Transformative Learning Theory and the transition from clinical skills to clinic

Transformative Learning Theory and the transition from clinical skills to clinic

Transformational learning is the process of deep, constructive, and meaningful learning that goes beyond simple knowledge acquisition and supports critical ways in which learners consciously make meaning of their lives. (Steel 2012, Encyclopedia of the Sciences of Learning,).

This appears to me to beg the question “Is this the type of learning we need, to help our students go from complete novices to dental professionals?”

Transformative learning theory, like many other learning theories, has both its advocates and its critics, but was developed by Jack Mezirow and colleagues over 35 years ago. According to the theory adult learning begins with a “disorientating dilemma”, which the student tries to give meaning to using their “frames of reference”. However, because the dilemma has disorientated the students this necessitates a modification in that “frame of reference” and so it needs to be modified by a combination of self “critical reflection “and external “rational discourse” to produce a new perspective.

Transformative Learning Theory

According to the theory, after a transformation in a “frame of reference”, a student is said to view themselves and their world in a better way, as a result of their assumptions and expectations having been challenged and modified to better fit their reality or context.

Surely “disorientating dilemmas”, are a familiar situation in dentistry where diagnosis and the production of a patient centred, yet evidence based treatment strategy is rarely straightforward. Furthermore, we expect our students to engage in “critical reflection” as they learn and we in turn are expected to provide feedback, which could be seen as contributing to the “rational discourse”.

Mezirow suggested that this pattern of learning followed 10 steps;

1. Disorienting dilemma
2. Self-examination
3. Sense of alienation
4. Relating discontent to others
5. Explaining options of new behaviour
6. Building confidence in new ways
7. Planning a course of action
8. Knowledge to implement plans
9. Experimenting with new roles
10. Reintegration.

(Mezirow, 1991, Transformative Dimensions of Adult Learning. San Francisco, CA: Jossey-Bass)

I wonder if these steps would help us understand the process students go through when they first move from pre-clinical, or clinical skills environment to the clinic. This is always seen as a difficult transition and I wonder if using transformation learning theory would help us to help our students.

There is no doubt in my mind that students often feel disorientated and find that their own internal resources cannot meet their needs, when treating patients for the first time. I wouldn’t be surprised to hear that they then feel a sense of alienation. They often then relate this to others, but in my experience the others are more likely to be someone they already know and trust, such as their peers or perhaps a personal tutor. Then over a period of time they become more acclimatised to the clinical environment, adopting new behaviours and building confidence. I admit some do this more efficiently than others, but as their confidence builds they are able to explain better their planning and put new found knowledge into practice. They grow into their new role as a potential dental professional and reintegrate, settling into the clinical environment and losing that sense of alienation and disorientation.

I’m struck by how closely this follows the theory and wonder if teachers who supported students using the theory more explicitly could help make the transition from pre-clinic to clinic just that bit easier, which would benefit not only the students, but also their patients and teachers.

Sandra Zijlstra-Shaw, June 2019