Lev Vygotsky

Peter Berger and Thomas Luckmann

Vico

Piaget

von Glaserfeld

Dewey

Once assigned the task of overseeing the weekly didactics, Mira started to analyze the lectures. When she critically observed the sessions, Mira realized that many people seemed to be paying more attention to their phones than to the lecture. Several had laptops opened and on their desks and were clearly working on other projects. A couple of residents were even asleep! Mira realized that perhaps these didactics weren’t as “good” as she had previously thought.

Mira decided to intervene. She sent an anonymous survey to the residents, asking their thoughts about the current weekly didactics, and asked for suggestions. The response of the residents floored her! They complained about “death by powerpoint” and called the material “extremely boring.” The residents expressed an interest in greater interactivity during sessions. Many stated that they don’t learn by just being “lectured at.” One person even wrote: “there are a million excellent podcasts out there, why don’t we just listen to those for 5 hours? Why are we reinventing the wheel?”

Mira started to feel insecure about the current state of her newly assigned weekly didactic sessions, realizing she had a much bigger job than initially anticipated.  She did some research online and learned about some innovative ideas that some residency programs were implementing. Should the program adopt  a “flipped classroom” model? That would require a total overhaul of the curriculum, something Mira wasn’t certain she could handle. Was it a reasonable suggestion to start listening to podcasts or watching videos from experts during the time allotted for didactics? Such an approach  might increase the quality of the presentations, but would not address the issue of improving active learning. Maybe the residents would get more out of didactics if they were divided by PGY level and given lectures mapped to their level of training? That seemed like a good idea but now Mira would need 3 lecturers every hour instead of one. Mira wondered if there was anything she could do to easily increase the quality of didactics without a complete overhaul of the curriculum.

In order to understand social constructivism, it requires understanding what constructivism means. In terms of  educational theory, constructivism perceives that  “the learning environment is one of experimentation and dialogue, where knowledge is seen within the context of problems to be discussed and solved.”¹ Put another way, constructivism involves the interpretation and explanation of information within the context of previous experiences and existing knowledge.  Knowledge is not transferred from teacher to learner in a passive, hierarchical manner; there is no single, absolute interpretation of information.  Rather, information is processed by what is already personally known with new understanding (i.e. interpretation of information) constructed in a manner unique to the individual.

Social constructivism takes the theory of constructivism a step further and states that information is influenced by the social environment with interpretation and construction of knowledge influenced by other learners and teachers. Social constructivists posit that comprehension is first  constructed on an inter-psychological level (i.e. between people). Once this is accomplished interpretations can be internalized (i.e. becomes intra-psychological).

Social constructivists argue that teachers should provide coaching and guidance, not passively convey information in a one-way direction to their students. Students learn from performing, interacting and experimenting with the material, while the teacher assists in the design, facilitation and presentation of the curriculum. A teacher may be defined in many ways, including another peer learner, a learning resource, or anyone with complementary or additional knowledge on a topic.

Social constructivists believe that traditional forms of assessment (e.g., written tests) may not assess a learner’s comprehension of the material. Traditional tests of knowledge may only  test the learner’s ability to interpret and respond to  the requirements of the test. Social constructivists favor a model where assessment is “embedded within the learning and teaching process.”¹  Assessment instruments that assess higher reasoning, such as analysis and synthesis, are favoured.

Social constructivist models in medical education are represented in problem based learning and small group work (e.g. seminars). However, technological innovation has advanced and expanded the scope of this learning theory.  The most obvious example is the “flipped classroom,” where students switch the lecture and homework components of a class. Recorded lectures are reviewed asynchronously prior to class with class time spent engaging the teacher and peers  on the application of the knowledge (e.g. homework).  The use of multimedia technology allows a feasible and efficient delivery of the traditional lecture outside of the classroom, making space for interaction and experimentation with the material within a group of peers.

In addition, there are digital platforms that facilitate group learning despite geographical barriers.   Platforms like Slack and Google apps facilitate asynchronous  discussion and collaborative project work typical of the ZPD.  Of course, the difficulty with online platforms is encouraging true collaboration. These platforms  are less easy to facilitate for teachers and social norms for all members to contribute are not as strong. Nevertheless, the ability to virtually collaborate across multiple time zones expands the influence of social constructivism in modern education.

