Teaching and Learning: The Art and Science of Making Connections

    Oh, Merlin, he cried [young King Arthur] Please come too.

For this once said a large solemn tench [Merlin] beside his ear,
        I will come. But in future you will have to go by yourself.
Education is experience, and the essence of experience is self-reliance

White (1958, p. 41)


It is impossible to encompass the huge body of information about teaching and learning in one chapter. Thus, Chapter 3 provides a broad overview of the field. There is no best way to teach, but there is increasing recognition that it is important to help people build connections and make meaning from what they learn, rather than merely completing tasks. Creating meaning involves developing collaborative partnerships and engaging learners (see Chapter 5).

Learning is not necessarily an outcome of teaching and many people, even well-educated people, do not understand as much as others think they do. People may be able to repeat what they were told or read, but questioning shows they do not really understand the information, or their understanding is incorrect.

Thus, educators must focus on the quality of understanding rather than the ability to regurgitate information. For example, people’s ‘knowledge’ scores may improve after a ‘diabetes education programme’ but their understanding may stay the same or decline, depending on the effectiveness of the teaching and the person’s ability to lay down new neural pathways that connect new information to existing information.

People have to construct their own meaning from the information they receive (turn information into knowledge) by establishing permanent neural pathways and connections in the brain. If the information is not used frequently, the connections become less well established, which is why ‘refresher programmes’ and repeating information are important teaching strategies, and why continuing professional development is essential for health professionals.

The information in this chapter is relevant to educating people with diabetes, health professionals (HP) and educating the self. It is also applicable to individual, group and online teaching, although there are differences between the three modes.

Purpose of diabetes education

The overall purpose of diabetes education is to help people with diabetes/family members/carers to:

  • Establish a therapeutic relationship between the educator and learner(s).
  • Acquire, retain and be able to use relevant information.
  • Make connections between new information and existing knowledge.
  • Develop problem-solving skills.
  • Understand the importance of self-care to health, well-being and quality of life.
  • Achieve the skills and establish behaviours and attitudes needed to self-care.
  • Provide appropriate support and make appropriate referrals.

An underlying assumption is that the educator has the relevant education and assessment, teaching, clinical and helping skills, and adopts a person-centred rather than a problem-centred approach.

Principles of learning and teaching

Principles of learning were developed to support educators to work with learners. The principles focus on the educator’s ability to create and maintain an environment conducive to learning. Importantly, the principles are also relevant to the educator’s learning. Principles are statements about the quality of learning and the teaching methods likely to create learning environments (see Table 3.1). The principles should be considered in conjunction with the educator’s teaching philosophy (see Chapter 5).

Principles were designed to be interpreted in particular learning contexts and to stimulate reflection and conversations about teaching pedagogies. Principles are not standards or curriculum statements: however, they can be used to develop curricula and standards. Importantly, principles focus on what educators should do, and are based on behavioural and learning theories.

Table 3.1 Principles of learning.

Principle Application to diabetes educator role
Careful planning, commitment to and resources for diabetes education are essential within busy clinical environments Education leadership and management
Advocate with and for people with diabetes
Ensure the environment is as learner friendly as possible
Educators are responsible for their own learning and continuing professional development Initial training and continued professional development
Seek mentors
Participate in communities of learning
Educators help each other learn and develop their pedagogies through formal education programmes, mentorship and communities of learning Participate in communities of learning locally and internationally, e.g. IDF D-net
Provide mentorship
Publish and present at conferences and other learning forums
Research engagement is important to evidence-based practice, the quality of teaching, education programmes and clinical and education outcomes Engage in research at the level of knowledge and skill
Practice in an evidence-based care climate: at least must be able to critique and understand research publications
Implement research findings
Undertake and publish research
Evaluate self and diabetes services using valid tools and processes
New understanding flows from research and reflection in and on practice Reflection in and on practice (Chapter 5)
Educators need to collaborate with other educators to stimulate and support innovation, enhance and share their knowledge and contribute to the profession Promote interdisciplinary team care and actively participate in team care
Educators must be willing to question existing practices and make relevant changes but change should be evolutionary rather than revolutionary Ask good questions and higher order thinking are correlated. Educators must value and encourage people’s questions
Educators need to take risks and support colleagues’ risk-taking Trying new teaching strategies such as those described in Chapter 7

Note: There are important outcomes of effective pedagogy that standard test measures do not assess. Educators often measure metabolic parameters, before and after knowledge scores. But these measures may not actually reflect learning. Likewise, they may only be surrogate markers for the educator’s effectiveness.

