Considering the Yin and Yang of Teaching and Learning: a Resource for the Novice Educator

Abstract

This paper introduces four key teaching and learning concepts that may be useful for novice educators new to the teaching and learning process. We have organized these concepts into the Chinese symbol of a yin–yang where one side captures what is needed for student learning to occur and, the other, what teachers need to do to prepare for teaching. This two-sided symbol brings together several practical ideas, such as cognitive load theory, co-construction of knowledge, and instructional design principles that may be useful for faculty new to teaching and learning.

Introduction

Faculties hired to teach in health science professional education are often tasked with teaching, typically without formal training in pedagogy or instructional design. This professional dilemma often results in novice educators either learning to teach through trial and error or sifting through vast amounts of literature to identify what is useful to their practice [1]. Given the high stakes of student evaluations on faculty performance [2], novice educators may benefit from targeted guidance on the basic principles of teaching and learning presented in a way that is easily retained.

Drawing on the teacher education literature that describes what novice educators need to know to be effective educators [3, 4], the goal of this article is to introduce four key concepts that will provide a conceptual understanding of some basic tenets involved in teaching and learning. These concepts are organized into the familiar cognitive structure of a Chinese yin–yang to aid novice educators in organizing and remembering them. In ancient times, the Chinese symbol of a yin–yang symbolized the balance between two opposite forces; for our purposes, one side represents what students need for learning to occur and the other side represents what teachers do to prepare for learning (see Fig. 1). We draw on this two-sided symbol to illustrate how seemingly opposite acts (teaching and learning) are actually complementary, interconnected, and interdependent, despite their often-separate treatment in health science education. It is our hope that by organizing the concepts into the yin–yang, novice educators will remember to consider both the teaching and learning process in the planning and design of their lessons.

Fig. 1.

Education as Yin–Yang

In our presentation of the yin–yang, we draw on literature that highlights structural aspects of teaching, such as those related to curriculum, assessment, and instruction and pedagogical issues, such as teacher/student interaction [4]. In all cases, curriculum refers to the overarching concept that refers to the content and organization of a course’s goals. Assessment refers to the act of examining teaching actions and student learning for effectiveness, and instruction addresses the interactive phase of teaching that occurs in the learning setting [5]. See Fig. 2 for our conceptualization of the model and its associated questions.

Fig. 2.

Concepts in teaching and learning

The Yin: How Students Learn

Learning as a Constructive Process

The yin side of the model describes how students learn, which has direct implications for how educators should approach teaching. Although many novice educators approach learners as passive gatherers of new information [6], learning actually occurs through the construction and co-construction of knowledge where students are actively engaged in the learning process. When novice educators conceptualize students as passive learners, teaching often results in PowerPoint presentations and teacher-driven lectures that require students to forgo opportunities to engage in the negotiation of conceptual meaning [3]. Information should not be thought of as being given to students, but rather that it is built with students through active cognitive processing [7]. From this perspective, the educator’s role in any teaching episode is to facilitate the construction of knowledge through activities in which learners are asked to investigate, analyze, interpret, or re-organize what they already know. For example, educators can ask students to look at lab results and interpret them in the context of the clinical scenario or investigate how cognitive bias may have played a role in a patient’s missed diagnosis. In giving students the opportunity to manipulate information (not just read it), students encode the information and associate new information with other knowledge that may already be known.

To assist students with constructing knowledge, there are several strategies available, including building cognitive structures through the use of advanced or graphic organizers [8]. Graphic organizers use spatial organization of words to show relationships between concepts [9]. They are helpful in encouraging students to construct knowledge in that they require students think about the newly presented information and organize it in a way that helps the information make sense. It is the act of cognitive manipulation in which students examine their own thoughts and arrange them in new ways that help the students identify gaps in their own knowledge development [10]. Examples of potentially useful graphic organizers include Venn diagrams, t-charts, flowcharts, and bubble maps, all of which help to organize complex information in meaningful ways. Table 1 provides a list of those that are commonly used in education with potential examples of classroom activities in which they may be helpful.

Table 1.

Types of organizers and applications

Type of organizer	Applications
Venn diagram	• Compare and contrast (could be two or more related drugs, diagnostic processes, etc.)
Flowcharts	• Can be used to trace physiological processes ○ Can be used backwards (start with output) to hypothesize about causes of an observed physiological response ○ May be branched to explore multiple pathways that could lead to same response • Can be used forwards or backwards for patient cases ○ Backwards: start with intervention and work backwards to provide rationale ○ Forwards: start with patient complaint and hypothesize about presentation ○ Middle: Start with tests and measures or initial impression and work backwards to patient complaint and forwards to intervention
Concept maps	• Used to visualize organization of concepts • May be used to assess students organization of knowledge (in relation to expert knowledge structure)

Educators may also want to consider using partially completed graphic organizers, a strategy that offers students an opportunity to fill in missing information that has been shown to be helpful [9]. Students not only demonstrate improved comprehension and application of content but also develop skills in designing their own organizers to work with other content [11].

