Current issues in the scholarship of clinical teaching - A pedagogy of the unexpressed


  • Hardie
  • K.
  • MScN
  • EdD


7JJ The Teacher


University of Toronto


Where the rubber meets the road. Unique Characteristics of Clinical Teaching and Llearning.


Situated and experiential learning
Context dependent
Often in small groups
In unpredictable / unstable environments - high stakes learning
Learning may lack continuity 
Potential for clinical teachers to be unprepared, unmonitored and unsupported??









There was a funeral ......but Behaviourism Alive and Well in Health Professional Education 

Continues to shape and structure programs, 
content driven curriculum, method of teaching, 
teacher student relationships and evaluation in 
relation to learning outcomes in classroom 
‚Äčand clinical settings


Competing Paradigms - Behaviourist vs. Emancipatory paradigm? Are they even compatible?

Should education be a tool for compliance and conformity or instrument of liberation?

Pros - While not appropriate for much of the health professional curriculum,  behaviourist approaches are well suited for instrumental and skill learning.

Cons- Binary discourses in the same curriculum increase potential for misunderstanding. Different paradigms may in fact be incommensurable. Importance of commitment to one paradigm.

Dilemma of rigour vs. relevance? 




The Limitations of Behaviourism... or... Why is it time for the final burial of behaviourist theory in teaching and learning ......

  • Grounded in logical positivist paradigm 
  • Does not challenge assumptions
  • Essentially a theory of teaching not learning
  • Is about an authoritarian teacher who “knows and gives”
  • Student viewed as a passive recipient of knowledge ; “listening objects”, dependent learner
  • Knowledge is decontextualized
  • Mechanistic - does not encourage creativity or critical thinking
  • Emphasis on grades to detriment of learning
  • Does not account for social aspects of understanding and learning

Summary of Work

Transformational Learning Theory (Mezirow, 2000)

A framework for clinical teaching practice incorporating:

1. Individual experience
2. Critical reflection
3. Dialogue
4. A holistic orientation
5. Awareness of context
6. Authentic relational practice. 









Reflection on Teaching - The Clinical Teacher as Student

Reflection Defined: Intentional contemplation purposefully done to enhance self-discovery

Reflection is the praxis piece of transformational learning theory and involves ongoing examination, questioning, validating and revisiting those assumptions which shape responses.

Levels of reflection
1. Unreflective
2. Descriptive reflection – reporting
3. Dialogic reflection-  discourse with self 
4. Critical reflection  - taking into account the social political context


Transforming points of view and habits of mind through critical reflection   

Hope to change how think …. Often produces changes in how act    

An important challenge for the reflective clinical teacher is the ability to self-consciously consider how power and hegemonic discourse could or has influenced and shaped their own learning experiences and teaching practices.

Questioning Assumptions about Teaching and Learning .... Beginning to Express the Unexpressed….  

We are our assumptions…..                                                                                       
What are our assumptions that are unquestioned and taken-for granted?

Consideration of how the exercise of power often benefits the teacher rather than promotes student learning.

How do our assumptions influence our teaching practice?

  • What do we think the role of teacher and role of student should be?
  • Teaching must essentially be an apolitical activity?
  • Producing enlightened change agents and students who are more socially and communally responsive is important but has a lower priority in education? 
  • We expect conformity in students? 
  • We believe that the curriculum as laid out is what students learn?
  • We believe teaching is about content?    
  • Are we committed to dichotomous or are open to dialectical thinking?
  • What are our hegemonic assumptions? 
  • How should a teacher enact professional collaboration?
  • What is our understanding of privilege and heirarchies?
  • Do we think our students share the same values and beliefs as us and each other about equality, compassion, health, family, death and dying etc.? 
  • What are examples of tacit understanding underpinning our teaching practices? 

Education is an inherently political activity. Traditional perspectives of teaching and learning, grounded in behaviourist approaches, are inappropriate for the challenging and complicated context of clinical teaching.

Critical pedagogies of teaching and learning, such as transformational learning theory, provide a more relevant foundation for clinical teachers from which to begin to address the complexity of situated, experiential, context dependent and relational learning in health professional education.

TL theory positions critical thinking, questioning and reflection on teaching as central to the clinical teaching role.  Through interrogation of taken-for-granted assumptions the reflective clinical teacher can begin to self-consciously consider how power and hegemonic discourse could or has influenced and shaped their own learning experiences and teaching practices. 


Brookfield, S. (1995). Becoming a critically reflective teacher. San Francisco: Jossey- Bass.
Mezirow, J., (2000). Learning as transformation: Critical perspectives on a theory in progress. San Francisco: Jossey-Bass..
Leonardo, Z. (2004) Critical social theory and transformative knowledge: The functions of criticism in quality education. Educational Researcher, 33(6)11–18.
Hatton, N., Smith, D. (1995). Reflection in teacher education: Towards definition and implementation. Teaching and Teacher Education 11, 33-39.
Mann, K., Gordon, J., Macleod, A. (2009) Reflection and reflective practice in health professions education: A systematic review. Advances in Health Science Education, 14, 595-621. 

Summary of Work
Send ePoster Link