Pedagogy encompasses ways of working with learners. Principles can help educators explore their pedagogy through reflection and discussion with other educators, which also helps bring tacit knowledge into the open for others to discuss and learn from (Polyani 1966, 1969). However, the thinking and behaviour that informs educator’s pedagogy is complex and personal. In addition, teaching strategies that are effective for one educator may not be as effective for others with different levels of experience, beliefs, confidence and behaviours.

Learning theory

Learning is a process that encompasses cognitive, emotional, experiential and environmental influences people use to acquire, enhance or change knowledge, skills, values or world views (Illeris 2004). Learning theories attempt to explain what happens when learning occurs and provide educators with the vocabulary and a conceptual framework for interpreting the learning they observe and suggest teaching strategies to enhance learning (Hill 2002).

Learning theories fall into three main philosophical frameworks:

1. Behaviourism: primarily developed by Skinner (1954) but encompasses Thorndike, Tolman, Guthrie and Hull’s work. Behaviour theories are based on three underlying assumptions:
a. Learning results in behaviour change through conditioning.

b. Environment shapes behaviour.

c. The principles of contiguity and reinforcement are central to explaining the learning process.

2. Cognitivism: Bode (1929), a gestalt psychologist, criticised behaviourist theories as being too dependent on overt behaviour to explain learning. Gestalt theorists believed the memory system actively processes and organises information, and prior knowledge affects learning. That is, cognitive theories look beyond behaviour to explain learning and the control the learner has over the learning process. Several cognitive theories emerged between the 1970s and the 1990s and others continue to emerge as the understanding of brain functions increases. Educators using a cognitive approach regard learning as an internal mental process requiring insight, information processing, memory and perception, and design education strategies to enhance existing knowledge and skills.

3. Constructivism: based on Piaget, Bruner Vygotsky and Deweys’ learning theories. These theorists viewed learning as a process in which the learner builds on current and past experience: ‘constructing knowledge from one’s own experiences’. Therefore, learning is personal. The educator helps ‘bring the learner to the threshold of his own mind’ (Gibran 2008). Knowledge is constructed in social contexts (social constructivism). Educators can help the learner explore social issues relevant to them to discover meaning and construct knowledge as distinct from acquiring information: for example, self-directed, transformational and experiential learning, situated cognition and reflective practice.

Other less formal and post-modern learning theories also exist, for example, restructuring knowledge (Marzano 1991). Marzano maintained new knowledge could not be told to learners. The educator must challenge a learner’s current knowledge so the learner can adjust their ideas in the light of the new information. Transformational learning involves using discourse to critically examine and reflect on habits and beliefs and seek alternative explanations. Transformational learning is more likely to lead to self-knowledge and responsible thinking (Mezirow 1991).

Educational Neuroscience or Neuroeducation theories are emerging (Radin 2009; Wolf 2010). These theories connect information about how the brain processes and stores information with education strategies, for example, conditions that enhance knowledge acquisition, storage and recall. Radin (2009) suggested the art and science of teaching accelerated after former US President GH Bush declared the 1990s ‘The Decade of the Brain’.

Brain research will influence diabetes education theory and practice in the future, for example the way we educate people with learning disabilities and the ability to individualise teaching to education effectiveness.

Laws of learning

In addition to principles of teaching and learning, ‘laws of learning’ provide insight into how people learn. The basic laws are: readiness, exercise, effect primacy, recency, intensity and freedom (Table 3.2).


There is no single agreed definition of ‘knowledge’. Generally, know­ledge refers to expertise and the skills a person acquires through experience and/or education. But it also refers to enlightenment and cognition (Macquarie Dictionary Online 2010). Significantly, for ­diabetes educators:

Real knowledge is to know the extent of one’s ignorance.

