Dialectic Teaching with Team Based Learning in Nursing Education

In The Dialectic Teaching with Team Based Learning in Nursing Education an important factor for effective learning and learning outcomes.

Dialectic Teaching with Team Based Learning in Nursing Education

Dialectic Teaching with Team Based Learning

Dialectic instruction is an integral part of TBL. TBL also incorporates the other pedagogy approaches that, when combined, offer the student an excellent opportunity to learn the content and also learn a process. Both play an important role independently, but when combined they can help the student develop success in a specific discipline and also develop lifelong learning skills. Prior to coming to the TBL session, the student is required to review all material provided in handouts, textbooks, and so forth.

In the classroom, the student will take the individual Readiness Assurance Test (IRAT) (Michaelsen, Knight, & Fink, 2002), which provides the student with a formative evaluation of the information the student learned independently. It also provides an instructor with an evaluation of how well students were able to gain information on their own. Following completion of the initial test, the students are provided with questions they work on as a group.

During the group discussion, the students learn important dialectic skills by expressing their own points of view and considering and evaluating the viewpoints of others. The dialectic portion of TBL also allows latitude in the thought process, providing an opportunity for the individual to add new information, new ideas, and so on. As such, the exchange of ideas is not a conclusion but a process in developing each individual’s own reasoning skills.

The mental process of the student does not stop when the evaluation of the ideas are complete. Instead, the student is encouraged to incorporate the knowledge gained through this process to build a new understanding and appreciation of the material being considered. The use of evaluation as a process, rather than an end point, highlights an important difference between dialectic and didactic learning.

In didactic learning, the teacher can tell the students how to evaluate a given situation, the student memorizes this approach and, when asked, can recall (or perform) the evaluation as described by the teacher.

For example, a professor tells a student how to evaluate a patient to determine if the patient has hypertension. This includes a complete description of how to manually determine diastolic and systolic blood pressure, where to record these values in the patient’s chart, and what constitutes normal values. The student is told the values determined in the patient are above the set limit, and the patient is considered to have hypertension. Once the process is memorized, the student can recall each step as described.

With a small amount of practice, the process can be demonstrated with an acceptable degree of accuracy. In dialectic teaching, this process is extended to include a completely different teaching approach. Instead of recalling the normal values for systolic and diastolic pressure, the student is expected to question the validity of the testing method and to determine if a more accurate method is available. Additional questions may be raised about the reliability or efficiency of using a manual blood pressure cuff.

Finally, the students may question the validity of the normal values that have been provided. Do these values represent a mean of the population? What happens when a majority of individuals in the population have chronic hypertension? Should the normal values be lowered to reflect healthy values instead of population means? Based on answers to these questions, new approaches may be recommended by the student.

These types of questions have led to the use of electronic devices for the noninvasive management of blood pressure in hospital patients; it has also resulted in the lowering of what doctors consider normal blood pressure. Without this type of consideration, the medical professional would be destined to repeat errors from the past. If students are taught the dialectic approach, they learn how to determine a patient’s blood pressure and how to critically evaluate a given situation.

Altering the parameter being evaluated to plasma cholesterol concentration instead of blood pressure would obviously be impossible for a student taught using the didactic approach; However, the student who learned to question the process can easily adapt. In addition to the obvious educational advantages of dialectic teaching using TBL, the methodology also provides practical advantages.

TBL brings together practical strategies to ensure the effectiveness of small groups working independently in class with high student-faculty ratios (for example, up to 200 to 1 ratio) without losing the benefits of faculty-led small-group instruction (Michaelsen et al., 2002). Maintaining the learning environment of small groups in large classroom settings should help build higher – order thinking skills and allow students to gain insight through each other’s learning processes.

Michaelsen stated that the use of small groups takes teaching and learning to new levels of educational significance (Michaelsen et al., 2002). Paul (1995) emphasizes the need to carefully consider how dialectic education is accomplished in the classroom. In the medical field it is important to discern the validity of information; However, it is also important to consider another individual’s viewpoint and to test the validity of the viewpoint using reasoned judgment (Paul, 1995).

This becomes particularly important when decisions cannot (or should not) be made on available fact alone. As our knowledge of a disease increases, the facts, as reported in the literature, also change. Put another way, fact is often not the same as truth. Each patient’s situation is different and may require a unique treatment plan that is not easily discernible based on facts alone. If we neglect the value of dialogical judgment in medical decision making, we will find ourselves unable to function because of inadequate information.

Teaching students to test the validity of the individual’s viewpoint based on reason is of greatest importance. Unfortunately, students often do not come prepared to participate in such activities. In most students’ backg round, traditional didactic lectures have resulted in a passive learning approach where statements made by the instructor are accepted without question.

