Keywords

Introduction

The production of competent development-related health promotion practitioners requires teaching and learning that is coherent across theory and practice. Student-active learning is promoted for its excellent outcomes such as deep learning, better understanding, greater ability to solve problems and longer memory of content. However, student-active learning is often applied in theory classes with no extension to or application in related practice. Biggs (1996) coined the concept of ‘constructive alignment’ in which teaching and learning activities (such as student-active learning) are aligned with the desired outcomes of the learning (such as practical application) and the selected form of assessing student learning.

Context

In the Department of Health Promotion and Development at the University of Bergen, Norway, we have long experience of student-active learning, particularly the method of problem-based learning (PBL). In 2002, most of the teaching staff attended a workshop at Maastricht University, Netherlands, to learn the method. It has been used ever since in the department with knowledge and experience being passed on to new generations of teachers.

In 2015 the Faculty asked us to set up a new master’s programme, and we used the opportunity to design a programme that attempts to extend student-active learning into practice experience. The new two-year M. Phil programme (120 ECTs in total) that started in autumn 2016 is called Global Development Theory and Practice (GLODE, 2021). We admit a new cohort of between 20 and 30 students every year for one year of taught modules followed by a second year of thesis writing (or students may choose to do an internship plus a short thesis). We accept both Norwegian and international students, and we have between ten and 15 nationalities per cohort, with students coming from Asia, Africa and Latin America as well as North America and the European Union. The programme has two specialisations (Health Promotion and Gender), and we admit students with a bachelor’s degree in a broad range of social and health sciences related to these two specialisations. We have an interdisciplinary staff with backgrounds in health promotion, geography, development studies, psychology and social anthropology.

In this chapter we describe two of the five taught modules, firstly a 20-ECT (12-week) introductory module called ‘Critical Approaches to Global Development’ (for the rest of this chapter, we refer to this as the ‘theory module’ (GLODE 301, 2021)) and secondly a 10-ECT (7-week) practice module called ‘Development Practice’ (referred to in this chapter as ‘practice module’ (GLODE 307, 2021)). Both modules involve approximately six to ten hours of classroom-based teaching and learning activities per week in addition to self-directed learning. Both courses are taught annually. [Three courses related to the Health Promotion specialisation are described in another chapter].

The overall objective of this chapter is to describe the ongoing process of designing and improving a course to prepare master’s students for development-related (health promotion) practice. Our first sub-objective is to describe the process of trying to achieve constructive alignment within two modules: (a) a theory module and (b) a practice module. Our second sub-objective is to describe the process of trying to achieve coherent outcomes across two modules (theory and practice).

Theories and Methodologies Used in the Teaching-Learning Process

Constructive Alignment

Coherence between the objectives of a course, the teaching and learning methods and the way the course is assessed, can enhance the teaching and learning experience for all involved. Biggs (2003) contends that meaningful learning is constructed by the student through relevant learning activities while the role of the teacher is to create a context in which such learning can occur. He understands teaching and learning as a system in which all components should be aligned in order to maximise the outcome. The procedure to achieve ‘constructive alignment’ involves establishing clear learning outcomes that students are expected to achieve; selecting teaching and learning activities that are most likely to result in these intended outcomes; and, finally, designing assessment that positively evaluates how well students have achieved the outcomes (Biggs & Tang, 2015). It is helpful to view the process of constructive alignment as iterative and dynamic so that course design and implementation can evolve (Ruge et al., 2019). Biggs (1996) notes that student activities during lectures tend to be passive and receiving (listening, comprehending, etc.) and these are not activities that will result in outcomes of ‘deep learning’ such as development of analytic skills and active integration of new concepts with old (Gordon & Debus, 2002; Wang et al., 2013).