While the small group sessions typical of  resident conference (i.e. academic half day) is an excellent example of leveraging social constructivism, the classic classroom example is problem-based learning (PBL). PBL is widely adopted in medical schools, where small groups of students work together longitudinally, addressing a new clinical problem each week. For example, a group may work through the diagnosis and management of a patient presentation suggestive of gastrointestinal bleeding. An experienced facilitator scaffolds the issues to be addressed in the problem.   Each group may achieve different learning outcomes based on their specific learning needs or the way discussion and research unfolds.

High fidelity simulation is an example of social constructivism in medical education.  Teams of learners are tasked to solve a simulated clinical presentation. If the team includes learners at different stages, more experienced members can scaffold support to the junior learners commensurate with their needs. This allows the learner to draw on the experience of all members of the group to rand internalize their own learning.

Adams P. Exploring social constructivism: theories and practicalities. Education. 2006; 34(3): 243-257.

This article is a comprehensive description of the principles of and rationale for social constructivism. It describes the evolution of social constructivism from constructivist theories. It is a must read for anyone studying social constructivism

Nalliah S, Idris N. Applying the learning theories to medical education: A commentary. IeJSME. 2014; 8(1): 50-57.

This article provides historical context for the development of social constructivism, tracing the origin from the 1700s to current day. The major contributors to social constructivist theory are profiled. Extra attention is paid to Vygotsky and to explaining current thoughts on social constructivism and how it applies to modern education

Kay D, Kibble J. Learning theories 101: application to everyday teaching and scholarship. Adv Physiol Educ. 2016; 40: 17-25.

This article is a great introduction to several different learning theories. For each learning theory, the authors describe a teaching scenario that employs the learning theory, then explains the learning theory. Commentary then follows that explains how the given scenario utilized the learning theory. Constructivism is contrasted with cognitivist and behaviourist theories

Dong C, Clapper T, Szyld D. A qualitative descriptive study of SimWars as a meaningful instructional tool. International Journal of Medical Education. 2013; 4:139-145.

This article is a qualitative study about the effectiveness of SimWars as an educational modality. The group used social constructivism theory to create the interview questions. The themes they identified centered around teamwork and debriefing concepts that rely heavily on the collaborative nature of social constructivism.

Social constructivism is dependent on social interactions between learners and teachers. Therefore, disengaged or shy participants limits learning. Facilitators must encourage all members to engage, while maintaining a safe and trustworthy learning environment.

Additionally, the best groups are diverse in background. In a given group (medical school class, clerkship group or residency) members may be homogenous, limiting the benefit of new insights from participants with different backgrounds and experiences. Creative solutions such as incorporating inter-professional learning may help promote diversity.

Social constructivism requires a marked change from traditional classroom teaching, where the learners are passive recipients of a the instruction from a teacher. A teacher not trained in the scaffold approach that supports the ZPD will inhibit learners engagement, discovery and incorporation of the material. Insistence on focusing on what is taught, rather than what is learned, is counter to social constructivist theory of learning.  Finally, learning that is individualized can be challenging to assess.

Mira  encountered many different theories during her research. She found aspects of many of them appealing, but it was the theory of social constructivism that resounded with her the most. She liked that social constructivism focused on working as a group and learning from one another. If the residents could work on problems together, in groups, she felt that this may help to alleviate some of their boredom with current model of academic conference.

Another aspect of social constructivism that appealed to Mira  was that concept of “scaffolding.” She could deploy  the senior residents as teachers, using them to scaffold the learning of the junior residents.

Mira decided to put the theory into action. She reorganized the design of conference into problem-based learning curriculum. She  formed small groups of residents stratified by levels of training. Mira also increased the amount of team simulation sessions, again employing the group to teach each other. Mira re-surveyed the residents and found that satisfaction with academic conference had increased, but now the residents wanted to discuss some of the rotations they didn’t like…