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Celebrating Human Connections in Teaching

A human connection is the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.

—Brené Brown (2010, p. 5)

The environments in which health professionals gain knowledge, skills, and attitudes that they need in their practice can be dominated by technology and mechanized procedure-oriented approaches. Health professionals achieve the competencies required by their discipline in clinical, classroom, and online settings. Health professional learners include pre-service students enrolled in higher education programs and in-service practitioners participating in graduate studies or continuing education activities. Students and practitioners in all health disciplines are expected to become, and remain, self-directed lifelong learners. Whether learners are registered in formal health profession programs or simply seek information on current best practices, they must reach out and engage with informed others and relevant resources as part of their learning.

Human connections can support learners in achieving success in all learning environments. Yet, in many instances, learners remark that they feel alone, disconnected from other students and the teacher, and bereft of human contact. Learning in isolation can negatively influence the educational experience. Learning outcomes that focus on higher-order affective domain competencies such as responding to phenomena and internalizing values are often best facilitated through human interaction and interpersonal communication.

For learners in the health professions in particular, learning in a community is essential. Health professionals provide care, kindness, and compassion to people when they are at their most vulnerable. Processes that students experience in their pre- and in-service education should model, integrate, and celebrate these human connections. Educators need to actively pursue ways to humanize the curriculum for health-care providers. In an early explanation of how educators can humanize education, Dutton (1976, p. 79) offered this simple explanation: “Make students feel ten feet tall.”

In this chapter, we begin with a glimpse of what the concept of human connection means. Next, we provide a brief introduction to humanizing pedagogy with a discussion of how educational environments that embrace immediacy, praxis, and affective learning can help educators and learners to establish successful human connections. We emphasize how personalizing learning, by inviting learners to set individual goals and by offering opportunities for “voice and choice,” can play a critical role in the education of health professionals. In each section, we include practical (and proven) strategies that serve one of two purposes. Some boxed strategies are designed for educators to assist them in reflecting on whether they approach learners in humanizing ways. Other boxed strategies are approaches that educators can use to help learners (in a variety of educational settings) “feel ten feet tall.”

THE CONCEPT OF HUMAN CONNECTION

People engage and connect with one another in different ways and for different reasons throughout their lives. Psychologist Mathew Lieberman (2014) suggested that the human brain is wired to connect with others and that this need to connect with others is even greater than the need for food or shelter. In some instances, when connections with others extend beyond superficial conversations or interactions to include profound and meaningful communications, those involved can feel a deep sense of shared humanity.

Understanding the concept of human connection is not straightforward. The role that humanity can play in interactions is not easy to define. Most of us would associate the meaning of the word humanity with the simple definition of “a quality or state of being human” (Merriam-Webster, n.d.). But the definition of humanity also explains that the concept includes “compassionate, sympathetic or generous behaviour or disposition: the quality or state of being humane” (Merriam-Webster, n.d.). This definition is particularly important for educators who teach learners in the health professions. The definition suggests that people’s behaviour toward others (e.g., educators’ behaviour toward learners) is what makes them human or at least humane humans.

Deconstructing the definition further leads to a cursory examination of the requisite humanizing behaviour of compassion. Compassion means a “sympathetic consciousness of others’ distress together with a desire to alleviate it” (Merriam-Webster, n.d.). It is beyond the scope of this book to fully explain behaviours that demonstrate compassion. However, it is important to emphasize the vital role that compassionate behaviour can play in cultivating relationships rich in humanity. Fostering human connections in health professionals’ education begins when educators strive to act with compassion, to recognize distress in their students, and perhaps most notably to alleviate or reduce that distress.

In contrast, behaviours that are inhumane and lacking in compassion are not difficult to identify. Behaviours that could be described as callous, insensitive, and unfeeling are clearly inhumane. In their literature review of humane interpersonal relationships among Russian educators, Kleptsova and Balabanov (2016) noted that educators considered inhumane are likely to be more oriented to themselves, to identify others with their own ideas of good and bad, and to behave immaturely. As well, inhumane educators were described as demonstrating egoism, anger, envy, fear, cynicism, apathy, aggression, indifference, detachment, and idleness. Although educators might not intentionally act in inhumane ways, it is important to recognize that inhumane behaviours can be present and that they do not support positive, compassionate, and humane connections among educators and learners. The following strategy can initiate individual reflection and awareness building related to the importance of human connection in teaching.