(Confucius 551–479 BC)

Many educators assume giving people with diabetes information is ‘giving them knowledge’. However, acquiring knowledge is a complex cognitive process involving perception, learning, communication, association, ­reasoning and reflection. Thus, the individual needs to process the information and construct neural pathways and connections before information becomes part of his or her knowledge base.

Table 3.2 Laws of learning.

‘Law’ Implication for diabetes education
Readiness People are more likely to learn when they are physically, mentally and emotionally ready to learn
Factors that could affect people with diabetes’ readiness to learn are age, health status, feelings about the diagnosis
Exercise/practice If information and skills are repeated, they are easier to remember and people are more likely to retain information
Politicians are experts at repeating information throughout speeches
Practice must be meaningful to the individual and should be followed by positive feedback
Effect Emotional reactions of learners directly affect learning and are related to motivation
Learning is enhanced when it is pleasurable and satisfying. People with diabetes should leave every learning experience feeling positive
Primacy Information learned first creates a strong impression and is difficult to erase
The first education encounter for people with diabetes should provide accurate information in a logical stepwise manner ensuring the individual learns the preceding step before progressing to the next step
Recency The most recently learned information/skills are more likely to be remembered
For example, it might be a long time before an individual needs to implement ‘sick day care’ and they may forget key self-care activities and information
Thus, such information could be part of an annual education review
Intensity A clear, dramatic, exciting, positive learning experience is more likely to engender learning. People learn more from real-life situations than abstract or simulated situations
Educators can use the individual’s blood glucose tests to help the individual determine the effect of food, exercise and medicines
Use creative teaching methods and involve at least two senses
Freedom Things learned freely are learned best and are more likely to lead to personal growth
Educators could involve people with diabetes in decisions about what they want to learn and the order they want to learn it in

Knowledge cannot be transferred directly from one person to another because of the way information is encoded and handled in the neural pathways in the brain that process information, make connections and lay down memories. Information can be transferred in many ways, especially via writing, technology and spoken and body language. Educators need to realise that incorrect information can be and is transferred and needs to be unlearned.

There are various types of knowledge. Broadly, knowledge is classified as procedural (learning tasks) and declarative (knowledge in store). In addition, knowledge is classified as:

  • Spatial knowledge: which is specific to a particular situation. Learning from experience (experiential learning) creates situational knowledge.
  • Experiential knowledge (a posteriori) gained through experience that was not there before (a priori).
  • Partial knowledge: it is almost impossible to have complete knowledge about anything. Thus, most people have partial knowledge, which they use to solve problems and understand issues, often by sourcing other information.
  • Tacit knowledge: is understood but is unspoken and implicit. People often know more than they can articulate in words. Importantly, although the individual may not be able to articulate tacit knowledge, they use such knowledge to make sense of their world.
  • Scientific knowledge: which continues to contribute to the empirical basis of diabetes education and evidence-based care. Scientific knowledge is acquired by conducting research, reading about research and using inductive and deductive processes to understand research findings and apply them to diabetes education.
  • Unconscious knowledge or intuition: A great deal of information ­processing occurs in an automatic non-conscious process that influences insight, creativity and decisions (Myers 2007; Kahneman 2011). Intuition bypasses the thinking part of the brain (cortex) and is often emotionally charged. It influences insight, creativity and prejudices ‘my gut feeling tells me …’. Kahneman referred to system 1 (fast track) or intuition, which requires little energy, and system 2 (slow track) the conscious mind that employs deliberate, rational thought and requires a great deal of energy. Intuitive responses mean people form an opinion about other people in 4–6 seconds (see Chapter 5).

Health professionals (HPs) regularly us intuition, for example experienced HPs often follow mental short cuts (heuristics) when making clinical and education decisions. Many decisions are based on experiential and tacit knowledge and pattern recognition. Less-experienced HPs are more likely to follow guidelines. Intuition can lead to costly errors.


Children and adults are influenced by small changes in context (Thaler and Sunstein 2009) and small, seemingly insignificant things, can have a significant effect on behaviour. Diabetes educators need to assume everything matters and make choices about education most likely to be beneficial: it is almost impossible to design the ‘perfect education programme’.