Formulating sound learning outcomes is key to the process of constructive alignment. Biggs (2003) distinguishes between declarative knowledge (knowledge that can be declared in written or oral texts) and functioning knowledge (knowledge that is put to work in practice, that functions). The former is usually content-based, while the latter reflects ‘what students should be able to do after being taught and how well they should do it’ (Biggs & Tang, 2015, p. 32). In various texts, Biggs refers to the importance of using high-level verbs in formulating learning outcomes: reflect, solve unseen complex problems, generate new alternatives, create, evaluate, improve (practice), etc. (Biggs, 1996, 2003; Biggs & Tang, 2015). Satisfactory functioning knowledge might include ‘apply’ or ‘recognise’, but levels of understanding below that tend to be declarative (Biggs, 1996). Biggs’ ‘functioning’ knowledge resonates with Hanstedt’s (2018) concept of ‘authority’ which he contends is more than just content knowledge and skills, but also includes ability to engage in the meaningful questions of the day. Current ‘wicked’ problems – comprising constantly changing dynamics or parameters, solutions that no longer work and incomplete or contradictory data – need ‘wicked students’ to solve them (Hanstedt, 2018). Wicked students can reflect, ask the right questions to solve complex problems, adapt ideas or technologies to new or alternative settings and are not afraid to fail and try again (evaluate and improve) (Biggs, 1996; Hanstedt, 2018).

Student-Active Learning

Active engagement in the learning process leads to students learning more than when they are passive recipients of transferred knowledge. Student-active learning is ‘any instructional method that engages students in the learning process’ and is often contrasted with the passive learning of traditional lectures (Prince, 2004, p. 223). Methods include group work (which may be collaborative or co-operative) and problem-based learning (PBL) (Prince, 2004). PBL uses collaborative teamwork to develop students’ self-directed learning practice, critical thinking skills, deep disciplinary knowledge and their ability to reflect on these processes (Reinschmidt et al., 2019; Yew & Goh, 2016). Students develop interpersonal skills; they learn to listen, to give and receive constructive feedback and to evaluate themselves relative to their peers (Servant-Miklos, 2019). Research evaluating the effectiveness of PBL has found that PBL (compared to lectures) makes little difference in short-term acquisition of knowledge, but when it comes to long-term knowledge retention, problem-skill development and satisfaction, PBL outperforms other learning methods (Tawfik & Lilly, 2015; Yew & Goh, 2016). Madsen et al. (2019) contend that collaborative learning and group work throughout a course foster the development of the skill set needed to work in health promotion partnerships between individuals, communities and governments.

Interestingly, research has shown that STEM students who are engaged in active learning may actually believe that they learn less than through lectures and that active learning has few benefits (Deslauriers et al., 2019). Initial engagement with a problem they do not know how to solve may frustrate and confuse students, unless tutors and teaching staff explicitly present the benefits in terms of long-term learning, problem-solving skills and critical thinking (Deslauriers et al., 2019). Prince (2004) evaluates different forms of active learning in engineering subjects, and regarding PBL, he notes that negative effects will be perceived when non-expert tutors are used. In addition, he recommends that problem-solving skills be taught explicitly in order to maximise the benefits of PBL.

Linking the above discussion on theory and methods , student-active learning appears to be an effective way of teaching and learning the high-level verbs needed in learning outcomes to achieve Biggs’ (2003) functioning knowledge. Hanstedt (2018) expresses it thus: ‘the best way to create an environment conducive to developing authority in our students, is to place them in situations where they must assume it’.

Achieving Constructive Alignment Within Two Modules

In this section our description of the two modules is framed by the dimensions of Biggs’ (1996) ‘constructive alignment’ concept, namely, learning outcomes; teaching and learning activities; and assessment.

The Theory Module

The learning outcomes we aim to achieve in this module include knowledge outcomes such as ‘advanced comprehension of multi-level and complex processes of development and the role of institutional actors in these processes’ (GLODE, 2021), an understanding of contemporary theories in their historical context to encourage critical reflection, ethical framing, governance issues and implications for rights and social justice. Skills outcomes include the ability to critically analyse different sources of information (from peer-reviewed articles to organisation reports and websites and media podcasts and videos); to use various perspectives in such analysis (e.g. health promotion or gender); and to understand the implications of the analysis for inequalities and injustice. General competence outcomes comprise the ability to communicate coherently, both in writing and verbally, as well as the ability to critically assess, select and apply relevant theories in specific contexts.