Another way to teach in a way that supports knowledge construction is when educators employ scaffolding. Scaffolding is a kind of support where information and tasks are meted out so that learners gradually take on the full complexity of new tasks over time [12]. Scaffolding can be integrated by presenting tasks first in their simplest form and progressing to more complicated tasks [13]. This powerful strategy begins with educators being cognizant of the way information is presented, explained, and organized. Then, as learning progresses to more complex concepts, the educator contemplates how to provide (and then slowly remove) supports so that students continue to effectively engage with the material.

Scaffolding is a powerful strategy in small group settings because it helps to reduce the cognitive burden accompanied by learning on one’s own. For example, in problem-based learning (PBL), students are asked to problem solve as a group to expose them to the ways clinicians think and diagnose patients [6, 14]. The educator’s goal in PBL is to guide students towards seeing the type of questions they should be asking themselves [14]. Scaffolding in PBL is implemented in multiple ways, including appropriately timed and formatted questions that help students see the type of thinking needed for their specific discipline [14]. Additionally, mini lectures help students better grasp specific concepts at the point in the learning process that they most need them [14].

Educators new to the teaching and learning process should identify and provide opportunities for students to organize and construct their newly learned content, rather than approaching teaching as a transmission of information. In considering how learning occurs, we hope that educators can better design their lessons and maximize opportunities for students to learn.

Cognitive Load Theory

The second part of the yin side of the model also considers the learning process as segue for thinking about teaching. In particular, this section discusses the importance of educators organizing content for long-term memory storage. Several articles have already helped to identify and label various cognitive processes that help move information from short to long-term memory (Regehr and Norman, 1996; Mayer 2010). Adding to this list, the inclusion of cognitive load theory (and multimedia design theory which builds on cognitive load they) is included because they provide useful approaches in thinking about how information can be presented in a way that promotes the learning process [13, 15–17].

The idea of cognitive load has direct implications for how information should be organized and presented to learners. It refers to the total amount of effort that is needed from a learners’ working memory and is often distinguished into three components [12, 13, 18]. Intrinsic load is associated with the essential components of the task, which is impacted by the nature of the content to be learned and the level of the learner [19, 20]. This means that highly complex content, such as developing a differential diagnosis for a sick patient, demands high cognitive effort from a novice medical student, thus resulting in a high intrinsic load. In contrast, a task that asks students to identify which type of imaging would be most important for a patient with a particular disease process only requires student to decide among several choices presented to them and thus carries a lower cognitive load.

Extraneous load, the second type of cognitive load, pertains to elements of instruction not essential for learning [20], such as how much content an educator should include in a single lesson. Extrinsic load is largely influenced by decisions instructors make in terms of how information is organized and presented within a specific lesson. In taking into consideration extraneous cognitive load, instructors should be familiar with components of strategic instructional design, which can actually free up students’ cognitive space for processing new information [12] and maximizing students’ ability to learn [19]. Educators will find that principles from multimedia design provide some concrete guidelines for the organization of teaching materials to reduce extraneous load [16, 17].

The last form of cognitive load, germane load, is associated with the learner’s strategies for monitoring and managing their own thinking [20]. This form of cognitive load is important in training future physicians who must be able to keep track of their own thinking processes, including the ability to monitor their own cognitive biases related to clinical decision making [21]. Germane load is rooted in learners’ own metacognitive processes and can be mitigated by the instructor’s management of the other two loads. Therefore, in considering germane load, instructors’ goal should be to provide learners with the opportunity to maximize the cognitive space they have for monitoring their own cognitive processing. To achieve this, instructors must attend to sound instructional design principles that will afford students the ability to question their own thinking and monitor their thought processes.

Evidence exists that these three elements of cognitive load are considered additive, such that excessive load in any one area can impair learning [13]. Practical tips for reducing cognitive load include combining content into meaningful “chunks” when presenting to students. This strategy is useful for novice educators to know because it is not necessarily intuitive. However, when content is grouped together, learners are able to encode information for more efficient storage and processing to expand and deepen their understanding [22]. Also, instructors can scale back the amount of content taught to students at one time or use more concise presentation methods and emphasize the key points to enhance students’ retention and transfer of the information [17].

