Bridging practice and theory in the professional classroom

November 30, 2020

This post is republished from Into Practicea biweekly communication of Harvard’s Office of the Vice Provost for Advances in Learning

This issue of Into Practice is adapted from Instructional Moves content produced by the Teaching and Learning Lab at the Harvard Graduate School of Education. 

Dr. Richard Schwartzstein, Ellen and Melvin Gordon Professor of Medicine and Medical EducationDr. Richard Schwartzstein, Ellen and Melvin Gordon Professor of Medicine and Medical Education, is revolutionizing textbook-dependent classrooms by incorporating real-life applications. In this case, first-year Harvard Medical School students apply their reading through case simulations. A robot functions as the patient, and a small group of students take on various roles to work together and treat the patient. Students are supported by a facilitator, who offers guiding questions but no direct answers, as well as the rest of the class, who serve as consultants or in other supporting roles in the case, like the patient’s family. “Instead of a paper case, now it feels much more real. And suddenly, they’re immersed in taking care of a patient,” Dr. Schwartzstein reflects. After a simulation ends, the whole class debriefs the case, including what students struggled with and how they felt during the exercise.

The benefits: Students learn to engage collectively and “pool understanding” to unpack a problem. As a result, the class is far more engaged in the discussion and thinking more deeply about the principles and concepts rather than simply what the right answer is in their textbook. They also apply these concepts in a way that is truer to how they will appear in life. This helps them transfer their learning to new contexts. Schwartzstein notes, “The hardest thing in education at any level is transfer. You can learn something in one context. Can you take that knowledge now and use it in a different context?” These simulations train students to do just that—apply the concepts to the scenarios they will appear in.

“The hardest thing in education at any level is transfer. You learn something in one context. Can you take that knowledge now and use it in a different context?”

The challenges: “The challenge of this kind of teaching, and I think the fun part for me, is that it’s largely unscripted,” Dr. Schwartzstein notes. While there are clear goals for the simulation, the professor doesn’t know how the students will react to it or what approaches they might take. This adds variety—even with an identical case, no two groups respond in the same way—but it also requires more of the professor to respond and guide students in new ways. Schwartzstein summarizes, “I refer to it sometimes as choreography. You sort of know where you’re supposed to be and what your marks are that you’re going to try to hit, but in the meantime, we allow a little bit of freelancing along the way.”

Takeaways and best practices

  • Encourage students to embrace uncertainty. “Getting students used to uncertainty is a tough thing,” Dr. Schwartzstein reflects, “because they want to know what the right answer is.” Yet often, in many fields but especially in medicine, there isn’t one. Simulations can help students become reacquainted with the uncertainty that real-life applications bring and instead learn from the mistakes they might make in these scenarios.
  • Debrief every case. This is critical to helping people unpack and examine how the real-life scenario and their prior learning converged. Unpacking these feelings together can also help, particularly in medical settings, to understand the high-intensity emotions that come in the work. “Were they surprised by that? Why did they get that reaction? Is it bad or good? How do you channel that? How do you make the most of that? How might that have affected your thinking at that particular time?” Schwartzstein asks. “These are all important things to prepare them for more intensive clinical experiences.”
  • When facilitating, don’t stop at the right answer. Even if a student knows the simple right answer to a question, the facilitator can help deepen understanding by asking questions. Dr. Schwartzstein mentions, “Students are very good at learning what I call ‘fill in the blank.’ Even if it’s the right response, tell me more about that. From these questions, I get to see: do they understand the principle, the concept? Or did they just memorize a few words?” Moreover, having this discussion deepens learning for the whole class, who also get to reason out why something is right, not just that it is.”

Bottom line: Any field has external connotations and conclusions that students can apply to their everyday lives, and every field has uncertainty. Experiential simulations like these help professors embrace and build these realities into the learning experience.