I recently saw a great editorial in the Medical Teacher. Medical Teacher is the official journal
of AMEE, an international association for all involved with medical and
healthcare professions education. The Medical
Teacher “addresses the needs of teachers and administrators throughout the
world involved in training for the health professions.” (1)
The editorial by Harden and Laidlaw (2) discussed the FAIR principles
that teachers can use to help their students develop and that lead to better
learning. As someone who works in faculty development for my department and my
institution, I found these principles to be an effective faculty development
tool.
The four principles of FAIR are:
F provide
appropriate Feedback to students
A make
learning Active not passive
I Individualize learning
R ensure
the learning is Relevant
Feedback is something that I have written about here in the
past (see- Feedback or Compliments? Which is better?) Feedback is important for learners. It helps students to get better by giving
the teacher the opportunity to correct mistakes. Dr. Harden quotes a 2007 review
by Hattie and Timperley. (3) The authors reviewed twelve large meta-analyses
that included 196 studies that looked at feedback. They found that the average effect
size of feedback on performance in several different contexts was about 0.79.
For perspective, it was lower than the effect of direct instruction (0.93) but
was greater than a student’s prior cognitive ability (0.71). Not getting enough feedback is one of the most
common complaints from medical students regarding their teachers. Feedback is
“the most powerful single thing that teachers can do to enhance achievement of
their students.” (1) An important point from this article is that is that
students need to use feedback for it to be effective. Students should use
feedback from the preceptors and faculty members to fix deficits through
increased practice, readings, and experiences.
The second point is that learning needs to be active. Active
learning has a lot of advantages for the learner—it keeps them engaged in the
process, it allows them to interact with peers in small group peer
teacher/learner activities, and it encourages learners to use electronic and
other outside resources to enhance their knowledge acquisition. Dr. Harden
makes the point that no matter what the context, learning activities should be
“designed to be meaningful”. Often students feel that learning activities have
no point. For some activities in medical education, I would have to agree.
This leads into the third principle of FAIR which is that
learning needs to be individualized. It is funny that Facebook, Twitter, and
Google have figured this out in less than a decade while in medical education
we still don’t do this. The model has remained for one hundred years, everyone
gets the same curriculum taught in the same way with the same assessments at
the end. There is data that suggests that students have different learning styles and benefit from individual attention to those
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| (reprinted from: Harden RM, Laidlaw JM. Med Teach. 2013; 35(1): 27-31) |
styles (see my 2012 blog--Self Regulated Learning and Performance) We get students into medical school from a wide variety of backgrounds and
experiences, but pay little attention to these differences. Some students come
from a science heavy background while others from a more liberal arts
background. Some students may have been heavily involved in clinical medicine
by volunteering in a free clinic while others have almost no clinical
experience. More attention to these differences would maximize the students’
learning.
The final area of concern to help us be FAIR to students is
relevance. This used to be a big deal in medical education. When I went to
medical school, there was very little clinical education before the third year
of medical school, it was all basic science. As a student you were just
trying to get through that so that you could learn to be doctor later. Now as a
faculty member who not only teaches in the basic science curriculum, but also
directs a basic science module, I find it easier to provide the relevance. I
think that we do a better job of using clinical cases and vignettes to frame
basic science knowledge in the clinical context. In this setting of relevance,
I believe student learning is enhanced.
I believe that the bottom-line suggestions from this article
can be very helpful in structuring our teaching:
1) Recognize the importance of feedback
2) Assess the extent of active engagement of your students
3) Individually tailor the learning environment
4) Ensure the relevance of all learning activities
References
(1) http://www.medicalteacher.org
(2) Harden RM, Laidlaw JM. Be FAIR to students: four
principles that lead to more effective learning. Med Teach. 2013; 35(1): 27-31
(3) Hattie J, Timperley H. 2007. The power of feedback. Review Educational Research. 2007; 77: 81–112.
