158 Chapter 6 We identified a new belief dimension which we labelled: ‘Creation of a conducive learning environment.’ While educators with a learning-centred belief orientation stressed its importance, and viewed it as a prerequisite for student learning, most educators with a teaching-centred belief orientation were unaware of this dimension. Educators with a teaching-centred belief orientation with learningcentred aspects (Orientation III, see Table 2.1) did emphasise its relevance, but for a different reason, namely to put students at ease. In this Orientation (III), the interaction between teacher and student is more reciprocal than in the other teaching-centred orientations. In contrast to the learning-centred orientations, the focus is primarily on the students as a group rather than as individuals, and on relating to the students in a positive way rather than on specifically facilitating the learning of the student. We also were compelled to refine existing belief dimensions. One of these is the dimension ‘Nature of knowledge,’ which needed to be expanded from two to three beliefs. In addition to knowledge, this dimension also includes skills and attitudes relevant to the discipline. The original framework distinguished one teaching-centred belief and one learning-centred belief. In the new framework, the teaching-centred belief of knowledge as factual and as obtained from outside, split into two beliefs. We uncovered that educators in the teaching-centred belief orientation with learning-centred aspects (Orientation III), although viewing knowledge as coming from external sources, believe that they should explain how this ‘factual knowledge’ can be used in the realities of medical practice. Figure 6.1 visualises and summarises the relationship between teacher, student, content, and environment, as it emerges from the new framework, for two maximally contrasting belief orientations: teaching-centred Orientation I (Fig 6.1.A) and learning-centred Orientation VI (Fig 6.1.C), as well as for the teaching-centred with learning-centred aspects orientation: Orientation III (Fig 6.1.B). By contextualising the framework in the medical education context, we gained a deeper and more detailed understanding of medical educators’ beliefs relevant to learning-centred education. This applies to most of the ‘cognitive’ dimensions (see Chapter 2, Table 2.1, Dimensions 1-6), but in particular to the ‘affective’ belief dimensions (Dimensions 7- 9). The cognitive belief dimensions of medical educators with learning-centred beliefs are qualitatively distinct from those with teaching-centred beliefs and can be summarised as focusing on conceptual change in students, with the aim of developing medical expertise, i.e., mastering a physician’s knowledge, skills, and attitude.
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