‘Nudging’ aims to induce people to change behaviour without necessarily banning activities. Nudging might be a useful strategy for diabetes education, but research is needed. Nudging is based on the theory that people tend to maintain the status quo but can be ‘nudged’ to change. Nudges, in diabetes education could include goal incentives (negotiated with the individual) and positive feedback. Economic incentives and other forms of ‘bribery’ are not ethical.

Interestingly, a BBC health news report of 19 July 2011 suggested ‘nudging is not enough to change lifestyles’ and that change will only be possible if the Government is prepared to legislate. However, legislation might be at odds with nudge theory of not banning things.

Learning and the brain

The brain consists of millions of neurons capable of connecting with each other via dendrites. Learning occurs when a connection is made. Table 3.3 shows the parts of the brain where specific learning activities occur. Neurons communicate electronically and chemically to send and receive information. Repeated stimulation enables the connection to become permanent, if the neural pathways are used frequently. Neural pathways/connections do not disappear: they become less established with disuse, but can be reactivated when needed.

Table 3.3 There are specific sites in the brain where particular learning activities occur.

Source: Wright (2006).

Left hemisphere: logical and rational Right hemisphere: creative, intuitive

  • Processes information in a logical sequential way in a stepwise manner
  • Processes the words and sentences used in speech

  • Deals with information in a random, holistic way by processing pieces of information that are significant rather than in the order they arrive
  • Responds to emotive stimuli
  • Makes sense of the way the information was said, e.g. accent, speech clarity and intonation
Types of learning activities that stimulate the left hemisphere are:

  • Describing something
  • Learning key words
  • Changing written information
  • Writing a description
To connect to the right hemisphere use:

  • Drawings, diagrams, flow charts
  • Poetry, mnemonics, colours
  • Pictures, mind maps, flow charts
  • Visualisation

Note: The neocortex is the central site for learning and is divided into two hemispheres, which work in ­different ways. Balanced teaching should include a range of activities that stimulate and connect both sides of the brain because both are important.

When people learn new information, the new neural pathway has to connect to existing pathways and other neurons for meaning to be made. Adults have many existing neural connections but children need first-hand experience because they do not have existing connections. The connections improve as they are used through chemical coatings on the transmitting end of the neuron that makes the connection permanent (myelination). Most of the myelination process occurs before age 16.

Encouraging children to use higher order thinking skills, for example, forming opinions about things/issues and then explaining them and evaluating or sorting information, helps make neuronal pathways permanent. Memories are a databank of knowledge and ideas in the brain. People remember things more efficiently if the new information can be connected to information stored in the databank. Engaging at least two senses facilitates learning by enhancing neural connections and making them permanent. Repetition also helps build neural pathways and connections.

Effective learning often requires more than making multiple connections between new and old information. Often people need to restructure their thinking and change established connections among the things they already know and/or discard outdated, often long-held beliefs. If rethinking and restructuring do not take place, new information can be distorted to fit existing beliefs, or discarded. People with diabetes and educators come to an education session with their own ideas, some correct, some not.

If the educator ignores or dismisses an individual’s misconceptions, their original beliefs are likely to remain, even when they give correct answers to questions during the education session. Contradicting the individual is unlikely to successfully change their beliefs: the educator needs to use creative ways to help the individual examine their beliefs and accept new information.


The hippocampus and the amygdala (the emotion centre) are involved in creating memories. There are different kinds of memory: ability to recall facts, personal experiences and physical skills, and each has its own properties. Importantly, memory is distinct from intellectual ability and perception (Koch 2010).

What makes things memorable? Why do people remember some things and not others? Why are some things indelibly imprinted in memory and others vanish like champagne bubbles? Many factors determine what people remember including how much attention the individual pays to the experience, how new and interesting the experience is, and the kinds and strength of the emotions evoked. Memories and their accompanying emotions are laid down together.

Recent research suggests memory consolidation occurs through several processes that stabilise (store) a memory trace once it is acquired. Memory consolidation consists of three main processes:

  • Synaptic consolidation, which occurs within the first few minutes to hours of memory encoding or learning. Synaptic memories last for approxi­mately 24 hours although there are some exceptions. It is achieved faster than other types of memory consolidation. Distributing learning over 24 hours can enhance synaptic memory consolidation.
  • System consolidation, which is a reorganisation process where memories from the hippocampus are moved to the neocortex for more permanent storage. System consolidation is a slow dynamic process that can take one to two decades.
  • Reconsolidation, which occurs when previously consolidated memories are recalled and actively consolidated.