Finally, it is important for novice educators to know that when too much information is presented, students can quickly become overwhelmed as they try to discern and prioritize what is essential information [15]. To mitigate these feelings, consider focusing on essential elements to ensure comprehension, rather than covering everything that could be taught in the lesson. Also, consider using strategic modes of presentation [12], in which students’ attention is not split. This is accomplished by first considering what modality (visually, in text, auditorially) will most effectively present the content [13] and then present only what is relevant. Finally, consider including fewer words in the presentation and using a more conversational tone to support enhanced knowledge retention and transfer [17].

Focusing less on the content to be covered and more on the way in which the mind manages information is a powerful teaching concept that educators can use in any teaching and learning situation. Although it might be uncomfortable for some educators to think about reserving some of the information they have always presented in a lecture for another time, the benefit for student learning and knowledge retention should be motivating.

The Yang: Teaching to Promote Learning

Instructional Design Principles

While the first side of the yin–yang model focused on how students learn, the other side focuses on ways teachers can support and promote the learning process, even as they are still learning how to teach. One of the ways to support learning is to employ models of instructional design, which help to create a framework for thinking about the curriculum, assessment, and instruction in a way that allows them to work in harmony in support of student learning [23]. These elements are most easily aligned by applying the concept of “Backwards Design,” which is useful in promoting instructors’ systematic thinking about teaching and learning [24]. The essential premise of Backwards Design is that instructors should first focus on identifying their desired outcomes for students [24], which entails clearly identifying and articulating one’s learning objectives [25, 26]. Once objectives are identified, appropriate assessments should be selected. These first two steps of the Backwards Design model should occur before planning any instruction; that is to say, identifying one’s learning objectives and assessments takes priority over instructional planning, which should be considered as the last step in this model. Figure 3 illustrates the instructional design process of Backwards Design.

Fig. 3.

Process of Backwards Design

In selecting assessments, two factors need to be considered: what knowledge should be assessed and the best means for assessing this knowledge. For example, if the learning objectives indicate that students should understand, synthesize or apply knowledge, then assessment should focus on thinking and problem solving over replication of facts [26]. However, if learning objectives require students to learn complex skills/knowledge (such as engagement in evidence based practice), no single type of assessment can capture appropriate learning [26], and multiple types of assessment are necessary. Then, only after these issues of assessment have been determined should classroom activities be planned [24].

This systematic and intentional approach to instructional design is clearly illustrated in a published example on the revision of a first-year pharmaceutics course [27]. The course designers stated their goals at the beginning of the process as improving students’ roles as critical thinkers, problem solvers, and team players [27]. They determined the assessments necessary to best address these goals included a project that involved identifying a real-world problem and writing a research proposal to target the identified problem (addresses goal of critical thinking and problem solving). The instructors also awarded points to students during classes for helping to facilitate group process (addresses goal of team work). Finally, they designed the classroom learning experiences. To promote student learning consistent with their goals, these educators specifically integrated classroom activities that included audience response questions, paired discussions followed by class presentations of problem solutions, and student presentations of their interpretations of assigned readings [27]. In this thoughtful use of Backwards Design, instructors were able to enhance student perceptions of the learning experience and students’ learning outcomes.

Novice educators often jump into the teaching and learning process at the instructional level, missing the important step of defining outcomes and choosing assessments that properly assess the desired outcome [3]. However, by paying attention to instructional design principles, educators ensure that teaching is deliberately focused on learning. Following these concrete steps of Backwards Design ensures that all aspects of teaching, including curriculum, assessment, and instruction, work together to ensure student learning.

Alignment of Assessment with Teaching Goals

The second concept on the yang side of our model highlights the importance of aligning assessment with the instructor’s teaching goals. When used properly, assessment should serve as a tool for optimizing student learning. However, in reality, assessment tends to drive student learning [28], a reality that can be difficult to navigate when moving into an educator role. Studies indicate students tend to make decisions about what is important to learn based on what content the instructor intends to test [29]. This practice suggests that instructors should be cognizant of the type of learning they want students to engage in and design assessments that foster that type of learning [29].

Ideally, assessment methods should align with the course’s over-arching learning goals [29] as a way to improve learning [25]. Alignment between these two aspects of instructional design helps students recognize the best way to frame what is important and ensure the program is meeting its intended goals. This will require that many educators incorporate other forms of assessment other than multiple-choice exams, the predominant method of assessment in health sciences education. At present, it is estimated that 50% of assessment questions in first-year medical student exams are multiple-choice questions at the level of recall [30]. Although multiple-choice exams are an efficient way to capture data, multiple-choice questions often focus on recall and not higher order thinking skills. Even though well written multiple-choice questions can address higher order thinking and problem solving, many faculties lack the training necessary to write this type of question [30]. Test questions written by faculty without training tend to focus on recall and include flawed items [31, 32], which can introduce systemic error into examinations and can negatively impact student performance [32]. Faculty training in item writing for medical board exams can improve the development of written multiple choice questions [31]. Further, the use of an in house committee to review items can enhance the quality of multiple choice test items [33]. In addition to greater training in writing board exam style multiple-choice questions [31], educators should also consider incorporating a variety of assessment methods.

