Indian Journal of Medical Sciences, Vol. 63, No. 1, January, 2009, pp. 1-3
How do we learn?
Peninsula Dental School, Plymouth
Code Number: ms09001
In their paper, Evaluation of a modified team based learning method for teaching general embryology to 1 st year medical graduate students, Shankar and Roopa describe the replacement of two traditional embryology lectures by an interactive learning opportunity.  On completion students were invited to complete a questionnaire probing the efficacy of the interactive learning method, its promotion of deeper understanding and interest and student engagement. Responses to the questionnaire were overwhelmingly favourable to the new method. Although these responses are subjective opinion and do not prove the superiority of one method over another, they are important. So why do the students feel so strongly?
Modern mass education has been practised for a relatively short time; in some countries for up to 150 years whilst in others considerably less. Wherever it occurs worldwide, this practice usually begins as a didactic process. It is intuitive for teachers to stand at the front of the class and tell their students what they know. Yet as early as the 1920s ideas about teaching methodology began to evolve as scholars investigated how people learn, construct knowledge and develop intellectually. , Theories which were tested empirically later in the century, proposed that learning is built layer upon layer via experiences in a social and cultural context. By the 1960s and 70s educationalists were questioning the efficacy of the didactic approach instead favouring active involvement of students in their learning. ,,, Freire and Bandura amongst others made interventions which showed that when learners are empowered to take responsibility for their own learning, they achieve more. , The concepts of deep and surface learning emerged.  Deep learning is more meaningful, connected to prior knowledge and able to be applied, whereas surface learning has less meaning or connection to prior knowledge, is remembered for a shorter time and is often rote learned. The ability to reorganise or reconstitute existing knowledge in order to solve new problems by creating a series of questions and possible answers is symptomatic of deep learning. 
The didactic lecture can be a truly inspirational tool used to ′kick start′ students′ interest in an area of learning or new ideas. The best lecturers change the way their students think. However, most lectures are not designed to do this. It is more likely that a series of lectures is planned to cover a quantity of defined content in which the delivery of facts dominates. At its worst this results in information being passed from the speaker to the students′ notebooks without provoking any brain activity and learning takes place at a later date in preparation for assessment. Thus for the student the lecture is usually a passive event; a format which flies in the face of the evidence on how we learn best.
The Modified Team Based Learning method used by Shankar and Roopa in their paper moves student learning into a different realm from that of a lecture. Small group learning when supervised by a trained facilitator demands a high input from learners and therefore, they are empowered to take control of their own learning. Although presented with starter material, students have to prepare prior to the session. This requires planning and organising their time, finding sources and finally reading and learning, to enable them to answer questions and present what they have learned. This is a very active process. The time they have to prepare before the session allows them to make sense of what they were asked, identify and elaborate on prior knowledge and formulate questions, all of which promote deep learning.  Although for most keen students this is refreshing, it is a new way of learning requiring more effort. In my experience some students will be resistant to change, some to hard work and some to both. For those of us resistant to change, what we are used to is always more comfortable than innovation. The results of the questionnaire show that although 80% of students were positively in favour of the new method, about 1% were negative about it, the remainder being ambivalent. Some of those who favoured the new method stated that they would not like all classes to use the new method, thereby expressing the need for a safety net for learning difficult concepts. Seeking such reassurance is absolutely natural but not necessarily logical. The more difficult the concepts are, the more active the learning needs to be. However, a variety of different types of synergistic learning opportunities is usually very popular.
To summarise, in this study most students preferred to be active learners. This is entirely consistent with my experience of other students in higher education and is probably because this way of learning aligns with the evidence from educational psychology of how we humans construct knowledge and make sense of the world.
Copyright 2009 - Indian Journal of Medical Sciences