Interestingly, forgetting appears to help the brain conserve energy and improve the efficiency of short-term (working) memory and the ability to recall important details. When people concentrate on remembering things, they put in less neural effort if they forget/ignore irrelevant things. As memories age the frontal, temporal and parietal lobes take on the role of recalling memories, and the hippocampus becomes less essential as the cortical brain regions become connected closely enough for the memory to be stable (Squire et al. 2007).

Keeping the brain fit: brain training

Food and oxygen are essential to all body functions including brain function. Inadequate diet leads to ‘mental fog’ and lack of essential nutrients affect cognitive functions such as concentration, learning, memory and decision-making (Kiefer 2007).

Cognitive function is optimal when blood glucose is stable and within the normal range. The brain depends on a constant supply of circulating glucose because it cannot store energy: it uses 20% of the available metabolic fuel. Hyperglycaemia and hypoglycaemia inhibit mental functioning and decision-making and affect memory and learning (Cox et al. 2000). In addition, rising blood glucose in older people, with and without diabetes, has been linked to ‘senior moments’ and impaired function in the dentate gyrus in the hippocampus (Swaminathan 2009). This finding highlights the importance of diabetes prevention and early detection strategies and normalising blood glucose.

Iron is essential for mental clarity because it is the basis for haemoglobin in red blood cells, which transports oxygen to cells. Essential amino acids and fatty acids are crucial to support brain function.

Brain training: mind-body fitness

The fact the brain needs exercise to maintain and improve function and be able to complete challenging and stimulating activities is not new information, for example:

It is exercise alone that supports the spirits and keeps the mind in vigor.

(Cicero 106–43 BC)

Likewise, John Adams, former US President, said:

Old minds are like old horses: you must exercise them if you wish to keep them in working order.

Cicero and Adam’s observations appear to be partly true. Modern technology such as MRI, PET scans used in recent research show physical activity is crucial to physical and mental well-being: ‘if you don’t use it you lose it’ (Hertzog et al. 2009). Cognition and mental functioning is enhanced by:

  • Participating in activities that require thinking
  • Undertaking regular physical activity
  • Social engagement
  • Having a positive attitude, which also enhances immunity.

The extent to which an individual engages in these activities influences cognitive functioning in older age. Older brains are able to change and ‘old dogs can learn new tricks’, although it may take longer to learn and older people generally do not achieve the same level of expertise they might have achieved when they were younger. The effects are likely to be long lasting.

In addition to specific memory training strategies, training people to manage thinking skills and executive functioning (strategic planning, control over what they attend to, how they manage the mind in the process) is also important, because these skills have a broader effect on cognitive functioning (Li et al. 2008; Hertzog et al. 2009). Although activities such as reading help, physical fitness that improves cardiovascular fitness and aerobic exercise are important, and if undertaken regularly in mid-life, they reduce the risk of dementia in later life.

Many ‘brain gym’ programmes are available but they do not all have robust evidence to support their claims and some may not improve ­executive functioning. Companies are being established that offer ‘personalised online boot camps’ to ‘enhance your core ability to learn and improve your brain’s health and wellbeing’ (Ferguson 2011; www.eliteminds.com.au).

Some of these programmes enhance people’s ability to perform tasks they are already performing more efficiently rather than boosting memory and cognition in a broad way. Peter Snyder, from the Neurosciences at Centre Brown University reviewed several brain training reports and concluded that many are not rigorous enough to support their claims. However, some programmes appear to improve a range of brain functions and bolster working memory and processing speed (Mossman 2009).

More rigorous research is required: despite the promise of brain gyms ‘the best memory enhancer is physical exercise’.

Sleep: vital for learning and memory

Quintillian noted: ‘the interval of a single night will greatly increase the strength of memory … the power of recollection undergoes a process of ripening and maturing during the time which intervenes’.

