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Teaching and Learning in Medicine

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Constructivism: The View of Knowledge That Ended Philosophy or a Theory of Learning and Instruction?
Jerry A. Colliver Available online: 20 Nov 2009

To cite this article: Jerry A. Colliver (2002): Constructivism: The View of Knowledge That Ended Philosophy or a Theory of Learning and Instruction?, Teaching and Learning in Medicine, 14:1, 49-51 To link to this article: http://dx.doi.org/10.1207/S15328015TLM1401_11

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PERSPECTIVES

Constructivism: The View of Knowledge That Ended Philosophy or a Theory of Learning and Instruction?
Jerry A. Colliver
Statistics and Research Consulting Southern Illinois University School of Medicine Springfield, Illinois, USA Background: Constructivism is referred to in two very different ways in education including medical education: to refer to a view of knowledge and to refer to a theory of learning and hence instruction. Summary and Conclusions: This proposal (a) distinguishes between these two usages of constructivism and (b) concludes that constructivism is not a theory of learning and thus as such has little to offer that might be of value to medical education.
Teaching and Learning in Medicine, 14(1), 4951 Copyright 2002 by Lawrence Erlbaum Associates, Inc.

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Constructivism is referred to often in educational writings and conversationincluding those in medical education. But the term is used in two different ways, to refer to two very different thingseven in the same contextand yet the equivocation seems to go unnoticed. On the one hand, constructivism refers to a revolutionary view of knowledge; on the other, to a theory of learning and hence instruction. The former1 is a profound insight that has resolved the problem of knowledge that plagued philosophy for over two millennia; the latter2 is a spinoff that muddles the distinction between knowledge (in the sense of the body of human knowledge and how it is verified or shown to be true) and learning (in the sense of an individual learner and the principles, theories, methods, and technologies that characterize and facilitate the learning process). The purposes of this article are (a) to distinguish between these two usages of constructivism and (b) to consider whether constructivism has anything to offer as a theory of learning and instruction that might be of value to medical education. Constructivism Constructivism refers to the view that knowledge is a human, social inventiona construction.3 Prior to constructivism, realism was the predominant theory of knowledge. The realist view is that knowledge and reality are separate and that knowledge is a picture or

representation of reality.4 Modern science was based on the realist view. But, the increasing abstractness of scientific knowledge made the realist theory of correspondence harder and harder to maintain. Thus, writers spanning the 20th Centuryfrom Wittgenstein to Rortyhave concluded that knowledge consists simply of languageour knowledge claimsand that knowledge is a linguistic construction. We may think and hope that our claims accurately represent reality, but there is no way to get outside of language to prove that they really do. Thus, realism, in contrast to constructivism, is a metaphysical positionmetaphysical in the sense that realism entails the assumptions that there is something out there, not directly accessible to us, hidden from us and that our knowledge claims can accurately depict this shadowy realmreality. Constructivism, on the other hand, is not a metaphysical view, but merely the humble admission that human knowledge consists simply of our claims, our constructions. The constructivist view is pragmatic: we can only determine whether our language claims work, whether they allow us to achieve our ends, whether they have the desired pragmatic consequences, and most basically whether they allow us to predict and control.5 The constructivist view is that knowledge claims are justified if we agree that they are useful in reaching our practical goalsrather than verified by proving that they correspond to reality.

This paper was presented as an Invited Address to the Constructivist Special Interest Group at the American Educational Research Association Annual Meeting, New Orleans, LA, April, 2000. Correspondence may be sent to Jerry A. Colliver, Statistics and Research Consulting, Southern Illinois University School of Medicine, P.O. Box 19623, Springfield, IL 627949623, USA. E-mail: colliver@siumed.edu

