I teach first year medical students human embryology and histology. Embryology is the discipline that deals with the development of a human from the time of fertilization until birth. Histology is the discipline that studies how the cells and tissues of the body are organized to form organ systems. The structural organization of these cells and tissues determines the way in which an organ functions. In our courses, we take students who are right out of the very competitive process of applying for and then getting into medical school, and we begin preparing them for the clinical practice of medicine. What is so intriguing is the pervasive sense of anxiety and fear that comes over these very bright students as each exam approaches. They become fixated on learning for the examination and lose perspective of why they are in these classes and what the goal of their learning is. I have a vision, though, the heart of which is a classroom that is a safe place for students and one they are not afraid to be in. In it they learn science and they learn who they are.
The courses I teach are taught to 180 students, and for embryology most of the teaching is done by lecture. In histology, the lectures are augmented by laboratories that in the past have been rather traditional (i.e., centered around microscope exercises). We place a series of tissue sections on glass slides for each of the organs and ask the students to learn the characteristic features of each organ. Our exams are multiple choice, with histology adding a "practical" examination that consists of cells, tissues, and sections of organs on slides that the students are required to identify. There are three examinations in each course and the students are expected to attain a 70 average to successfully pass each. These are the first examinations the students have in medical school, and the fear that they have is understandable and real. The question that I continue to focus on is whether that fear is necessary or desired, or if can I develop a classroom that feels entirely different.
In my vision, students are working together to learn, to teach, and to help each other accomplish shared goals. The vision includes faculty acting as facilitators who guide their students' learning and help them find their way. My vision also sees students learning as much about themselves as about science "facts," for they must become lifelong learners about both their clinical specialty and their ethical and moral responsibilities. As Steve Gilbert reminds us, students should understand Gandhi's teaching that "science without humanity" is one of the "seven blunders of the world that lead to violence" (Gilbert, 1998).
I think about the recent advances in medicine and all of the new technology that now allows us to even clone animals and humans, and I ask whether my students consider the awesome power that will be in their hands. We can use sophisticated techniques to predict diseases and congenital disordersyet when do we ask students to think about the moral issues that surround these new capabilities? My students are so wrapped up in passing an exam that they often miss the incredible power that their learning will bestow upon them. My students get so wrapped up in figuring out what it is they need to know that they often forget why they have to know it and who they have to know it for. Their classroom is so outcome-oriented, so fact-directed, that they are almost totally engulfed in acquiring facts simply to safely pass an examination. Their mantra is, "Tell us what we need to know and we will learn it." But they learn it in fear and they learn it as a rite of passage, not as something that they will hold dear for future use.
In the near future, technology may allow us to build an alternative, what I think of as a safe, holistic classroom. Jane Tompkins talks about it in her book A Life in School: What the Teacher Learned: "...School should be a safe place, the way home is supposed to be. A place where you belong, where you can grow and express yourself freely, where you know and care for the other people and are known and cared for by them, a place where other people come before information and ideas" (Tompkins, 1996, p. 127). Edward "Ned" Hallowell said in 1996 in his plenary session at the 2nd Annual Teaching, Learning, and Technology Roundtable Summer Institute in Scottsdale, Arizona, "...fear is the most serious learning disability." Susan Saltrick said in her beautiful piece "Through a Dark Wood": "If Goethe is right, if we learn from those we love, and if love is the opposite of fear, then one might be tempted to say that real education can occur only when there is no fear" (Saltrick, 1997).
Yet as I teach, and watch others around me teaching, I find that for most students who are learning science and math, the major motivating force is fearfear of failing, fear of a bad grade, fear of feeling inferior to others in the classroom. As faculty members, some of us have taken pride in providing our students with "egotrauma" that we thought might provoke them to learn. Especially in science courses, we have thought more of gate-keeping than inspiring; more of filling heads with facts than helping students learn; and more about testing for memorization of those facts than showing our students how to relate them to their learning about the rest of the world. Many of us followed the path so exemplified by the TV character Professor Kingsfield, played by John Housman in "The Paper Chase." As much as we were convinced that he loved his students, he used to terrorize them so that they would come to class prepared. He would badger them throughout to see if they really knew the material. I remember as a student having a class like that. I remember years later teaching a class like that. I cannot teach that way any more.
Higher education is in need of science faculty who, as Tompkins and others might say, want to provide a holistic approach to learning. I am tired of seeing my students approach their first examinations with fear, and having fear pervade the course. Students feel no joy in learning. They have no fun in accumulating knowledge. They can't see themselves or their intellects grow.
Can't technology drastically change the paradigm? Can't we use technology to help our students pace their own progress, assess their own accomplishments, and succeed by working together?
I think of the garden that my wife and I grew last summer. We worked together to till the soil, to plant the vegetables, to weed and water. Now, as another spring is about to arrive, she reads books on how to grow this garden. She spends hours looking at catalogues planning, and we talk to others about our garden. In particular, we like pond gardens. We have three. Now we are about to build a bog garden, and we talk to people in nurseries that supply pond gardens about the best way to build a bog garden. Often my wife ends up teaching them about bog gardens. Other times they teach us. However, as I look back over our vegetable, flower, and pond gardens, we knew how we did in the end, and our progress was very evident. We knew when we learned!