HUMANIZING PEDAGOGY

Immediacy

At a basic level, the word humanizing means making things friendlier, more understandable, and “easier for humans to relate to and appreciate” (Vocabulary.com Dictionary, n.d.). Similarly, the word pedagogy refers to “activities of educating or instructing; activities that impart knowledge or skill” (Vocabulary.com Dictionary, n.d.). These definitions establish that humanistic pedagogy features educational activities grounded in friendliness and relatability.

In learning environments, educators describe friendly, relatable activities as expressions of immediacy. In the 1960s, social psychologist Albert Mehrabian defined the construct of immediacy as an affective expression of emotional attachment, feelings of liking, and experiencing a sense of psychological closeness with another person (Melrose, Park, & Perry, 2013). Verbally, educators express immediacy by sharing personal examples, engaging in humour, asking questions, initiating conversations, addressing learners by name, praising learners’ work, and encouraging learners to express their opinions (Gorham, 1988).

Non-verbally, immediacy is expressed by manifestations of high affect such as maintaining eye contact, leaning closer, touching, smiling, maintaining a relaxed body posture, and attending to the voice inflections of the speaker (Andersen, 1979). In higher and continuing education today, these expressions of immediacy between learners and educators continue to contribute significantly to student learning (Violanti, Kelly, Garland, & Christen, 2018).

Expressions of immediacy between educators and learners, and within learning groups, establish the foundation for humanizing pedagogy in any setting. In areas of clinical practice, new graduate nurses felt more satisfied with their jobs when their preceptors expressed immediacy by communicating an openness to their ideas and a sense of caring about their well-being (Lalonde & Hall, 2016; Quek & Shorey, 2018). In technology-rich online and blended classroom settings, higher-education nutrition students experienced a sense of closeness, community, and belonging within their class groups when educators encouraged open expression of opinions and provided opportunities for relationship building (Haar, 2018). In postgraduate e-learning classrooms, in which learners were separated geographically and temporally, nursing students highly valued interactions in which their educators acknowledged both who they were as individuals and their personal and professional responsibilities (Walkem, 2014). In staff development settings, dental hygienists were encouraged to strengthen their verbal and non-verbal immediacy skills in order to portray positivity and caring with patients (Dalonges & Fried, 2016).

Although educators might not have influence over the extent to which curricula and practice settings foster immediacy, there are always opportunities to integrate warmth and immediacy into interpersonal relationships with and among learners. The following strategy invites reflection on the construct of immediacy.

Praxis

Adult educator and philosopher Paulo Friere (1970) added to our understanding of humanizing pedagogies with his view of learners as co-creators of knowledge rather than recipients of information. Friere viewed education as a mutual process of critical consciousness in which educators and learners share a radical philosophy that actively challenges oppression, injustice, inequity, and societal conditions in the world around them. He defined this process of reflecting critically, and then acting to transform existing structures, as praxis.

In Pedagogy of the Oppressed, Friere (1970) argued against traditional banking approaches in which learners are perceived as empty accounts that need to be filled by educators. Banking approaches are characterized by educators who tell students what to do, what to learn, and what to think, and they seldom provide opportunities for learners to offer input, suggestions, or feedback about their education (Salazar, 2013).

In contrast, Friere (1970) called for educators to consider learners’ unique abilities, backgrounds, languages, and interests rather than treating all learners the same. Known for his work to empower oppressed adults in impoverished communities through literacy education, Friere asserted that hierarchies of power exist between educators and learners. He advocated for democratic relationships, critical examination of existing and accepted assumptions, and collaborative problem-posing dialogue in educational activities.

Praxis, with its emphasis on critical reflection followed by challenge and action, extends the notion of humanizing pedagogies beyond approaches that are friendly, relatable, and rich in demonstrations of immediacy. In health professions education, required disciplinary knowledge, technical skills, and competency-based curricula can reduce, however inadvertently, learning to a series of measurable skills and behaviours (Halman, Baker, & Ng, 2017). In turn, this narrow curricular focus potentially deflects educators’ attention away from humanistic pedagogies designed to foster caring, compassionate, and socially responsible health-care providers.