Or, as my grandmother used to say, ‘sleep on it’. Sleep is important to consolidate motor skills (procedural memory) and declarative memory but not in the same way. Insight and clarity increase after sleep (Stickgold and Ellenbogen 2008). During sleep the brain:

  • Appears to stop processing incoming sensory signals and information.
  • Processes the day’s information by sorting through recent memories, and stabilising and filing them.
  • Makes memories resistant to interference from other information, which allows memories to be recalled more effectively the next day.
  • Sifts through newly formed memories, probably identifying what to keep, and selectively maintaining or enhancing these memories.
  • Saves important emotional elements of situations and discards less relevant background information.
  • Analyses collections of memories to determine relationships among them and perhaps even find meaning in the information acquired.

Thus, adequate sleep appears to be important. Experts recommend 8 hours but individual differences need to be considered.

His brain, her brain

Not surprisingly, research also shows male and female brains differ structurally, chemically and functionally, despite other similarities (Cahill 2005). Thus, gender influences many areas of cognition and behaviour including memory, emotion, vision, hearing, processing faces and the brain’s response to stress hormones. Some key differences are:

  • Response to stress and remembering stressful experiences.
  • Males navigate spatially, compared to females who navigate by remem­bering landmarks.
  • Reaction to learning experiences.
  • Lay down memories of emotion-laden incidents (Hines 2004).

Although some of this work is based on animal models, it suggests men and women with diabetes may learn differently and require different teaching strategies and language.

Brain research holds significant promise for the future given the increasing age of the population in many countries and the increasing prevalence of diabetes in older people.


The expanding use of technology is shaping neural processing and brain evolution (Small and Vorgan 2008) (see Chapter 12). Undertaking Internet searchers for an hour a day changes the way the brain processes information: strengthens new neural pathways and weakens old ones. Research suggests the constant barrage of e-information is stimulating and sharpens cognitive and discriminatory skills, but it is also draining.

Digital technology also influences how we think, feel and behave, and communicate. As the brain evolves and the focus shifts towards new technological skills, social skills such as reading body language or interpreting the emotional context may decline. Significantly, a lot of the exposure to technology is passive (watching TV or listening to iPods). In addition, monitoring Facebook and emails creates continuous partial attention (CPA) or distracted mental state, which is a heightened state of stress, which detracts from the time needed to reflect, contemplate and make thoughtful decisions.

Once people become accustomed to CPA they get ‘high’ on the perpetual connectivity because it boosts ego and self-worth. Research suggests the sense of self-worth protects the hippocampus, which allows people to learn and remember new information. However, CPA eventually causes brain strain and leads to more frequent errors, fatigue, irritability and ­distraction (digital fog) (Small and Vorgan 2008).

Technology itself does not guarantee learning, but it might help the educator create the conditions in which learning can occur (Driscoll 2002). Thus, it is important to use technology appropriately in diabetes education (see Chapter12), for example:

  • Learning occurs in context, therefore, young children might lack knowledge but they can to reason. Computer simulations and games can offer appropriate scenarios to supply context.
  • Learning is active: Learners learn more when they are mentally and emotionally involved in learning activities. Technology can enable learners to manipulate information and participate in group e-learning and problem-solving activities. Research focus groups are sometimes conducted online.
  • Learning is social: As stated, technology can be isolating, unlike other programmes such as the Computer-Supported Intentional Learning Environment (CSILE) (Scardamalia and Bereiter 1994), which is a networked multimedia environment that enables people to collaborate about learning activities. Participants read and respond to notes and build a communal database.
  • Learning is reflective: People with diabetes and educators should reflect on their learning and its outcomes. Computer programmes that include ‘reflective journals’ and feedback can be used.

Psychological and social research has significantly influenced teaching and learning principles, theories and laws. Table 3.4 provides an overview (but not an exhaustive list) of some psychological theories that can be applied to diabetes education.

Helping people learn: proactive strategies are more effective

Some suggestions for helping people learn are shown in Table 3.5. Many other suggestions are distributed throughout the book. Good creative writing requires the author ‘to show not tell’; effective education requires the educator to show and tell as the following anecdote illustrates:

I just wanted to say I really enjoyed your presentation last night.

Thank you. I appreciate the feedback. It is always difficult knowing what to say at graduation ceremonies.