And there was no fear! We did not get anxious about the green beans. Maybe the lima beans were only an average crop, but the cherry tomatoes were great! The lotus in one pond was marvelous. It was too bad my wife never saw it open; she missed a spectacular show. Now the question is: why can't learning be like that for our students? I think it can be and should be. Technology might allow us to transform the classroom into a plot of earth that students can tillwhere they can work together.
I often think that we teach science as if we are lecturing students about a garden. We quiz them on the different types of lettuce; multiple choice questions about tomatoes are great for our exams. We ask them to tell the difference between the germination time for cherry tomatoes as opposed to the "early girl" variety. We give them the catalogues and books and then we tell them to memorize what is in them. At times during our lectures we show them pictures of our own gardens, but we will not let them in the garden. We fail to ask them to work side by side with us to discover the joy of gardening. Trent Batson and Randy Bass recently addressed this issue in their article in the March/April 1996 issue of Change: "...many teachers have long expressed a desire that students experience more directly the process of how knowledge is discovered, created, shared and shaped in their fields. Instead of reading a textbook about American history, for example, teachers want students to get closer to primary materials or to history-in-themaking, to understand the complexity of analyzing events in context" (Batson & Bass, 1996, pp. 42-47).
The challenge we now face is giving up the old paradigm and reconstructing one that permits students to get into the garden to learn the discipline, to till the original data and to find out information that is going to be important to them and their field of interest. Instead of giving my students slides and then asking them to identify a kidney or a liver, maybe I can give them a CD filled with images of organs and tissues and they can make their own histology atlas. They can reconstruct their own atlas and label their images the way they find most useful. They can organize the material the way they find most suited to their learning needs. In the end they will know how much of the information stayed with them and how much more they need to learn before they enter clinics.
I also want my students to be able to take the time to stop and listen to the rests between the notes, as Susan Saltrick encouraged us to listen to Bach's Goldberg Variations this summer at the 3rd Annual Teaching, Learning, and Technology Roundtable Summer Institute in Phoenix, Arizona. I want my students to experience the silent moments that Tompkins discovered were so important. I want my students to learn that even in science classes it is important to be connected to each other and to other fundamentals of human nature, as Ned Hallowell continues to remind us.
Can't we use technology to add the humanistic part of the equation that makes a person whole? Many of my own students and others taking science courses do not see the relationship between science and human needs, between science and human capabilities. They do not see the relationship between what science has accomplished, how it is conducted, and the impact it has on the world. I think of Palmer Parkers words in To Know as We are Known: "At this crucial moment, we have an opportunity to revision education as a communal enterprise from the foundations upin our images of reality, in our modes of knowing, in our ways of teaching and learning. Such a revisioning would result in a deeply ethical education, an education that would help students develop the capacity for connectedness that is at the heart of an ethical life" (Parker, 1993, p. xix).
My students were in the midst of studying for their midterm exam this past semester, and many were clearly anxious and worried. Their faces showed the strain of trying to anticipate whether or not they could measure up to their classmates and do well on this examination. Some had really lost sight of why they were therenot just to learn about the liver, the gallbladder, and the rest of the abdominal organs, but also to be able to use this information when they were to go into the clinic. At the same time, my mother was about to have a gallbladder operation. I entered the classroom and read them Michael Harpers poem "Sac A Woe: Gallstones as History," from his book of poetry, history is your own heartbeat. I think my students realized that the gallbladder became more than an organ to learn about. They would need to use their information to help people, people such as my mother. As I personalized their learning, I hope they came to see that there was more than the exam. Their goal needed to become lifelong learning, rather than the immediate feedback of the midterm.
Now, can I remove the exam altogether? Or at least can I offer online assessments that the students can take at their own pace, with their own sense of readiness? I am moving my testing to the garden. I would like students to see the tomatoes that they have sown. I want them to appreciate all the work they have done. I want them to build a portfolio of accomplishments that will fill them with pride and that they can take with them, to the clinical rotations, to their residency programs, and finally to their practices. They can add to these portfolios and develop them through their careers, and with the aid of technology these portfolio databases can now be accessed anywhere the student is located.
As a final example, I am teaching a few students an advanced elective in embryology. I thought that the course should be student directed. One of the first questions they asked was if they could develop a timeline of development. When do certain organs first appear, mature, and become functional? When does a fetus first have fingernails? When do premature infants start to suckle? When can they be breastfed? Together we will begin to accumulate this timeline and then we will put together a Web site so that they will always be able to reference this work. They can claim ownership. It will be their garden and they can harvest from it.
Batson, T. & R. Bass (1996). Primacy of process: Teaching and learning in the computer age. Change March/April, 42-47.
Gilbert, S.W. (1998, February). Welcome back! TLT group and Gandhi's list [Online]. Available: Click here.
Harper, M.S. (1971). history is your own heartbeat. Urbana, IL: University of Illinois Press.
Palmer, P.J. (1993). To know as we are known: Education as a spiritual journey. New York: HarperCollins Publishers.
Saltrick, S. (1997, November). Through a dark wood [Online]. Available: Click here.
Tompkins, J., (1996). A life in school: What the teacher learned. Boston: Addison-Wesley.management gamesaction gamesword gamespc gamesshooter gamestime management gamesdownloadable games