Students need to learn and apply the power of reason gained through critical thinking before offering viewpoints and to apply this same approach when evaluating statements made by others. The extent to which a person accomplishes this process defines his or her level of competence in a given field. Determining the validity of a statement through reasoning requires a variety of approaches including inductive and deductive reasoning skills. Although most students have acquired rudimentary critical thinking skills useful in daily life, they have been encouraged to disregard the same skills in the educational setting.

Evaluation Of Didactic And Dialectic Teaching

Didactic instruction is easy to evaluate; However, the results often suggest an overinflated sense of true knowledge. As mentioned earlier, students who are able to answer fact-based questions are often tempted to assume that they have mastered the topic. This gives a falsely elevated feeling of confidence, suggesting to the native student that he or she has the insight needed to apply the information in a real-world setting.

This can result in a falsely inflated formative evaluation for the student and/or a falsely elevated summative evaluation. In either case, the student will be misled into believing he or she can perform well in a real-world setting. If the professor (or institution) believes student performance on fact-based multiple-choice tests predicts performance in clinics, both will be disappointed. The evaluation of dialectic teaching is much more difficult but provides a much greater insight into the student’s ability to perform in a real-world setting.

This evaluation requires a shift in methodology from a fact-based exam to an evaluation that measures process instead of content. If the goal of dialectic teaching is to produce students who can think independently, evaluations should measure these same skills. In their original 1956 publication Bloom, Engelhart , Furst , Hill, and Krathwohl noted that educational objectives (also called behavioral objectives) evaluate the product of the cognitive process and not the process that produced the outcome.

Objectives written using Bloom and others’ taxonomy will be found inadequate in attempting to evaluate the process. New goal and objective statements should be developed that focus on the students’ ability to improve their thinking skills. Methods of questioning must also be developed to determine if this has occurred. Standard multiple-choice questions (even second- and third-order questions) will most likely be found lacking.

Evaluating dialectic versus didactic instruction is analogous to judging a diving competition as compared to a 100-yard dash. In diving, judges evaluate the process used to accomplish the dive, not the elapsed time from the platform to the water. Conversely, in the 100-meter dash, no points are awarded for style, and simply measuring the length of time between the starting gun and the finishing line chooses the winner. Obviously the latter is easier.

TBL provides an excellent built-in opportunity for the student and instructor to evaluate the dialectic process. One of the most powerful tools is the discussion phase. The discussion achieves two distinct evaluation goals. First, it provides a formative evaluation tool for the student. Each student in the group can compare his or her level of understanding to the level of expertise that is expected. Second, it provides the teacher with a means of determining the level of performance demonstrated by each student, each group, and the class as a whole.

Discussion, unlike any other form of evaluation, reveals the level of true knowledge and of application skills possessed. As mentioned earlier, Socrates used this approach to extract information from his students while also stimulating individuals to reveal the process used to formulate their thoughts. When individuals initiate a discussion, they will display their level of content knowledge and will also reveal the process used to relate the content to the problem being discussed.

This dynamic evaluation process goes far beyond what could be accomplished on a multiple-choice test, or even an essay test. It is difficult, if not impossible, to assess thought process using multiple-choice tests. Essay tests can evaluate the process more accurately; However, provides this students with a starting point that may be above or below their knowledge base. It may also ask them to perform a thought process level that is above or below their ability.

Evaluating students’ performance through a discussion format circumvents both problems, freeing the students to start at their own level of content knowledge and apply this knowledge using the processing skills equal to their ability. The professor is left with the task of appropriately selecting the case presentation to encompass the content material to be covered and the level of competence possessed by the students.

For example, it would be pointless to ask beginning students to diagnose a complex case using data they did not understand, or to process the data at a level requiring skills beyond their training. It would also be pointless to ask advanced students to evaluate a simple case. In either situation, the students will not be challenged appropriately and will not be able to demonstrate their level of skill.

Conclusion

Didactic teaching transfers content information while dialectic teaching allows students to learn thought processes. Didactic is teacher focused, while dialectic is student focused. Didactic teaching is easy to evaluate, but the evaluation provides little information about the student’s thought processes. Dialectic is more difficult to evaluate, but the results of the evaluation process can truly describe the student’s ability to process the data and apply it in a meaningful manner in a real-world setting.

TBL is a dialectic methodology that provides an excellent opportunity to teach and evaluate the students’ ability to apply knowledge in a meaningful manner. Additionally, TBL allows the dialectic process to be accomplished in a manner that demands group interaction and fosters interpersonal skills, mutual respect, and communication skills.

It allows this to develop in a cost-effective manner requiring a relatively small amount of professor time. Learning is focused on the student rather than the teacher. When intermingled with other learning experiences, TBL is a powerful tool useful in the medical school curriculum.

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