Box 11.1 Trial PBL Problem

Research shows that learning occurs in greater depth, with more critical reflection and longer-lasting results when driven by the learner rather than the teacher. In other words, active, participatory learning is more effective that ‘teacher-tell’. A certain professor wholeheartedly believed and tried to practise this proposition, but year after year, he failed to get his students to read the recommended literature – and as many other participatory activities were based on these readings, they often flopped too. He was sorely discouraged, but before giving up altogether, he tried one more approach.

The professor has commissioned you, a group of highly motivated, engaged graduate students, to come up with some strategies (minimum of three) to effectively involve and inspire his students in their own learning.

We employ a wide range of teaching and learning activities. We start off right away during the introduction/orientation week before the theory module begins. On day two, we give a short lecture about the procedures and beneficial outcomes of problem-based learning (PBL), why we use it and how it works; we get the students to put PBL into practice, working in groups to solve a problem about self-directed learning (see Box 11.1). The groups present their solutions on day three. This activity has a double outcome, as in the process of learning the PBL procedure, the students also discuss self-directed learning with each other – far more effective than a lecture on self-directed learning! Shortly after the start of the theory module, we publish the module’s PBL vignettes. We write new vignettes each year that represent development issues or themes within the content of the module (typically climate change, migration/refugees and education), and at the same time, there is a common theme between the groups (in 2020 it was Covid-19; in 2019 it was ‘food’; see Table 11.1). We set up the groups to contain maximum diversity in gender, nationality and previous education. Unlike the trial PBL, the module PBL stretches over three or four weeks comprising six tutored two-hour meetings (with additional student-organised meetings and work activities in between) and culminating in a 30-min presentation in which each group member must participate. During the three weeks used to ‘solve’ the problem, each group member takes a turn at ‘chairing’ the group and acting as secretary to record decisions made, thus developing leadership skills. The only active role played by the tutor is to lead the process and progress evaluation in the last 15 min of each two-hour session. The tutor will also point in the direction of resources if asked by group members.

Table 11.1 Example of PBL vignettes combining themes
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Communication skills are also central to our teaching and learning activities. During the theory module, we run two three-hour workshops on communication, encompassing both presentation and writing skills. In presentations skills we teach about organising content, timing, engaging the audience as well as feedback: giving feedback constructively, receiving and responding to feedback. (These feedback skills are important during the process evaluation at the end of each tutored PBL session.) Students use presentations, both individual and in groups, as a key means of communication throughout the two years of the programme: in PBL presentations, in student-led lectures, presenting chapters while writing their thesis, etc. Likewise, writing skills can be used individually (for writing assignments or for the full thesis in the second year) or in groups (e.g. in report writing).

A range of other teaching and learning activities is also used. Lectures are used to present threshold concepts and research-based applications. These also include student participatory activities to promote active learning within the lecture. Student-led lectures involve small groups of students preparing a topic to teach the rest of the class. We run workshops to help them structure the lecture and ensure all required aspects are covered. We have found this to be one of the most effective ways to get students to read the curriculum! Feedback is given after the student-led lecture. Another group-work approach is the use of colloquiums. In their groups, students allocate the set readings between group members, and, guided by the questions for discussion, these are read in preparation before the colloquium. During the colloquium students discuss the questions in-depth in relation to the readings. One group member is chosen as ‘rapporteur’ to bring the group’s conclusions back to the plenary. We also regard the feedback given on writing assignments as a teaching and learning tool.

Assessment is not straightforward as we cannot award a single grade based on both group and individual works. To cope with this complexity, we make participation in the group work obligatory, and students may only submit their portfolio of two writing assignments once they have fulfilled all obligations. Each student’s grade is then based on the portfolio of written work only. Students have a choice within each of the two writing assignments, and they receive feedback on the first assignment with the opportunity to make adjustments before submission. The topics reflect themes the students have addressed in their PBL and student-led lectures (climate change, migration/refugees and education) so that what they write is based not only on their reading around the topic but also on in-depth discussions with other students during the module. Students are able to choose their desired theme in the PBL and student-led lectures – and of course in their writing assignments. A student may choose the same theme across all three activities (in-depth knowledge) or a different theme in all activities (broad rather than deep knowledge). The writing assignment questions address the learning outcome skills and competences as much as knowledge outcomes. The questions provide students with the opportunity to integrate knowledge from their own learning with taught content, to critically analyse and discuss issues from various perspectives and reflect on relationships between the approaches. This form of assessment is in line with Biggs’ (1996) functioning knowledge.

