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Journal of Pediatric Gastroenterology & Nutrition:
Book Review


Ludvigsson, Jonas F.

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Orebro University Hospital


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Teaching at University

Ramsden P. Learning to teach in higher education. New York: Routledge, 1992.

McKeachie W. McKeachie's Teaching Tips: Strategies, Research, and Theory for College and University Teachers, 11 ed. Boston: Houghton Mifflin Company, 2002.

Cannon R, Newble D. A Handbook for Teachers in Universities & College: A Guide to Improving Teaching Methods: Kogan Page Ltd, 2000.

Biggs J. Teaching for quality learning at university. Buckingham: Open University Press, 1999.

Medical teaching attracts more and more interest, especially in journals focusing on the subject (e.g., Medical Education:;Medical Teacher:;Teaching and Learning in Medicine:;Academic Medicine: Journals dealing with general medicine, such as the BMJ, regularly publish research on medical education (

A recent editorial in Medical Teacher clearly illustrates that doctors studying medical education are keen to improve their teaching (1). Among the most requested articles online from December 2000 to December 2001 in Medical Teacher were “Twelve Tips for Potential Distance Learners”(2), “Simulation and New Learning Technologies”(3), “Rewarding Teaching Excellence . . .”(4), “AMEE Guide No 21: Curriculum Mapping . . .”(5) and “AMEE Guide no 22: Refreshing Lecturing: A Guide for Lecturers”(6). More and more, scientists are growing aware that teaching is not only about transmitting basic facts. We want students to learn. In his book Learning to Lead in Higher Education, Paul Ramsden (7) lists six key principles [page 96] of effective teaching:

1. Interest and explanation

2. Concern and respect for student and student learning

3. Appropriate assessment and feedback

4. Clear goals and intellectual challenge

5. Independence, control and active engagement

6. Learning from students.

Teaching is fun; reading a book about teaching may even make it hilarious! There are several teaching books on the market. The purpose of this article is to review four such books (Table 1).

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Teaching for Quality Learning at University was published by the Society for Research in Higher Education (8). The publishers have probably gotten what they wanted; a stringent book where most statements are supported by a scientific reference. Though the book contains some practical tips, the focus is on theory. On page 11, the groundbreaking, and by some claimed to be the most cited research papers ever in psychology, Marton and Saljo's “On Qualitative Differences in Learning” are cited (15,16).

Biggs' book must be read from the very beginning. Expressions such as “TLA” (Teaching and Learning Activities) were new to me and are only explained when they first appear.

In a way, the book is utterly theoretical but at the same time Biggs has the gift of teaching himself. The use of schematic illustrations makes his reasoning easier to follow. His schematic figure of two students, one using a so-called deep approach to learning and the other one a surface approach is clear and interesting (Fig. 1.1). Readers of this review should note that the same individual may use a surface approach in one setting, and the deep approach in another setting. There are situations where a surface approach is to prefer and not one human being will always apply a deep learning approach.

Biggs talks of criterion-referenced objectives and norm-referenced objectives (the latter is based on student comparison). He talks of aligned teaching, which means that teaching, learning, and assessment should follow a common thread. Biggs claims that most students will adapt their teaching according to assessment techniques. If that is so, why not change the assessment so that it will suit our purpose and direct students towards a lifelong understanding instead of a surface learning?

Chapter 7 concerns teaching international students. Biggs discusses the problem of extreme teacher-dependence in some groups of students: an uncritical dependence and a learning strategy that may emphasize rote learning. However, blaming the students may not be a constructive approach. The problem is not what the students are. Instead it is about what they do. Biggs suggests a framework to help international and other students to reflect and to exploit their own capacity. At the same time the reader is introduced to what Biggs calls Level I–III thinking about learning [pages 125–35].