Although novice educators do not always have this opportunity to make changes to the assessments they use, it is important to consider whether the types of assessment match the course’s learning objectives. For example, if the learning objectives indicate that students should understand, synthesize, or apply knowledge, then assessment should focus on thinking and problem solving over replication of facts [26]. Multiple-choice exams, while convenient, may not foster deep learning [28]. For complex skills/knowledge (such as engagement in evidence-based practice), no single type of assessment can capture appropriate learning [26]. In many cases, multiple types of assessment are necessary to effectively assess complex learning [29] and choosing the right form of assessment to demonstrate the desired learning is both challenging and should include careful consideration. For educators new to thinking about other forms of assessment outside of multiple-choice questions, Table 2 is offered as a reference.

Table 2.

Types of assessments and reasons to use

Type of assessment	Purpose or goal	Limitations
Multiple choice	• Factual recognition • Quick to grade • Perceived objectivity	• Difficult to include ill-defined topics (i.e., professionalism) • Focus on surface-level learning • Does not measure quality of performance
Essay/extended response	• Likely includes factual replication • Can require integration and organization of ideas	• May have subjective element in grading
Portfolios	• Documentation and student reflections on a particular area of competence • Multiple domains of assessment compiled (longitudinally) into a portfolio can require the student to synthesize multiple types of information as is required in clinical work • Requires creativity	• Can be time-consuming to review • Require clear instructions to communicate expectations to students
Clinical Simulations	• Objective Structured Clinical Exams (OSCEs): simulations and examiners have a checklist to identify desired behaviors • Assesses real life skills	• May lack full contextual elements of true clinical setting • Structure may support performance of skills but not always problem solving • Requires multiple patients to gain true assessment of student ability
Direct clinical observations	• Rich data in true contextual setting • Debriefing can be used for post observation reflection (video can be used to enhance debriefing)	• Can have subjective interpretation issues • Can be limited in number of cases observed
Multiple source (360° assessments)	• Provides input from many stakeholders (supervisors, peers, patients)	• Can be time-consuming • May be difficult to get clear feedback from all stakeholders
Concept sorting	• Evaluates organization/ structure of student’s knowledge	• Requires extensive instructor knowledge to evaluate • Can be time-consuming to evaluate
Self-assessments	• Promotes reflection, self-awareness

Source: [28, 29, 34–39]

Discussion

In this article, we presented four educational concepts that may be useful for novice educators interested in advancing their understanding of the teaching and learning process. We offer these concepts as a resource because educators are very often held to high expectations for teaching but are rarely given guidance on how to advance their understanding of the teaching and learning process. We represented the interrelatedness of these concepts in the form of a yin–yang, where on one side, we examined what educators should know about the teaching process, and on the other, what educators should know about what students need for learning to occur. Taken together, this model represents the information that we believe educators should consider as they design and teach in their courses and programs.

On the yin side of our model, cognitive load reminds us that as educators, we need to consider how much information students can learn at a given time and the ways in which educators may sabotage learning when too much is presented. The idea that knowledge is constructed informs us that students need opportunities to apply, synthesize, and organize information for proper storage and recall. When information is poorly organized, students struggle to make sense of what is being presented. On the yang side of the model, instructional design principles and the alignment between assessment and learning goals remind us that we need to think about alignment between various components in teaching and learning in our work as educators. Learning goals determine assessments, and instruction should support both learning goals and the assessment of students’ learning. The structural aspects of teaching, curriculum, assessment, and instruction must be considered and treated together as three interrelated pieces of the same puzzle.

The four concepts found in our yin–yang model are those cited as most helpful in the development of novice educators and may be useful to others who wish to advance their own teaching and learning skills. Further, these concepts can be integrated in any form of teaching (i.e., flipped classroom, interactive lecture, PBL) and any type of curriculum (i.e., traditional, PBL, hybrid). Educators interested in further advancing their understanding should consider exploring these concepts in more detail, as they will help anchor the vast educational literature available on teaching and learning. It has been our experience that the more attention educators pay to the interrelatedness of teaching and learning, the greater the benefit they will see in student learning.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there is no conflict of interest.

Ethical Approval

Ethical approval was not sought for this paper due to the nature of its contents.

Informed Consent

There are no participants, so no informed consent was needed.