The constructive theory has been said to be consonant with the action theory [1
]. Contrary to the traditional belief that learning takes place before acting, action theory believes that activity (sensory, mental and physical) occurs prior to learning. It assumes that mind and body are inter-related. Hence, knowing can only take place in context of doing. Activities are complex and interactive, which necessitates a collaborative effort. This has been explained with an example that how activity is the product of inter-relatedness and is independent of the individual. In a piano concert; manufactures, designers and builders involved in buildings the concert hall and accompanying orchestra. This all the extra elements are engaged for the successful concert [1
In Constructive Learning Environments, (CLEs) it is necessary to study in situ practices that we hope to simulate in the learning environment [2
CLEs consist of several inter-dependent components: a problem-project space, related cases, information resources (literature, media etc.), cognitive tools, and conversation and collaboration tools [3
The focus of this commentary is to provide a basic understating of constructive learning theory to the readers. The objective is to provide health education providers to understand the significance of the constructive learning environment (CLEs) in training the health care professional in practical case based scenario. As discussed further throughout the paper, on very few occasions this theory has been tested through actual experimental conditions, rarely in health education. More so, till date none of the data available so as to provide an insight for possible application of this theory in the field of physiotherapy teaching and practical learning.
It is true that this theory is neither novum nor that it has not been explored before. But it has been very rarely experimented in health education context and never so in the training of physiotherapy students. Through this paper an attempt is made to highlight the possibilities of application and employment of this teaching learning method to improve the student’s understanding into patient’s problems and further problem solving.
Since, physiotherapy practice and therapy deals with improving quality of life (QOL), students are required to understand patient problems not only in the context of structural change but functional change and patient’s difficulty in carrying out daily life activities (ADLs). This requires a though understanding on the part of student about of patient’s problem in the context of environmental situations. This is likely to improve his decision making to undertake appropriate treatment measures. This further requires an in-depth insight in understanding of patient’s requirements and actual restriction imposed by the disease process regaining the functions. The understanding of this factors underlies an effective interaction and communication with that particular patient or his care takers. This analytical skill and decision making of student depends on the practical understanding of the patient’s problems which in turn requires an effective interaction. This however cannot be taught with the methods which are based on classroom teaching. If students are provided an opportunities to explore their own way of establishing the effective communication and applying the onsite knowledge based on the previous experiences or theoretical literature reading, understanding of the problem based approach can be effectively facilitated. This has to take place under the constant guidance and direction of the teacher or expert instructor whose role is to facilitate and let student explore his own string to reach the final intended goals. Expertise required for clinical reasoning and decision making with problem solving approach can then be achieved with incorporation of this underexplored teaching learning method in the field of physiotherapy practical learning.
Through this commentary author wants to take this opportunity to highlight constructivists learning theory and provide a basic framework for its possible application in the field of physiotherapy as well. Hence, encouraging and providing a stimulus to potential health education researchers in the field of physiotherapy to consider it for further exploration and providing the evidences and setting the guidelines for physiotherapy teaching in the interactive and constructive learning environments.
In order to accomplish the objectives of learning through CLEs an in-depth understanding of this components is mandatory for the teachers or instructors prior to embodying CLEs for any of teaching activity
Certain components of CLEs [1
] are explained with incorporation of appropriate life examples to lay a foundation for further understanding of constructive learning theory in field of physiotherapy.
Problem-project space: In CLEs the problem-project space presents a learner with a problem in form of physical context, the actors and stakeholders, and the organizational and cultural climate.
For example; a patient with an episode of acute low back pain with neurological deficit admitted as an inpatient for the institution base rehabilitation services.
This case scenario would then provide a challenge for the learners. Hence, students are presumed to bear the responsibility of a problem and attempt to affect or manipulate the problem in some important way [1
Related cases: related problems in CLEs enable learners to examine prior experiences and relate them to the current problem. This exposes student to multiple perspectives or approaches to the problems or issues. This can be an important element if learning through case series is employed. Also this can be used to facilitate leaners understanding in establishing connection with the community at risk of suffering from the same health ailments.
Cognitive tools: for an instructor it is very important to identify the skills that are required to solve the problem and to provide a framework. This would help the learner to use his cognitive skills enabling him to perform those tasks. The frameworks should support the learner’s exploration, articulation, and reflection in the environment [1
For example, a problem should be compliant with a required level of student’s skills of problem solving and complex enough to exhaust his capabilities to the core.
In contrasts to the traditional teaching methods where results are taken as the ultimate product of the learning, in constructivist’s theory a process involved to attain those results is also given an equal importance [4
]. Hence, not only what we know (K), but what we want to know, and what we have learned (L) but how we know it (H), is also important. Similarly, what are the evidences (E) to support our views and what are the new areas (W=wonderings) for further exploration. To employ the process an assessment based on KLEW (know, learn, evidence, wonderings) chart [5
] can be followed.
In a scenario, where students have to diagnose and manage adhesive capsulitis in the final year undergraduate students. Students would think and already expected to know (K) that, Shoulder moves in three degrees of freedom, it has a capsule and ligaments. For the degree of freedom they are expected to know that, large amplitude of range of motion is the function of articular shape of bones in given degrees of freedom and hence shoulder joint allows for reach and overhead activities etc. What students are learning (L)? Adhesions in capsule can lead to movement restriction in capsular pattern which is altering the activities of daily living (ADLs) , quality of life (QOL), etc. Student know this on basis of evidence (E) which means, how student know this? Whether they did some reading about it, followed internet, followed some published literature, their clinical encounters with patients, whether followed any research article, whether discussed with seniors etc. What are student’s wonderings (W)? Students have come up with some further testable questions about the adhesive capsulitis etc. Emphasizing evidence may encourage students to gain more valid information through scientific investigations and understand the prospects of future research. The student can come up with ideas about modifications to existing investigations or designing the new tests. Hence, in CLEs students work in a group. Learning is interactive and starts with what students already knows. Teachers interacts with students and help them to construct their knowledge. During the entire process, the student competency, his observation, perspective, point of view is assessed along with the end product.