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Epistemology is the branch of philosophy that is concerned with bridging the gap between knowledge and reality, with verifying that our knowledge claims accurately represent reality, with showing that our claims are truea tough job considering we have no direct access to reality. Thus, epistemology has played a central role in philosophy, given the predominance of the realist view in modern science. But with the emergence of constructivism, the importance of epistemology has declinedsome say epistemology is dead.6 Constructivism is often described in educational circles as an alternative epistemology,2 but strictly speaking, constructivism is not an epistemology, because its premise is that there is no way to show the correspondence of knowledge to reality, to show that our claims are true. Constructions are not representations of a metaphysical reality, but simply claims that are hoped to provide a basis for actions that achieve our aims and reap the desired outcomes. Thus, constructivism sidesteps the problems dealt with by traditional epistemology. Interestingly, because of the centrality of epistemological issues in philosophy, some writers speculate that constructivism spells the end of philosophy.6

constructivism has important implications for curriculum development and design. Constructivism shifts the view of knowledge from ahistorical, eternal truthswhich would seem to focus curricula on current knowledge, the truth, the realto historical, cultural inventionsthat are changing and evolving, making the meaning of current knowledge more dependent on where we have been. The implication is that curricula should focus more on the development of knowledgea sort of history of us and our thinkingto help us better understand where and who we are. Most of the teaching of constructivism would likely be pre medical education; although even in medical education, some thought about the nature of knowledge would seem to be indicated with the increasing emphasis on evidence-based clinical practice.8

Constructivism as Learning Theory The problem with constructivism in education2 is that it blurs the distinction between epistemology and learning. Constructivists in education promote a set of mandates that favor one view of knowledge (constructivism) over another (realism) and act as if these are principles of learning/instruction that capture the underlying learning process (how we learn) with implications for instruction (how we should teach to optimize learning). For example, constructivists say instruction should promote learning that involves world making rather than world mirroring, creating rather than finding, focusing on activities rather than on things and substances2as if learning would be improved if the former of each of these dichotomies were employed in instruction. The presumption is that somehow our view of the nature of human knowledge (constructivism versus realism) in someway determines the nature of the learning process (how we learn). But the principles of learning would seem to be the same regardless of whether we think knowledge is a construction or a representation of reality. The students task is the same, to learn and understand information, whether that information is a construction or a representation. In either case, the information is a construction, the difference is whether we think it represents reality or not. The constructivist view of knowledge most definitely should be taught as noted above, because it is the current view of knowledge that seems to resolve the dilemmas caused by realist thinking, but not because it has been shown to facilitate the learning process. Teaching the constructivist view is not the same thing as devising instructional methods and techniques that emphasize making, creating, action! At best, the presumed learning theory is simply a metaphor that exploits the rough synonymity of con-

Constructivism and Educational Practice So what are the implications of the constructivist view of knowledge for educational practice? To begin with, constructivism most certainly should be taught. In all disciplines, subjects, and topics, students should be made aware that the knowledge they are learning is a human social construction. At least, they should be told that this is the current perspective on knowledge with reminders sprinkled liberally throughout. As students and teachers become immersed in their readings and discussions, there is a natural tendency to act as if this is the way it isso from time to time reminders should be given that the it refers to the construction, not reality. At certain points in the curriculum, constructivism per se should be the focus, addressed in the broader context of epistemology and realism. In this context, the role of power in the construction of knowledge should be emphasized.7 Constructivism in effect reverses the adage knowledge is power to say that power is knowledge. The point is that knowledge is determined by social and political factors in addition to logic and reason, and even logic and reason are determined by social and political factorsfurther undercutting the idea of knowledge as an accurate representation of reality. In addition to teaching constructivism directly and reminding students of the constructed nature of the knowledge they are studying in different domains, 50