Results Achieved and Challenges Faced

Student evaluation of the theory module comprises a focus group discussion (without teaching staff present – run by student representatives) on the learning outcomes and the teaching and learning methods, among other things. When students comment on participation in different learning and teaching methods, regarding PBL, they invariably include comments like ‘it is a waste of time considering it does not contribute to your final grade’; ‘the main concern is how much time, effort and work it requires’. Later in the focus group, we include a question: what contributes most to your learning? Year after year the answer is PBL – and since we have started the student-led lectures, these are included too. In other words, when reflecting on the learning methods separately, students state that they have not learned as much from student-led work as from more traditional teaching methods. This is not surprising, as research shows that student-active learning methods demand more of students and may result in students feeling they learned less than they actually did (Deslauriers et al., 2019). When the question is stated differently, students reflect on the module more holistically and come up with a different answer. Programme staff take evaluations seriously; we discuss most points and respond to core issues raised by the students. We inform the students of our responses through their representatives, and we also make minor adjustments to goals in learning outcomes or our teaching methods. We believe the way we introduce PBL, and the trial PBL problem linking it to self-directed learning, contribute to positive outcomes in the practice of PBL.

Student-active learning methods (PBL and student-led lectures) may require less staff input during the module, but they require thorough planning and preparation beforehand. Framing the module in constructive alignment dimensions has been helpful in broadening our focus beyond only knowledge outcomes. Student-active teaching and learning methods are also effective for teaching and learning skills and general competences.

The Practice Module

The overall aim of the practice module is ‘to introduce students to the Development Practice arena first and foremost as a field of practice, but also as a research subject and as the object of critical scholarship’ (GLODE 307, 2021). Students work in small groups throughout the module to solve real-life problems identified by public or private sector organisations or NGOs (see some examples in Box 11.3). They write a professional report on the process and outcome. In addition, each group gives an oral presentation of the outcome of their group work to the relevant organisation and the rest of the class.

As with the theory module, the learning outcomes we aim to achieve in the practice module include knowledge, skills and general competence. The main knowledge outcome in this module is to understand development practice as the facilitation of collaboration across sectors, with the possibility of multiple perspectives, such as human rights, gender, health promotion and integral ecology. Cultural context and practices have significant implications for development practice. In the practice module, there is much greater emphasis on skills and general competence outcomes (see Box 11.2) with many more specific skills and competences identified than in the theory module.

Box 11.2 Practice Module Learning Outcomes (in Part)

Skills:

The student has the ability to:

  • Conduct community needs and assets mapping

  • Negotiate: align, optimise and orchestrate diverging perspectives on community needs, priorities and resources (citizens’, local officials’, regional, national and global authorities’)

  • Communicate to colleagues and to community groups and representatives about methods and approaches to development practice

  • Facilitate communities in developing, implementing and evaluating development strategies

  • Facilitate community-based participatory action research

  • Locate particular development projects within local, national and global frameworks

General competence:

The student has the ability to:

  • Assist in establishing community collaboration

  • Respond to community priorities with suggestions for adaptive action

  • Advise communities on actors and resources that are potentially available for community development

  • Help build, manage and evaluate community partnerships

  • Work effectively across organisational cultures

Teaching and learning methods in the practice module are less varied than in the theory module in that contact time usually involves a workshop to ‘teach’ relevant concepts or practices, such as the use of log-frames, or how to plan and conduct a needs assessment or an outcome evaluation. Groups then literally work with the concept or practice in the ongoing process of solving the problem they have been set. Assessment is in the form of a portfolio that includes the report to the organisation, plus the presentation of the group’s solution to an audience comprising the organisation, the teaching staff and the rest of the class. We regard this as highly ‘authentic’ assessment as it is closely related to experiences of working life. Students can list their report on their CVs.