Educational activities geared to questioning and critiquing existing power relations and assumptions, particularly those that could be complicit in perpetuating inequitable and unjust social conditions, might not be supported at system and structural levels (Halman et al., 2017). However, when educators do find ways to integrate the critical reflection inherent in praxis into their teaching, they communicate a willingness to recognize and value learners’ perceptions, lived experiences, and questions. Whether learners are novices beginning careers in their chosen professions or expert professionals advancing their knowledge, they need to feel valued and welcomed for who they are. The next strategy suggests a way to value learners for their “fresh views.”

Affective Learning

Affect, or how people express emotions and feelings in their communications with others, plays an important role in the education of health professionals. Throughout their careers, they learn and practise in emotionally charged situations. Creating learning environments that embrace the affective nature of health care is a foundational element of humanizing pedagogy.

In his seminal work to classify the domains of learning, educational psychologist Benjamin Bloom (Bloom & Krathwohl, 1956) is credited with identifying three taxonomies of learning: psychomotor (physical/kinesthetic), cognitive (thinking), and affective (emotion/feeling). Health professionals commonly learn psychomotor skills during skills labs and practice sessions; acquire cognitive skills in both classroom and practicum settings; and develop affective skills in collaborative, group, or preceptored experiences. Affective learning is considered a higher level of learning in which understanding the complexities of human connections is essential.

Although a committee of professors and examiners in higher education also contributed significantly to the process of organizing learning into psychomotor, cognitive, and affective domains, the taxonomy is referred to as Bloom’s Taxonomy. Revisions of the taxonomy, particularly in relation to affective learning, have continued since the 1950s (Anderson et al., 2000; Anderson et al., 2001; Krathwohl, Bloom, & Masia, 1964).

Educators from a variety of sectors have integrated Bloom’s Taxonomy into their teaching. The hierarchical levels identified in each domain provide important guidance in creating learning activities that move from simple to more complex. Most frequently, Bloom’s Taxonomy is used to develop outcomes that learners are expected to achieve at the completion of a learning experience.

Five hierarchies have been established in the affective domain: receiving, responding, valuing, organization, and characterization (Krathwohl et al., 1964). First, at the simplest level, for learners to receive information, they must be aware that a stimulus for learning exists, and they must be willing and receptive to pay attention to this stimulus. Verbs used to describe receiving include feel, sense, capture, experience, pursue, attend, and perceive. An example of affective learning in the receiving domain is the expectation that students in the health professions attend a practicum placement in which they work under the direction of a preceptor. Learners are present to receive information related to the experience provided.

Second, responding requires learners to pay active attention, demonstrate motivation to learn, and experience feelings of satisfaction with their participation. Here descriptive verbs include conform, allow, cooperate, contribute, enjoy, and satisfy. When learners in practicum placements go beyond receiving information, they demonstrate responding by working cooperatively with their preceptors and actively contributing to patient/client care.

Third, valuing involves learners integrating information into their own beliefs and values about what they perceive is personally important and valuable. When this level of affective learning occurs, learners express an acceptance of information and show genuine commitment to certain values and beliefs. Descriptive verbs include believe, seek, justify, respect, search, and persuade. An illustration of valuing is when learners in practicum placements undertake efforts to persuade members of the health-care team to consider a particular treatment approach.

Fourth, organization occurs when learners internalize the personal and professional values that they have begun to conceptualize and include in their thinking. Organization includes establishing priorities based on values. In other words, achieving organization in learning requires that people know what is important to them as well as to their profession. Verbs such as examine, clarify, systematize, create, and integrate illustrate how the notion of organization reflects an increasingly more complex level of affective learning. When learners in practicum placements converse with others about how they are making connections between what they believe is important and what they are learning from their preceptors and other professionals, they are engaging in this high level of affective learning.

Fifth, characterization occurs when learners act in ways that reflect their internalized values and philosophical views. This high level of affective learning occurs when learners can demonstrate internalization of their own values without compromising expected disciplinary competencies. Verbs used to describe characterization include internalize, review, conclude, resolve, and judge. An example of characterization in practicum placements is a learner who might not agree with implemented patient/client care. In this example, learners must make judgments about care that they are expected to provide and know when and how to seek the help needed to ensure the safety of those whom they have been assigned to care for.