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struct and learn. Construct is used to impart a sense of overt activity to learn. One of the few predictions from this theory/metaphor that can be tested in a practical setting concerns the effect of peer group discussion. The reasoning is loose, going from the view that knowledge is a human, social construction to the conclusion that instruction should involve social interaction, namely group discussionfrom a post-epistemologic view of knowledge to a learning/instruction directive. However, research that tests this weak prediction shows little or no effect of group discussion. For example, cooperative learning consists of a number of teaching approaches in which students in small groups work together to help each other learn material presented by the teacher. A review of the research literature, though, showed only weak effects of cooperative learning compared to individual seat work, individual study, and individual drill.9 Student Team Learning methods, one of the most researched methods, showed only a mean effect size of d = +.21 based on 25 studies that used standardized outcome measures. For all 77 studies reviewed, involving a variety of cooperative-learning methods, the mean effect size for all outcome measures (local and standardized) was only d = +.26. Roughly, this means that only about 8% to 10% more of the cooperative-learning students were above the control group mean (about 58% to 60% above mean versus 50%). In medical education, problem-based learning (PBL) is said to be grounded in constructivist theories of learning, whereby students actively construct learning in small groups guided by a tutor.10,11 However, four reviews of PBL research provided no convincing evidence that PBL improves basic knowledge and clinical skills.1215 One review concluded that the results generally support the superiority of the PBL approach, but even that review reported only weighted mean effect sizes that ranged from d = (.28 for the National Board of Medical Examiners I (NBME I) to d = (.09 for other measures of basic knowledge to d = +.08 for NBME II to d = +.28 for clinical performance.13 Even these small effects are possibly overestimates given the operation of self selection which typically favors PBL. The learning theory also maintains that conceptual learning requires the monitoring and assessment of a students conceptualization as a whole and not just a few particularly salient aspects that stand out from the whole or are easily measured. This is hardly a controversial point. But it would seem to be true regardless of whether knowledge (the conceptualization) is seen as a representation of reality or a human, social construction. Also, the theorys assertion that a students background is important in the construction of learning seems obvious and it seems consistent with either view of knowledge. These are typical of the theorys predictions for practice: the effect of group discussion,

the need for holistic appraisal of a students conceptualization, and the importance of background in new learningand they do little to convince one of the value of the theory. Conclusion In brief, is constructivism a profound insight into the nature of human knowledge? Yes! Should it be taught? Yes! Is it a theory of learning? No! The constructivist metaphor provides a fleeting insight into the learning process, but it is not a theory of learning. It confuses epistemology and learning, and it would seem to offer little of value to medical education. References
1. Rorty R. Truth and Progress: Philosophical Papers, Volume 3. Cambridge: Cambridge University Press. 1998. 2. Steffe LP, Gale J. Constructivism in Education. Hillsdale, NJ: Lawrence Erlbaum Associates, 1995. 3. Toulmin S. The construal of reality: Criticisms in modern and postmodern science. In WJT Mitchell (Ed.), The Politics of Interpretation (pp. 99117). Chicago: The University of Chicago Press, 1983. 4. Rorty R. Philosophy and the Mirror of Nature. Princeton, NJ: Princeton University Press, 1979. 5. Colliver JA. Constructivism with a dose of pragmatism: A cure for what ails educational research. Advances in Health Sciences Education August 1999;4(2);187190. 6. Baynes K, Bohman J, McCarthy TA. (Eds.) After Philosophy: End or Transformation? Cambridge, Massachusetts: The MIT Press, 1987. 7. Foucault M. Madness and Civilization: A History of Insanity in the Age of Reason. New York; Vintage Books, 1965. 8. Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone, 1997. 9. Slavin RE. Cooperative Learning: Theory, Research, and Practice (2nd ed). Boston: Allyn and Bacon, 1995. 10. Gijselaers WH. Connecting problem-based practices with educational theory. In L Wilkerson and WH Gijselaers (Eds.) Bringing Problem-based Learning to Higher Education (pp. 1322). San Francisco: Jossey-Bass, 1996. 11. Stage FK, Muller PA, Kinzie J, Simmons A. Creating Learning Centered Classrooms: What Does Learning Theory Have to Say? Washington, DC: The George Washington University, 1998. 12. Albanese MA, Mitchell S. Problem-based Learning: A review of literature on its outcomes and implementation issues. Academic Medicine 1993;68:5281. 13. Vernon DTA, Blake RL. Does Problem-based Learning Work? A meta-analysis of evaluative research. Academic Medicine 1993;68:550563. 14. Berkson L. Problem-based Learning: Have the expectations been met? Academic Medicine 1993;68:S79S88. 15. Colliver JA. The effectiveness of problem-based learning curricula: Research and theory. Academic Medicine 2000;75:259266.

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Received 15 August 2000 Final revision received 24 January 2001 51