Active Learning in Professional Health Education

Active Learning (AL) is gaining popularity all over the world, even though giving up the ineffective traditional methods of education proves to be a prolonged process (Aliakbari, Parvin, Heidari, & Haghani, 2015). Moreover, AL is being actively promoted in nursing, midwifery, and other educational environments (Herinckx, Munkvold, Winter, & Tanner, 2014, p. 31). The approach is democratic in ensuring the participation and active engagement of students, which appears to correspond to modern trends, but to understand the reasons for its popularity, more extensive research into its theory, practice, and context is required.

Definitions
Modern health professional education (HE) can be defined as a broad and complex set of events, processes and influences, both deliberate and unplanned that surround the aspiring medical specialist since the beginning of studying and until the final day of practice (Mann, 2010, p. 61). Indeed, nowadays, healthcare professionals are expected to improve their skills continuously; apart from that, medical competence is now considered to be the professional identity of a person (Mann, 2010, p. 61). This identity includes the profession-related skills and knowledge but is not limited to them: the requirements of the profession include cognitive and communicative skills, self-awareness, self-improvement, self-assessment, and others (Mann, 2010, p. 62). As a result of these changes, lecturing has stopped being the key or the most effective way of teaching (Kroning, 2014). Traditional education is hardly capable of producing such an outcome, but new approaches, especially AL is technically geared towards achieving it.

AL is any engaging activity other than that of passively listening to teachers lecture (Kroning, 2014, p. 448). This definition is very generic, but it is understandable since the means of engaging students are numerous. In this paper, several approaches that can be used in classroom settings will be presented to illustrate the notion.

Active Learning Approaches
To better understand the notion of AL, its specific approaches should be considered. Classroom diversity implies that the on these approaches can be suitable for or preferred by a particular part of the learning cohort. As a result, the use of various techniques may be preferable and should be introduced in every particular classroom (Boctor, 2013; Cubas et al., 2015; Moore, 2012; Robb, 2013).

Problem-Based Learning
Problem-based learning (PBL) is an AL approach that uses authentic artifacts reflecting real-world situations for students to through collaboration with their peers (Martyn, Terwijn, Kek, & Huijser, 2014, p. 829). Thus, apart from providing the profession-related knowledge, it is aimed at the formation of cognitive and communication skills; besides, this approach qualifies as a self-directed one. It is widely used in nursing and midwifery since problem-solving skills are of especial importance for their future professions (Choi, Lindquist, & Song, 2014). As a result, the approach has proved to be useful for the training of nursing and midwifery students in pre-and post-graduate programs, especially when compared to (Martyn et al., 2014; Choi et al., 2014).

Team-Based Learning
Team-based learning is a very popular means of teaching nowadays that has also been proved to be effective in HE (Clark, Nguyen, Bray, & Levine, 2008; Maslakpak, Parizad, & Zareie, 2015). It improves engagement, provides the training related to interpersonal skills, and most often is also geared towards the development of other skills, for example, cognitive ones (Lubeck, Tschetter, & Mennenga, 2013). A type of is the near-peer one that is particularly useful for nursing and can also be combined with simulation experience (Owen & Ward-Smith, 2014). For example, the near-peers (who are the upper-level students) can play the role of patients and mentors. As a result, not only profession-related, collaborative, and communicative skills of the students were trained; for the upper-level student, leadership and teaching ones were also being developed.

Hands-on Learning
The hands-on learning approach offers the students the opportunity to apply what they learn through physical demonstration (Robb, 2013, p. 304). It reinforces knowledge, improves the students confidence, and helps them to determine and deal with difficulties. An example of such an approach is simulations.

Simulations are concerned with creating an experience that is matching reality to some degree and is meant to recreate a real situation but is not real (Moyer, 2016). Both low- and high-fidelity simulations have been proved to help students organize their knowledge and apply it in the course of such a practice. At the same time, low-fidelity simulations are much more feasible and easier to arrange, which is a plus in classroom settings (Moyer, 2016, p. 68). In nursing and midwifery, simulations can be created with the help of software (even in virtual classrooms) or mannequins and actors (McAllister, Searl, & Davis, 2013).

Games
Learning games can also be mentioned as a technique that is particularly approved by a large number of students (Boctor, 2013, p. 96). It is especially good at attracting attention and making students curious, which is one of the goals of AL (Kroning, 2014). From the point of view of the teacher, the specific outcomes may vary. The game described by Boctor (2013), for example, mimicked the Jeopardy game and included nursing questions, answering which brought a team money. It was aimed at reviewing and learning new knowledge and collaboration. Also, games produce immediate feedback in the form of scores.

Justifying AL
The reasons for the popularity of AL and its promotion in nursing and midwifery education are numerous. First of all, it is admittedly more innovative and suitable for the modern kind of HE than the traditional approach (Herinckx et al., 2014). Besides, AL has been suggested as a more appropriate model of learning for Millennial students: for example, by Robb (2013), Kroning (2014), Welch (2013). Therefore, it is a timely approach suitable for modern students. Moreover, nursing students have reported preferring AL: in other words, it contributes to their satisfaction, which is essential for engagement (Boctor, 2013, p. 96).

The shift towards AL is of particular importance for the classroom settings that are typically concerned with the acquisition of knowledge. Modern opportunities (for example, simulations) have started to blur the line between classroom and clinical settings, though, but it is still apparent that AL is in the process of dramatically changing the former (Fahlberg, Rice, Muehrer, & Brey, 2014; Moyer, 2016). Indeed, AL challenges the classic means of passing the knowledge, which makes the application of its theory to the classroom setting particularly timely. It is also noteworthy that the classroom and clinic settings should not be considered completely detached from each other: in reality, the two need to be collaboratively used to ensure that students use their classroom knowledge in the clinical environment (Po-Han, Hwang, Liang-Hao, & Yueh-Min, 2012). AL is capable of affecting both settings and assisting in uniting them (Dewing, 2010; Wonder & Otte, 2015). Still, they both have their specifics that need to be taken into account, and here, the focus will be on the classroom settings.