By Shady S. Shebak, MD
Psychiatry Resident, Virginia Tech Carilion School of Medicine, Roanoke VA
I have developed a personal educational philosophy over the past several years during psychiatry residency training. I have come to understand that in any educational philosophy, there are elements of pedagogy (classic teaching that was designed to teach children), but as Knowles1 discussed, adults are internally driven and learn best when they feel as though their interests and their independence are respected. Group work, discussions, and relaying of experience to one another is essential when discussing how adults learn, and as we will see, androgogy (adult learning theory) as explained by Knowles has elements of several of the classical and resurgent learning theories, as well as educational philosophies.
From reading Knowles, I realized that indeed, I am always much more keen on learning when I am included in creating a teaching environment that will house my mind. He makes a point when laying down the foundations of androgogy that traditionally teachers were the planners (and might I add executioners) of the learning process. Teachers most definitely have a crucial role in planning lessons and didactics, but involving their adult students (be they undergraduate or graduate students) shows a respect and creates a sense of comradery that I find very fruitful and motivating. On a personal note, I’ve learned best when I’ve been given an opportunity to involve myself in the planning of what I am expected to learn. This is the defining difference between pedagogy and androgogy.
Moving on to the classic learning theories, humanism resonates most strongly with me. Learning for the sake of self-improvement, improvement of the human condition, and eventually to gain self-actualization2 are driving factors in my striving to learn and gain knowledge. I believe the self-actualization is actually to attain or achieve a level of wisdom that a true lover of learning yearns for; in the same manner as Parsifal yearned for and chased the Holy Grail during his mythical expedition. Humanism is in summary, what medicine is. In Arabic, one of the terms for physician is hakim, which stems from the word hikma, and hikma means wisdom. I think humanism leads one to wisdom, and is essential to the practice of medicine. As Stern, et al.,3 outlined, humanistic physicians demonstrate respect, empathy, and integrity in patient-doctor interactions. Furthermore, I find humanism a summary of many of the classical learning theories, as it has within it the appreciation of role-modeling of social learning theory4, as well as reflecting and creating knowledge out of experience, and emphasis on the learner as outlined by constructivist learning theory5.
Let me shift and discuss another learning theory that I find important, and that is narrative learning theory. The best way to explain this theories importance to me as it relates to my learning is to provide a story… a narrative.
It was my first week as a psychiatry resident. I was presenting a patient to an attending who was filling in for my team for that day. I was expecting it to be an easy day as he was ‘just filling in’. As I started to present the case and the diagnoses, he asked me for my reasoning. I told him that the patient has a long history of these diagnoses, and that is when the attending asked me to be careful in sticking to the diagnoses in the chart. He told me I should always challenge what is in the chart and that sometimes we may have to rely on past diagnoses, but that we should always try to conduct a full diagnostic review for our patients if we expect a diagnosis. He also said that by relying on the chart for my diagnoses, I may be missing the bigger picture that the patient may have underlying personality issues or developmental issues that are mimicking another disorder. By not doing a full review with the patient, and without challenging the chart, I may be missing a big component of the patient’s presentation.
Looking back now, it is almost an obvious lesson, but at the time it was a big step forward for me. As I became more analytical, more comfortable with changing diagnoses or removing diagnoses, and even more comfortable suggesting new treatment plans. I utilized this attending as a role model, and since then, I’ve chosen him to be my mentor. He has provided me with books on mythology, story-telling, as well as articles that challenge the status quo within psychiatry. I’ve learned a great deal by putting more effort in acquiring the narratives of my patients, as well as from reading stories from various cultures and eras. He ignited in me a latent curiosity that has taken me on a journey of learning through reading stories, understanding my patients’ stories, and modeling his own qualities that I find appealing. Hence, my encounters with him are representative of narrative learning theory as these encounters hold a significant portion of my unfolding book of life, but these encounters are also embodied within social learning theory, which places emphasis on learning through modeling4. I’ve reflected deeply on these encounters with him, but I’ve also spent considerable time reflecting on my life in general; upon my childhood, my loved ones, and my future. I agree with narrative learning theorists that our experiences and our actual person are one and the same, and that these things are much more intimately related than what many constructivists have postulated6.
Oral traditions, poetry, Perennial wisdom from thinkers and writers alike, as well as spirituality are things I consider to be essential for my continued growth. I view my life, human life, nature, careers, interests, and paths to be sacred. This sacred feeling or plane is something I believe is hardwired into us, and thus any knowledge produced from the heart, with purity of intention falls under this ‘sacred’ category that I’ve created for myself. And because of my belief that it is hardwired into us, I feel as though all learners have a capacity to grow and learn by utilizing traditional and spiritual methods. Hence, seeking knowledge from the outside world as well as from my own inner world is a form of worship, and I feel constantly energized and replenished when learning something worthwhile.
I like to think of my passions as emergencies or urgencies, and the way I address these emergencies is to teach them to others in the hopes of reforming and adding onto incomplete ideas. As someone who is somewhat introverted and somewhat extroverted, I usually form an idea or ideas, make personal conclusions about that idea, and then I share the idea with friends or colleagues in the hopes that they will add onto it or take something useful from it. Teaching should not be something that is dry and fully curriculum oriented, nor should it be done with the goal of ‘bestowing’ knowledge upon another. Rather, it should be done enthusiastically, with inner purpose, and with the goal of sharing knowledge and attaining knowledge through the experience of teaching. Some of my favorite learnings occurred outside of the rigors of curricula, and at times, without verbal exchange. Teaching and learning is multi-dimensional, complex, and truly a personal and collective process. We live in a social environment, and if we pay close attention we will find a library of plots, as mentioned by Sarbin7, and we will find lessons all around us and within us. In teaching my students, I want to ignite that inner curiosity, and will do so by utilizing all that I have outlined above. I will respect my learners’ adulthood and independence, utilize discussions, and encourage writing, oral presentations, and reflection amongst my learners. I value what I have learned and what I will continue to learn, and value what I teach, holding that duty to be sacred. As a scholar, mystic, and Muslim saint Imam Ali once said, the taxation of knowledge is to teach it! I recommend all who participate in education develop a personal philosophy about teaching and learning.
- Knowles, M. Androgogy, not pedagogy. Adult Leadership. 1968:16(10):349-386.
- Merriam SB, Caffarella RS, Baumgartner LM. Learning in Adulthood: A Comprehensive Guide. San Francisco, CA: Jossey-Bass. 2007:275-297.
- Stern DT, Cohen JJ, Bruder A, Packer B, Sole A. Teaching humanism. Perspectives in Biology and Medicine. 2008:51(4):495-507.
- Bandura A. Social Learning Theory. New York, NY: General Learning Press; 1971.
- Schweitzer L, Stephenson M. Charting the challenges and paradoxes of constructivism: a view from professional education. Teaching in Higher Education. 2008:13(5):583-593.
- Clark M, Rossiter M. Narrative Learning in Adulthood. In: New Directions for Adult and Continuing Education. 3rd update. Wiley Periodicals; 2008:62.
- Sarbin TR. The Narrative as a Root Metaphor for Psychology. In: TR Sarbin (ed). Narrative Psychology: The Storied Nature of Human Conduct. New York: Praeger; 198