Box 11.3 Examples of ‘Real-Life’ Problems to Solve 2017

  • Establishing a ‘people’s fridge’ in the community to reduce food waste (Framtiden i våre hender – ‘The future in our hands’ an Environmental organisation)

  • 2018 KombiClass: an evaluation. Young adult refugees (18+) completing primary school (responsibility of the municipality) in an upper secondary school venue (responsibility of the county)

  • 2019 Loneliness – mapping its extent among students and strategies to reduce it (Red Cross)

Results Achieved and Challenges Faced

Student evaluations show that they really appreciate the authentic nature of the group work, for example, from the 2019 evaluation: ‘Students felt as though the work mirrored real life situations’. They commented that even when organisations failed to give clear instructions, or when there are cross-cultural tensions within the group dynamic, having to deal with these ‘mirrors real life situations’. Every year students appreciate having to plan and conduct research as an application of the research methods modules they have completed. Each year we send an email to the participating organisations to ask for feedback, but not one has answered. We do ask for verbal feedback immediately after the presentations, and the organisations are generally delighted both with the report and the presentation.

In 2020, the practice module started in tandem with the first lockdown in response to the Covid-19 pandemic. This was incredibly challenging for a practice module! We had to abandon all the planned collaboration with organisations and convert the ‘problems’ to real-life research problems related to the pandemic (to identify and map creative responses to the lockdown among students, staff and those planning internships). We converted one of the early workshops into how to conduct research ethically using digital means – with an invited expert to instruct us. In an attempt to maintain authenticity, we invited relevant key personnel, such as the Vice-rector for Education, to the final (Zoom) presentations. In their evaluation, the 2020 cohort stated that they felt unprepared for practice as they had not had the relevant experience with genuine organisations. They know the theory but have not applied it in practice.

Coherent Outcomes Across Two Modules

Achieving constructive alignment within the two modules described in this chapter is a work in progress. We actively use student evaluations and our own evaluations on how the module has gone each year to reflect on how we could improve it. In this way, each module is gradually evolving, being updated and, we hope, improving.

Meaningful coherence across the theory and practice modules could enhance overall learning outcomes for students. The most obvious logical progression between the theory and practice modules occurs in our teaching and learning methods. In the theory module, students learn through student-centred and student-active learning methods such as PBL and student-led lectures. In the practice module, students learn through real-life problem-solving working in collaboration with organisations in the public, private or civil society sector (NGOs). The problem-solving procedures and reflective processes learned while solving (fictional) problems in PBL during the theory course are employed with confidence in the authentic task set by the collaborating organisation. The skills and competences of working in teams, exercising leadership and utilising different means of communication are easily transferred from solving fictional problems to unravelling real-life challenges. Likewise, the coherence between forms of assessment is visible between the two modules. In the practice module, the report written by the group builds on writing skills developed in the theory module in the individual writing assignment. Both individual and group presentations in the theory module provide a foundation for the professional presentation the group gives to the collaborating organisation in the practice module.

Coherence between the learning outcomes of the two modules may not, at first, be so obvious. However, if one moves beyond declarative knowledge (the knowledge content in each module) to the functional knowledge outcomes (skills and competences), there is a link between the two modules. The ability to deal critically with various sources of information and to analyse challenging issues from various perspectives (theory module) builds the foundation needed to negotiate and align diverging perspectives on community needs, priorities and resources (practice module). The ability to analyse implications of alternative development processes on poverty and vulnerability, inequalities and injustice (theory module) lays the groundwork for communication to colleagues and community groups about various methods and approaches to development practice (practice module).

Discussion

In this section we consider the core competencies for health promotion (Barry et al., 2012) and how well the two modules described above contribute to students developing these competencies. In addition, we consider the potential applicability of our teaching experiences in other contexts.

