Developing mentors to support students in practice, Part 4: Facilitation of learning
Summary
Following on from the last article that looked at the importance of creating an effective learning environment this article will set the context for the facilitation of learning. This will start by first visiting some of the key principles and theories for understanding and describing the process of learning. Examples will be provided to link these concepts to practice but the more practical aspects of utilising these theories in a practice setting will be discussed in the fifth article ‘Developing mentor and practice teachers to support student in practice, Part 4: Facilitation of Learning. Together these Articles will provide mentors and practice teachers with a firm grounding and understanding of the learning process. This will then enable them to meet the requirements of standard 3 ‘Facilitation of Learning’ set out in the Nursing and Midwifery Council (NMC (2008) ‘Standards for Supporting Learning and Assessment in Practice’ (SSLAP). These are highlighted in box 1 below for both Mentors and Practice Teachers respectively.
Introduction
It can very easily be argued that the central feature of mentorship, is learning. More specifically; how it is undertaken, what promotes it, what detracts from it and how it is managed. The use of the word learning here is very deliberate and this word will be used throughout this article given that the focus will be upon how people learn, not necessarily on how they are taught. This dichotomy of language is an often-discussed topic within the literature. The general basis of this argument is that engaging in the act of teaching does not necessarily mean that someone is learning something (Robinson 2013). Likewise, it can be feasibly argued that learning does not necessarily require direct tuition. Thus the emphasis within mentorship is on the facilitation of learning not of the teaching of nursing skills. Its feasible to assume some amount of teaching may take place, but this would be but one aspect of the facilitation process.
At face value learning appears to be a fairly straightforward concept, it is something everyone does every day and all human beings have a long history of engaging in it. Its complexity is revealed however when people are asked to define it, this is when the rich and diverse variation of ideas comes out. This is because learning is a very multifaceted process that requires an appreciation of many different factors in order to understand it (Gardner 2012) and this is very much reflected in the ever-evolving understanding of how people learn. This presents a particular challenge for mentors as they are faced with the need to find ways to promote meaningful learning opportunities for their students.
The theories and concepts discussed below are rooted in the social sciences; initially psychology but many of the later theories also incorporate strong sociological influences as well. Each has its own features that separate it from the other theories yet many ideas and concepts are shared between them. Along with this, each has its own strengths and weaknesses and consequently individuals will have differing levels of affinity towards them. Mentors and practice teachers should seek to develop a clear understanding of the different theories of learning and avoid a tendency towards adhering to a single one (Gaberson et al. 2015). This will enable them to be adaptive in their facilitation of learning for different individuals and in different circumstances. In addition to this it provides a wide repertoire of knowledge with which to review and analyse the process of learning, particularly in new situations or instances where students are struggling. This comprehensive analysis will then provide a good starting point from which the mentor and practice teacher can devise a plan of how to better support learning.
Before continuing it is worth noting at this point that these theories need not be mutually exclusive. Whilst they are born out of very different assumptions and worldviews they can be complimentary to each other. The different theories of learning did not evolve from each other in a clear chronology. Instead they developed over time, in some cases and extended period of time, along side each other, often cross-pollinating each other. Skilful and experienced mentors/practice teachers will use a combination of theories in order to create a very rich and engaging learning experience that challenges different aspects of a student’s abilities.
Behaviourism
One of the earliest theories of learning is that of Behaviourism. This theory dates back to the beginning of the 20th century and the work or researchers such as John Watson, Burrhus Skinner and Ivan Pavlov (Kellogg, 2002). Behaviourism is very objective in its nature and seeks to only analysis that which is readily observable, such as people’s behaviours and any changes in those behaviours that result from some kind of stimulus or response (Skinner 1969). Within this theory individuals become conditioned to either avoid or repeat particular actions, habits or activities based on the response they receive. The emphasis here is on the feedback received in response to the actions or behaviours performed and whether or not this promotes repetition of those initial actions or behaviours. This theory has no concern with what thought processes might be going on in relation to behaviours performed or the feedback received. It is only concerned with whether or not a particular action receives a positive response, such as a reward, then they are more likely to repeat that action. Conversely, if an action elicits a punishment or some other kind of negative response, then they are less likely to repeat that action again.
The apparent simplicity of the behaviourist theory of learning can hide its usefulness in both managing learning and diagnosing problems with learning and or behaviour in general (Miltenberger 2012). There are two main models that could be considered key in understanding learning within the mentorship context. Firstly there is ‘Classical Conditioning’ which was a model developed by Ivan Pavlov (Pavlov 1960) who undertook experiments to see if he could cause dogs to exhibit a physiological response to an associated and natural external stimulus. In these experiments he would ring a bell each time a dog was fed. Overtime the dogs linked the sound of the bell to the expectation of food. Thus after repeated reinforcement in the form of rewards, the dogs would salivate as if anticipating food at the ring of a bell. The important aspect of this association is that it is formed in the prescience of a neutral factor that does not itself elicit any kind of response but becomes perceived as such.
