Constructivist learning theory is based on an epistemology in which knowledge constructs are individual and experiential. Constructivists maintain that knowledge building is an internal cognitive process. As knowledge is internally filtered through our experiences, values, and perceptions of the world, any external reality can never be fully known or understood. Similar to the Gestalt movement’s “Law of Closure,” constructivist learning theories maintain that we often “fill in” missing information to build a construct of a complex phenomenon (Ormrod, 2012). Early constructs are typically oversimplified, reducing the complexity to the most basic and useful form – as in the Gestalt movement’s “Law of Pragnanz” (Ormrod, 2012). Such constructs are only restructured when necessary. Piaget notes a driving force for such adaptation, describing it as “disequilibrium.” Understood as the discomfort of a construct not matching a new experience, disequilibrium can either be ignored or resolved through the cognitive process of assimilation or accommodation. By experiencing multiple aspects of a situation through multiple modes of learning, adaptive disequilibrium can be fostered and drive us to reconstruct knowledge with more nuanced understanding and more flexible applications. In experiencing “multiple juxtapositions of instructional content,” Spiro claims that we are effectively “crisscrossing the [cognitive] landscape” to build a richness and depth that is more readily adaptable to new experiences (Nix & Spiro, 1990).
This concept of “crisscrossing the landscape” is helpful in health professions education where the complexity of many topics promotes pragmatic oversimplification. However, “crisscrossing the landscape” can be practically challenging. Our learners are apt to complain or lose focus when we present yet another case of dyspnea. They may fail to adapt to the disequilibrium. As teachers, we can develop strategies to combat this common trap. With the spiral approach to education teachers strive to expose a learner to a topic on multiple occasions with increasing levels of nuance and sophistication as they developmentally progress through training. Using temporal proximity to juxtapose the distinguishing features of case studies in varied settings and through multiple media can help promote more sophisticated understanding of a topic. Advanced organizers can serve as blueprints to building knowledge. Using different instructional styles, simulation, or live patients can help maintain attention and provide scaffolding of contextual relevance for the learners while simultaneously providing a juxtaposition of various sensory experiences and multiple modes of learning. Health Professions Education (HPE) leaders have an opportunity to model this strategy directly in teaching. We can also promote such a strategy through faculty development programs. HPE leaders must ensure programs have the necessary time, financial support, and technical infrastructure to deliver such robust learning opportunities. With enough effort and attention, we can crisscross the landscape with good educational practices that will ultimately promote better learning.
Nix, D., & Spiro, R. J. (1990). Cognition, Education, and Multimedia: Exploring Ideas in High Technology: L. Erlbaum.
Ormrod, J. E. (2012). Human Learning (6th ed.). Upper Saddle River, NJ: Pearson.