As Bloom’s Taxonomy of affective learning suggests, measuring whether this type of learning is occurring (and at what level) is difficult. Learning experiences in the health professions often include outcomes that indicate an expectation of affective learning. Without human connections to compassionate others, learners might not progress beyond simply attending and responding to requirements of designated activities. When educators focus on the humanizing pedagogies of immediacy, praxis, and affective learning, learners will feel valued for their beliefs and their ways of piecing information together. In turn, this will propel learners to engage in the more complex actions of organizing and characterizing their thinking in new ways.

PERSONALIZING LEARNING

In the preceding section, we discussed how environments in which educators and learners are viewed as co-creators of knowledge can celebrate and facilitate human connections in teaching. Next, we extend these ideas by emphasizing the importance of inviting participants in educational experiences to personalize their learning. Clearly, any program that provides education to health professionals must include goals that address content related to required disciplinary knowledge. Traditionally, goals in many programs for both pre-service and in-service learners were geared primarily to the acquisition of systematized skill sets, a relatively finite body of knowledge, and attitudes typically associated with a professional group.

Today, in developed countries around the world, most educational systems have shifted toward more personalized learning in which individuals are also involved in determining the goals that they want to achieve (Ignatovich, 2016). From elementary school to middle school to high school, most students who enter higher education now have some experience setting goals. Guiding learners toward setting personally meaningful goals, giving them the freedom to make choices related to those goals, and helping them to implement relevant problem-solving tools that aid in achieving those goals have emerged internationally as a foundational element in the “democratization and humanization” of all levels of education (Ignatovich, 2016, p. e5).

Personalizing learning focuses on the learner and “refers to instruction that is paced to learning needs, tailored to learning preferences, and tailored to the specific interests of different learners. In an environment that is fully personalized, the [individualized goals] and content as well as the method and pace may all vary” (Bray & McClaskey, n.d.). When the personalization of learning includes individual goal setting, learners can strengthen their individuality, independence, creativity, and competence, and the process can aid them in discovering and developing their humanity (Ignatovich, 2016). Educators in the health professions can no longer focus exclusively on goals stipulated in required curricula. Learners also need opportunities to set goals for themselves and to achieve those goals through means that suit their ways of learning.

Individual Goal Setting

In educational settings, the expectations of educators and learners are communicated through goal, outcome, and objective statements. According to the Eberly Center (n.d.), goals refer to broad statements about the purpose of a program or course and what educators expect learners to achieve over a period of time, outcomes refer to statements about what graduates are expected to know and be able to do once they have completed an educational activity or program of study, and objectives refer to specific, measurable statements that describe what learners must demonstrate by the end of a course or workshop. In essence, “goals are where you want to go; objectives are how you get there; and outcomes are proof that you have arrived” (Center for Technology, n.d., para. 1).

Differentiating among these different types of statements is important as educators in the health professions consider ways to help learners create individualized goals. At the curricular level, educators in these professions will (and should) always establish the program goals, outcomes, and objectives that will help learners to acquire the skills, knowledge, and attitudes that they need to practise health care safely. However, educators must also remain open to understanding, supporting, and celebrating the goals that learners themselves hope to achieve over time. This process begins when educators establish human connections with their students and intentionally explore what is important and meaningful to them.

When educators actively encourage learners to set individual goals, they nurture the higher-order affective competencies that health professionals need to function effectively in the real world of constantly evolving practice knowledge. In the seminal Nurse Educator Core Competencies publication from the World Health Organization (2016, p. 14), “facilitat[ing] professionalization for learners by creating learners’ . . . personal goal setting” is one of the core competencies expected of nurse educators.

Most regulatory bodies and associations in the health professions expect members to establish individualized goals as part of their continuing professional development. Professionals must demonstrate an ability to create and progress toward attaining individual goals throughout their careers. By integrating individual goal setting into experiences for pre-service and in-service learners, educators provide guidance toward succeeding with this professional expectation.

Individual goal setting can help learners with short-term successes in their classes or workshops as well. For example, when pharmacy students were supported with individual goal-setting activities such as creating self-developed study plans and openly discussing their progress toward achieving their goals, they demonstrated significantly improved continuous engagement with learning, improved focus on academic goals, and improved academic performance (Yusuff, 2018). When medical students set individual goals to improve their interviewing skills, they performed better on their Objective Structured Clinical Exams (OSCEs) (Hanley et al., 2014).