What this demonstrates is that the repeated presence of a neutral factor (the bell) when an individual is experiencing some kind of stimulus, be that positive or negative can result in an association being made. This association can then lead to a physical or emotional response from just the presence of the neutral factor (Pavlov 1960). Within the theory of classical conditioning mentors and practice teachers would not be setting out to intentionally create these associations between a stimulus and neutral factor that falls under operant conditioning which will be discussed shortly. Instead, it is likely that such individuals may notice such reinforcement occurring naturally and chose to pick up on this and further reinforce such behaviour. This could be where learners are seeking out particular opportunities (such as talking to patients) because of the enjoyment (engagement from patients) they derive from them or conversely, avoiding them because of previously troubling results (awkward silence or unwelcomed questions).
Another very popular model within behaviourism is that of Operant Conditioning which was first explored by Burrhus Skinner (Skinner 1969). Within this model behaviour is deliberately conditioned through the application of different types of reinforcement in response to the exhibited behaviour (Skinner 1969). The most commonly held view of this model is the application of either a positive or negative stimulus in order to encourage or discourage repetition of that behaviour (Kinnell & Hughes 2010). So the exhibition of good behaviours are encouraged through some kind of positive reward, which in Skinners experiments would have been a highly desired food item. Unwanted behaviour would be discouraged by either punishment, or the withholding of the positive reward, thus this is considered to be negative reinforcement (Kinnell & Hughes 2010). In Skinners original work however he broke these down into four categories: - positive, negative, no reinforcement and punishment. In his original work negative reinforcement was distinct from punishment and it was mainly a technique applied by the learner to make situations more bearable and avoid detriment to themselves (Skinner 1969).
It’s fairly easy to see how Skinners Operant Conditioning fits into the context of mentoring. Mentors and practice teachers will be observing a student’s behaviour and performance with a view to either reinforcing or discouraging particular aspects of that behaviour. As noted above, this is where the simplicity of behaviourism can be very deceiving to Mentors and practice teachers and there are several pit falls that people may succumb too. There is often an assumption made that providing punishment of and undesirable behaviour increased the likelihood of the desirable behaviour being performed in future (Butts & Rich 2014). This may be the case in some instances but it is not a universal principle. A learner who is chastised for not having enough knowledge of a particular subject does not necessarily go and learn more about it. They may instead find way to avoid working with the person who provided the chastisement in the first place (an example of negative reinforcement). Truancy in school is another good example of this kind of avoidance behaviour.
It is for the reasons noted above that the provision of a positive stimulus (e.g. praise or reward) to the desired behaviour is more powerful (Butts & Rich 2014; Killgallon 2012). There is a much clearer link between the reward and the desired behaviour and this makes it easier for the learner to then repeat the behaviour that instigated the reward in the first place. Mentors and practice teachers need to be mindful however that positive stimuli work equally well for encouraging the repetition of undesirable behaviour as well as desirable behaviour. This is because it is recipient of the stimulus who essentially decides if it was pleasant or unpleasant, thus reward or punishment. For example a student may find that by cutting corners and rushing particular aspects of their roles they can get them completed quicker. This in turn gives them more time to engage in the activities they enjoy as well as getting them praise from their mentor or practice teacher. Thus positively reinforcing the behaviour or rushing their work and cutting corners. Now complete Learning Activity 1.
Social Learning Theory
The ability to learn from the action and response scenarios of behaviourism are not tied exclusively to the individual’s own interactions in the world. Albert Bandura (Bandura 1977) developed a Social Learning Theory that described how individuals can observe the outcomes achieved by the actions of others in order to decide if this is behaviour they would want to emulate. He undertook a very famous series of experiments with children in which different groups of children observed an actor in a playroom. Some groups would see the actor being aggressive towards a Bobo doll (large inflatable clown) and other would see the actor only playing with the doll. Those who had witnessed the aggressive behaviour were more likely to exhibit the same behaviour. Equally, if the children saw the actor receiving punishment for their aggressive behaviour, they would be discouraged from enacting it themselves for the fear of the same outcome.
This has pretty serious and significant implications from the clinical learning perspective that mentors and practice teachers need to be very mindful of. It demonstrates that learners in a clinical environment are likely to look at the practice of those around them as a guide for how they need to act (Klunkin et al. 2011). This is not to say that every practice witnessed will be mirrored by the learner or that bad practice will be mirrored with equal likelihood. That would be an oversimplification of the theory. Instead, learners will first enter what is termed the ‘attentional’ phase, whereby they decide whose actions they should be paying attention to, or rather who are the role models. The decision is often influence by the status of the potential role model in terms of standing, grade, seniority, number of other followers etc (Bandura 1977). This process is particularly powerful in helping learning to pick up skills/behaviours that they think they may need in the future, but have had little or now opportunity to develop; such as communication skills in different situations, or handling complex and challenging situations. Identifying a suitable role model does not necessarily mean their behaviours will be copied, the learner has to progress through the stage of ‘retention’, ‘reproduction’ and ‘motivation’.
In the ‘retention’ phase the learning will observe closely the behaviours and outcomes and store them for later use. They will then start to practice these behaviours during the ‘reproduction’ phase. The purpose of this is twofold; firstly it is to gain a degree of skill or expertise the behaviours they are modelling. Secondly, it is to see if they get the same kind of results or feedback as the role model. This is a very key phase for mentors and practice teachers to be aware of since their reinforcement or lack of it here will influence how likely they are to continue those behaviours. This then progresses into the ‘motivation’ phase where the individual will decide if they have the motivation to continue those practices based on their expertise at them, and the response they have gained.