Core Competencies for HP

The CompHP Core Competencies Framework for Health Promotion (Barry et al., 2012), before describing nine groups of competencies, outlines, firstly, the ethical values and, secondly, the knowledge base underpinning the health promotion core competencies (see Fig. 11.1). Ethical values ‘include a belief in equity and social justice, respect for the autonomy and choice of both individuals and groups, and collaborative and consultative ways of working’ (Barry et al., 2012, p. 20). Ethics is explicitly included in the learning objectives of the theory module, and equity and social justice are present in the learning objectives of both the theory and practice modules. Although the knowledge base underpinning the health promotion core competencies is not explicit in the two modules discussed here, we teach it in its entirety in the Health Promotion specialisation module (see also the Chap. 16 by Urke and Daniel in this volume).

Fig. 11.1
figure 1

The CompHP core competencies framework for health promotion. (Barry et al. (2012, p. 19))

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The Core Competencies in Health Promotion

The first two competencies are ‘enable change’ and ‘advocate for health’. Barry et al. (2012, p. 22) describe these competencies as including processes such as working collaboratively; using approaches which support empowerment, participation, partnership and equity; using community development approaches to strengthen community participation and ownership; and generally regarding individuals, communities and organisations as stakeholders to collaborate with. Many of the same phrases are found in the learning outcomes for the practice module (see Box 11.2).

Our team-building, student-active teaching and learning methods like PBL and student-led lectures (in both the theory and practice modules) equip our students with several of the competencies. The third competency is ‘mediate through partnership’ and is described as working collaboratively across disciplines, sectors and partners (Barry et al., 2012). Likewise, our teaching and learning methods equip our students with excellent competence in communication – the fourth competency in the framework. Our students are able to communicate individually and in groups, in writing (of various forms) and in verbal presentations, giving feedback as well as listening and including. In addition, we require our students to rotate leadership during PBL and other group work so that they all have the opportunity to practise it – and during the evaluation – reflect on their own and others’ leadership qualities and practices.

The practice module provides students with opportunities for assessment (competency 6), planning (competency 7) and research and evaluation (competency 9). These are all practices and methods that are taught – and then applied to particular real-life problems – during the workshops in the practice module.

Perhaps the only competency which we do not cover in these two modules is number eight, implementation. Students who choose an internship and work with organisations, for example, humanitarian organisations or consultancy firms, may have the opportunity to participate in implementation (see also the Chap. 16 by Urke and Daniel in this volume).

Have We Prepared the Students for Development-Related (Health Promotion) Practice?

So although for both these modules, the Gender specialisations students are included, in fact all the students are learning health promotion competencies that are in development contexts related to their specialisation. For those following the Health Promotion specialisation, they learn the knowledge base underpinning the competencies during the health promotion course (see also the Chap. 16 by Urke and Daniel in this volume), and consequently, by the end of the two years, they are well-equipped for health promotion practice.

The fact that our students include some who are specialising in gender – and they are all present for the theory and practice modules – means that the type of learning and teaching methods we use could successfully be applied in other subjects and disciplines. As shown above, we write our own PBL vignettes, so if courses were taught in very different contexts, it would be a matter of writing vignettes appropriate to that setting in order for students to get a similar learning experience.

Conclusion

The overall objective of this chapter was to describe how we prepare master’s students for development-related (health promotion) practice – and the fact that we are constantly evolving and improving the course. We have described two modules in detail, a theory module and a practice module, and shown how we achieve constructive alignment between the learning outcomes (to achieve functioning knowledge); the teaching and learning methods (student-active for effective learning); and the forms of assessment (authentic). We have reviewed the links between the two modules and determined that there are coherent outcomes across the modules (theory and practice). We have shown that our students learn eight out of the nine core competencies for health promotion through these two modules. The examples we use in the theory module are related to the Bergen and Norwegian context, and, in the practice module, we work with local available organisations. However, the processes we use are universally applicable: highly relevant problems can be generated for a wide variety of disciplines and contexts. Likewise, in practice, collaboration can be arranged with organisations that are available to achieve authentic outcomes.

Table 11.2 brings our reflection on the six triggering questions suggested by the editors.

Table 11.2 Authors’ reflections on the six triggering questions suggested by the editors
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