Comments such as “they are passive, they won't even talk in class” puts the blame on the students' characteristics and is an example of Level I thinking. Level I says that learning is dependent of what the student is. Naturally this cannot be so; students are not static. Applying Level I theory to teaching would mean that we ask students to assimilate. Level II says that what is important is what the teacher does. In a way, Cannon-Newble (9) apply that theory when they give us a number of tips and tricks to survive teaching activities! McKeachie is also inclined to apply a Level II thinking about teaching when he says that what makes you survive the first few days of teaching is not a thorough knowledge about teaching theory but rather the tips and tricks (11). Fans of Level III suggest that teaching should be education. The purpose of teaching should be to facilitate the learning of students. Level III is not about what the student is, but what the student does.

Biggs challenges the authoritative teacher even more when he talks of the need for convergent and divergent assessment [page 154]. He is very much against the use of multiple-choice questions since they will not encourage deep learning and understanding but short-term rote memorization. He also notes that students who take a deep approach to learning often perform poorly in multiple-choice questions tests.

Biggs' book also includes some practice. Chapter 11 is a good read and is about implementation of theory. In Chapter 11 he also reflects on “research vs. teaching” and “teaching as research”. Some people perceive the two as opposites. The opinion of the author of this book review (J.F.L.) is that we desperately need both. Research is fun, but so is teaching and can anyone come up with a better way to implement research findings than to make medical students interested in these findings? Medical students are tomorrow's colleagues. As such they are worthy of not only respect but also of engaged teaching—aligned engaged teaching!

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All the above books are well worth reading and it is up to the reader with an interest in medical teaching to choose what book he/she would want to read. Still, as most scientists at one stage of their career attend a course in biostatistics, more of us should be concerned about the way we teach. Not being able to transmit knowledge and enthusiasm for pediatric gastroenterology will in the long run lessen research efforts and clinical expertise in this area.

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1. Lilley P. Topics in Medical Teacher that most interest readers. Medical Teacher 2002; 24:237–8.

2. Hartley S, Gill D, Walters K, et al. Twelve tips for potential distance learners. Med Teach 2001; 23:12–15.

3. Issenberg SB, Gordon MS, Gordon DL, et al. Simulation and new learning technologies. Med Teach 2001; 23:16–23.

4. McLean M. Rewarding teaching excellence. Can we measure teaching `excellence'? Who should be the judge? Med Teach 2001; 23:6–11.

5. Harden RM. AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Med Teach 2001; 23:123–37.

6. Brown G, Manogue M. AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers. Med Teach 2001; 23:231–44.

7. Ramsden P: Learning to teach in higher education. New York: Routledge, 1992.

8. Biggs J: Teaching for quality learning at university. Buckingham: Open University Press, 1999.

9. Cannon R, Newble D: A Handbook for Teachers in Universities & College: A Guide to Improving Teaching Methods: Kogan Page Ltd, 2000.

10. Balla JI, Biggs JB, Gibson M, et al. The application of basic science concepts to clinical problem-solving. Med Educ 1990; 24:137–47.

11. McKeachie W: McKeachie's Teaching Tips: Strategies, Research, and Theory for College and University Teachers, 11 ed. Boston: Houghton Mifflin Company, 2002.

12. Booth V: Communicating in Science, 2nd ed. Cambridge: Cambridge University Press, 1993.

13. Nordenstrom J, Dahllof G, Ekstrand J. [The merit profile–an instrument for the evaluation of academic achievement]. Nord Med 1998; 113:208–10.

14. Angelo TA, Cross KP: Classroom Assessment Techniques. A Handbook for College Teachers., 2nd ed. San Francisco: Jossey-Bass, 1993.

15. Marton F, Saljo R. On qualitative differences in learning—II: Outcome as a function of the learner's conception of the task. British Journal of Educational Psychology 1976:115–27.

16. Marton F, Saljo R. On qualitative differences in learning—I: Outcome and process. British Journal of Educational Psychology 1976:4–11.

© 2003 Lippincott Williams & Wilkins, Inc.


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