feedback during workshops. The participant is allowed to expand their thinking
In the health profession, there is no substitute for actual
patients/clients, so for the past 50 years at Northwestern University we have
had the students work with model demonstrators. The students evaluate, assess
and implement various treatment plans and fabricate upper limb, transtibial,
and transfemoral designs. The purpose is to simulate actual clinical practice
and force the student to troubleshoot under the guidance of the faculty.
Lastly, especially as the master’s curriculum becomes more
prevalent, the question arises if fabrication should still be taught in the
schools. My answer is yes. I realize the future business models downplay
practitioner fabrication, but I believe it is a necessity in school and in
residency. Fabrication skill enhances the learning process and pays dividends
in later years after certification, even as the practitioner focuses on
clinical skills. The Master’s program at Northwestern University will
continue to support fabrication and patient/client interaction, because we feel
very strongly about its effectiveness in student learning. There is a dynamic
blend of cognitive and psychomotor skills when the student fabricates, making
it the best way to learn by recreating real situations.
So, now, how can we recreate reality when the students are online for 22
weeks before coming to our school in Chicago?
One of the more effective methods is problem-based learning (PBL),
popularized in the late 1960s at McMaster University Health Sciences. This
method has been adopted by many medical centers to help produce a deeper sense
of learning through student-centered problem solving. The biggest change to the
modern curriculum is to introduce more PBL to the program and re-introduce the
connection between facts and clinical setting.
Problem-based learning is a total approach to education. As defined by
Dr. Howard Barrows and Ann Kelson of Southern Illinois University School of
Medicine (Kelson), PBL is both a curriculum and a process. The curriculum
consists of carefully selected and designed problems (case studies) that demand
from the learner acquisition of critical knowledge, problem solving
proficiency, self-directed learning strategies and team participation skills.
The process replicates the commonly used systemic approach to resolving
problems or meeting challenges that are encountered in life and career.
One of the aims of PBL is the development of self-directed learning
(SDL) skills. SDL is defined as a “process in which individuals take the
initiative…in diagnosing their learning needs, formulating goals,
identifying human and material resources, choosing and implementing appropriate
learning strategies, and evaluating learning outcomes.”
PBL theoretically positions the student in a simulated working and
professional context that involves policy, process and ethical problems that
will need to be understood and resolved to some outcome. By working through a
combination of learning strategies to discover the nature of a problem,
understanding the constraints and options to its resolution, defining the
input, and understanding the viewpoints involved, students learn to negotiate
the complex sociological nature of the problem and how competing resolutions
may inform decision-making.
In this learning method, the traditional teacher and student roles
change. The students assume increasing responsibility for their learning,
giving them more motivation and more feelings of accomplishment, setting the
pattern for them to become successful lifelong learners. The faculty serve as
resources, tutors and evaluators guiding the students in their problem solving
The PBL techniques will also utilize all levels of Bloom’s Taxonomy
to produce a greater understanding of the information that should increase
long-term memory retention. The student will be called upon to remember
critical facts about the patients, understand various pathologies affecting
treatment of the patient, apply then analyze the newfound information to the
evaluation process and finally create a treatment plan based on sound
justifications. This mimics what is done every day in the clinic setting for
Community of learning
Another technique that is gaining popularity is called the
“community of learning.” With this strategy, the learner enlists help
from many sources to solve a problem. The best analogy I can offer for this is
Wikipedia. Although many educators frown on Wikipedia as a resource, I like it
because there is input from many individuals, instead of just one person. The
references are under constant scrutiny but some interesting factoids can be
found as one sifts through the subject matter. It is a valuable resource built
from many contributions. Years ago we called that a “think tank”
involving many people brainstorming to find a solution.
The O and P listserv is another example of this strategy. The purpose of
this listserv is to allow practitioners to post a problem on the listserv with
the hope that other individuals can help and provide a solution. Over the years
I have learned many treatment strategies from the listserv that I can teach to
my students. I also encourage my students to join this listserv during
residency to help their learning; it is like having a world of practitioners
helping you with a problem patient. Unfortunately, few in our profession choose
to utilize this valuable tool.
Enhance learning experince
Both of these strategies are used at Northwestern University to enhance
the online learning experience. The students are given open-ended case studies
and placed into small groups to find a resolution. The group then must use all
their resources individually and collectively to provide a treatment plan for
that case study and then report back in live video to the faculty at a later
date. They also utilize peer assessment, so group members are held accountable
for their participation. The faculty believes this has been a very effective
tool in training the future practitioner and we constantly strive to find
better methods with the design.
As schools move to a master’s level education and the future
business model promotes less fabrication by the practitioner, the individual
has to be more effective at evaluation, assessment, and implementation of
treatment plans. These learning strategies give residency directors better ways
to work with their residents. Instead of giving them the answers to the
questions outright, make them work at the answers. Make the resident problem
solve and arrive at the answer by using a deeper thought process and understand
the “why” of the solution. Give them homework assignments that will
force them to use PBL techniques or rely on the community of learning. You will
find that the resident will become a more effective practitioner through the
process and in turn a more effective part of the company.
For more information:
Aspy D, Aspy C, Quimby P. What doctors can teach teachers about
problem-based learning. Educational Leadership. 1993; 50(7): 22–24.
Bridges E, Hallinger P. Problem-based learning in medical and
managerial education. Presented at: Cognition and School Leadership Conference
of the National Center for Educational Leadership and the Ontario Institute for
Studies in Education; Nashville, TN; September, 1991.
Friere P. Pedagogy of the Oppressed. Philosophy of
Kelson A. Proceedings from Instructional Design and Delivery. A
course for Instructors of Prosthetics and Orthotics. 2003.
Palmer P. Knowing in Community. The Courage to Teach. San
Francisco: Jossy-Bass; 2007:93–116.
Palmer P. Teaching in Community. The Courage to Teach. San
Francisco: Jossy-Bass; 2007:126–131.
Savery J. What is problem-based learning? Presented at: Meeting of
the Professors of Instructional Design and Technology, Indiana State
University, Terre Haute, Ind. May 1994.
Sousa D. How the Brain Learns. Thousand Oaks, Calif.:
CorwinPress; 2006:44–49; 157; 267–271.