I went to a lecture about how to use PowerPoint to get your point across. The teacher said to use bullets and not have too much writing on the slide. He said use lots of pictures: he didn’t do that in his PowerPoint, but you did. When he spoke about it I couldn’t see how pictures would work, and he didn’t show us. Now I know from your talk. He told us but he didn’t show us. You showed and told but left space for the audience to form their own opinions.

I am pleased you enjoyed the presentation.

I really did. But you have to choose the pictures carefully, don’t you? The audience has to be able to relate to the picture and understand the context.

Table 3.4 Overview of some of the psychological (behaviour) theories that influenced diabetes education; the theories are not presented in any order.

Seven out of ten leading causes of death are linked to behaviour (Harris and Lustman 1998).

Theorist Key message
Robert Bolton Described ‘people skills’ that could help educators enhance communication skills and ability to establish relationships by focusing on listening, connecting and engaging
Edward de Bono Effective thinking can improve creativity and problem-solving, generate alternatives and think about thinking
Nathaniel Branded Deep needs can only come from within and get stronger the more they are developed. Educators can reflect and help people with diabetes reflect on their needs
Louann Brizendine Men and women see the world differently
Educators might need to consider gender-specific education strategies
Mihaly Csikszentmihaly Creativity can only emerge once a person masters their work domain. Creativity can help people change the way they see, understand and appreciate things. Creativity can add fun and interest to education and enhance the learning environment. For example making up rhymes with children
Milton Erickson The unconscious mind can provide wise solutions. Erickson used ‘teaching tales’ based on anecdotes from his life to establish rapport, enabled people to glean messages from the anecdotes and use show as well as tell to engage people in learning
Victor Frankyl People can be transformed if they accept suffering (wound) or fate and can be transformed and achieve great things
Facing unchangeable fate with great courage
Howard Gardner Theory of multiple intelligences that questioned using single IQ test. The theory challenged teaching strategies and gave rise to various descriptions of learning styles such as Kolb (1984), Honey and Mumford (1986) and Hopson and Scally (1986)
Daniel Goleman Emotional intelligence that suggests the individual’s characteristics, personality, a skills and drive for exceptional performance motivates people to become self-regulated, self-aware and motivated and able to see the big picture
Later social intelligence theories
William James Psychology is the science of mental life. Everybody sees the world differently and personal consciousness is not the same from day-to-day
Abraham Maslow Hierarchy of needs theory. People can only be fulfilled and self-actualised when basic needs are met
Applied to education, the world is changing and aiming for the basics may no longer be acceptable. Educators have a responsibility to strive for excellence for themselves and help people with diabetes achieve the best they can
Ivan Pavlov People may be less autonomous than they think. For example, educators might not salivate when a bell rings (unless it is a fire bell) but automatically refer to guidelines or tick boxes on an assessment log,
that is, we are trained to our work culture
B.F. Skinner Learning is a function of change in overt behaviour as a result of a stimulus
Reinforcement is important to strengthen the response. Reinforcers can be anything relevant to the individual, e.g. praise (as long as the reinforcer is ethical)
Carl Rogers A genuine relationship or interaction is one where individuals feel comfortable to be themselves and can see each other’s potential
For diabetes education the individual guides the process, care should be person-centred, listening is essential
It is necessary to heal the self because ‘life is a flowing process of becoming’
Edward Deci Self-determination theory, another way of considering locus of control:
Internal, self-directed and motivated
External, under other control, e.g. HP, fate, family, diabetes
Suggest educators must consider satisfying intrinsic effects:
Competence, succeeding
Relatedness, connecting with others
Autonomy, being in control
Andrew Perrin/Ziva Kunda Motivated reasoning, which concerns starting with a conclusion one hopes to reach and selectively evaluating evidence/information to achieve the desire and discarding the rest, i.e. find ways to support preconceived ideas
Educators need to recognise motivated reasoning in themselves and people with diabetes and use strategies to build confidence, promote questioning
Motivated reasoning can lead to inappropriate decisions and self-care and education practices

Note: The information was derived from a number of sources, primarily Butler-Burdon (2007) Deci and Ryan (1985) and Kunda (1990).

Another important issue is to try to ensure information and messages are consistent among HPs.

Listen to them! They’re all playing different tunes!
Well, for 55 days they played the same tune.