Different theories can serve as backdrops for understanding the value of individual goal setting. Notably, in his classic publication Towards a Theory of Task Motivation and Incentives, Edwin Locke (1968) theorized that, when people consciously and intentionally set their own goals, they are more motivated to undertake actions that lead to completed tasks. As Locke noted, when people set individual goals, they choose goals that are challenging rather than easy; when those goals are linked to specific tasks, they are more likely to be achieved.

Locke’s (1968) thinking lends credence to the notion that educators can help learners to succeed by encouraging them to individualize the goals, outcomes, and objectives identified in their designated curricula. When learners are accountable for their individual goals, that is, when they share them with someone else, they are more likely to succeed (Simon Fraser University, n.d.). With the knowledge that individual goal setting can be highly motivating and lead to successful outcomes, the importance of implementing activities in which learners can practise and become proficient with individual goal setting becomes clear. The strategy below outlines one such activity.

Voice and Choice

When educators provide learners with voice and choice, they honour the voices or views of what is important to learners, and they ensure that opportunities for making personally relevant choices are available. The phrase originated in the 1930s when educational systems began to shift toward more democratic education and freedom-based education (Morrison, 2008). These types of education are rooted in a view that people are curious by nature and naturally drawn toward learning, growing, and finding ways to make meaning from their experiences. This curiosity can be diminished when educational practices neglect personal learning.

In contemporary educational settings, the phrase serves as an important reminder for educators to remain vigilant about listening to learners and tuning in to choices that will support their unique learning goals. In pre-service programs offered by institutions of higher education such as universities, learners can choose elective courses of interest to them and might have some flexibility in the sequencing of their courses. Student representatives might be invited to join curriculum planning committees. In pre-service and in-service programs offered by other educational institutions and clinical agencies, learners have fewer choices of courses that they are required to take and when they are required to take them, and they are less likely to be included in planning committees. Many programs in the health professions are time limited and dependent on clinical placement availability.

Despite the limited choices that learners in health care might seem to have at a program level, learner voice and choice can readily be introduced at the instructional level. For example, educators in the health professions are required to deliver content that addresses disciplinary knowledge. All too often a lecture method is used to deliver this content. Similarly, assignment choices are often focused on writing papers or reports. Yet other methods of delivering content and developing assignments are also available. Educators and learners alike can work with multimedia technologies and social media to exchange information and demonstrate understanding of required content in new and exciting ways. Discovering these innovative approaches is most likely to occur when educators express a genuine confidence in learners’ capacity to make wise and thoughtful choices.

It is important to emphasize that providing learners with voice and choice also involves thoughtful direction from educators. Learners need to know about options that are (or could be) available to them. They need to know how to access a comprehensive body of required and supplemental resources that will help them to explore their interests and passions. In her work with student teachers, Jackie Gerstein urges educators to “show learners the possibilities . . . and then get out of the way” (n.d., p. 1).

CONCLUSION

In this chapter, we invited educators to celebrate the human connections that they can establish and affirm in learning environments. Compassion and humanity are vital in establishing human connections. Humanizing pedagogies, those that emphasize friendliness, immediacy, and affective learning, help educators and learners to work together as co-creators of knowledge. Health professionals must maintain ongoing competence in disciplinary knowledge and best practice guidelines. They must also demonstrate praxis in which they reflect critically and act to transform inequities in these structures. Educational activities in which learners’ views and critiques are valued can begin to ameliorate this tension.

Most learners in the health professions now come to programs, courses, and workshops with some experience in personalizing their learning. Educators must intentionally seek ways to strengthen this existing knowledge and help learners to extend their individual goals, objectives, and desired outcomes. Doing so will enhance learning and support professional development. We reminded educators to include voice and choice in the development and instruction of courses and workshops. Voice and choice are particularly important when delivering content and developing assignments in courses and workshops.

In summary, human connections are the heart of successful education in the health professions. Learners, whether they are pre-service or in-service, are continually required to learn new knowledge, new technologies, and new procedures. Educational activities grounded in a genuine commitment to humanizing learning will support learners and help to foster in them a lifelong love of learning.

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