(Fifty Five Days at Peking 1963)

Inconsistent information creates confusion, is a disincentive to learning and may cause the individual to doubt some or all HPs’ knowledge and credibility. We need to play the same tune all the time—the challenge is HOW?

Table 3.5 Teaching strategies should suit the individual or group and consider the principles and laws of learning.

Learning Teaching strategy
Ensure the environment is conducive to learning Private
Position seats
Try to minimise interruptions
Try to commence the session on time
Find out what the individual expects to achieve
Be informed, flexible and use appropriate language Develop the relevant skills and knowledge
Determine the individual’s story and existing knowledge
Attend and be present in the encounter
(Chapters 5 and 6)
Establish a relationship with the individual Be present and connected
Use congruent body language
Use appropriate questions to clarify and collect information
Show empathy and understanding
Be mindful of signs of distress
Determine goals for the session and management goals with the individual
Progress from the known to the unknown and concrete to the abstract Find out what the person already knows and build on the information and help them connect new information to existing information
Young people learn best about tangible tings they can touch, feel and smell. As they develop they learn to understand abstract concepts and reason logically
People construct meaning by connecting information to existing knowledge. Educators can help people explore their existing knowledge and beliefs so they can build on or help the person change existing knowledge
People learn when they are able to practice and are actively engaged in experiential learning For example, ask them to find information in a brochure, interpret their blood glucose patterns and/or think of a reason for the pattern and strategies for managing the issue
Practice is important for tasks such as blood glucose monitoring but also for solving-problems, recognising patterns
Practice is more effective if it matches the individual’s goals
Activities should be challenging but achievable
People require positive feedback to learn effectively To become self-caring people with diabetes need to learn to monitor their body cues and adjust to compensate, e.g. recognise and treat a hypo. Allow the individual to express their opinions and provide feedback/suggestions at the teachable moment (an example of where they should be used)
Use mistakes as learning opportunities
Learning is affected by expectations People have ideas about what they can and cannot do/learn. This is partially related to their locus of control and views about their competence. Building confidence and praise are important
Use evidence when appropriate People want evidence-based care but they may need help interpreting the scientific language and applying it to their unique situation
Use activities to help learners find answers for themselves Use appropriate questions
Suggest they read specific information and decide whether it is appropriate to their situation
Help the individual develop problem-solving skills
Use mistakes as teaching opportunities
Welcome questions, and people’s stories Questions help people learn—they usually ask a question because they want an answer
Try not to put the question off until ‘later’
People’s stories are a clue to who they are and how to help them learn and become self-caring
Use mistakes as learning opportunities Help the individual reflect on the issue and the context surrounding it and engage in problem-solving to make relevant changes
Be creative and engage both sides of the brain Children love stories and rhymes. Create a story about their diabetes or use existing books written for children
Familiar ‘nursery rhymes’ were originally social commentaries, e.g. Ring a Ring of Roses referred to the plague, Mary, Mary, Quite Contrary to Queen Mary’s (Bloody Mary) Catholicism

Note: We don’t receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us (Marcel Proust).

Asking the ‘right’ questions to encourage conversation rather than debate is an art (see Chapter 2). Use open, probing questions. Leading questions are appropriate to elicit some information. ‘Good’ questioning involves:

  • Attending and active listening
  • Paraphrasing core information: It sounds like
  • Reflecting feelings: You seem unsure about
  • Reflecting meaning: You feel … Becauseis that correct?
  • Mirroring, but not too often or you might sound like a parrot: Use the individual’s words but not their tone of voice
  • Summarising: The issues that seem to be emerging from what you are telling me are … have I missed anything?

Consider including fun in teaching strategies. Aristotle said ‘Laughter is a bodily exercise precious to health’. Research appears to support Aristotle’s belief: laughter assists people to achieve cognitive distance from stress, which is psychologically protective. Laughter also helps manage pain, and cheerfulness facilitates relationships (Bennett and Lengacher 2008). Humour needs to be culturally appropriate and used with discretion.


Teaching and learning is an interrelated process. It should be person-centred, collaborative and holistic. Turning information into knowledge is a complicated process that occurs within the brain through establishing neural pathways and connections.

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Aug 31, 2016 | Posted by in ENDOCRINOLOGY | Comments Off on Teaching and Learning: The Art and Science of Making Connections

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