Learning through the senses.

Everyone who rides a bicycle or plays music will experience that such tasks demand more than a cognitive process; the body seems able to process and even ‘remember’ knowledge and skills that cannot easily be reasoned and explained. In the paper ‘Body pedagogics: embodied learning for the health professions’, Kelly et al.1 make a well‐founded argument regarding how embodiment is central in the actions of health professionals. They offer examples of how senses and bodily movements interact with the environment and feed expertise development. In doing so, they highlight a lack of attention to embodiment in health professions education and suggest filling this gap by means of ‘body pedagogics’ (i.e. ‘the central pedagogic means through which a culture seeks to transmit its main corporeal techniques, skills and dispositions, the embodied experiences associated with acquiring or failing to acquire these attributes, and the actual embodied changes resulting from this process’2). This argument follows from the last decade's increased interest in embodied cognition within the learning sciences. In that broader literature, embodied cognition describes a spectrum of theories that view learning, and human cognition in general, as driven by a body's interactions with the environment.3

If bodily sensations are key to learning in the health professions, the development of learning environments that support embodiment may benefit from insights developed through the educational sciences. It is important, for example, that we avoid overloading a curriculum with activities that stimulate the senses without leading to learning. Activating learners by having them use gestures that do not facilitate learning will only provide extra load on learning processes without yielding the desired benefits. Although the authors explain the importance of sensory learning and provide many clear examples, the concept remains rather implicit in terms of what learning is and how learning takes place. To add to that representation, therefore, we use the taxonomy of embodied cognition put forward by Shapiro4 to explain three main accounts of embodied cognition in an attempt to take a position regarding how the concept of embodied cognition can benefit health professionals’ learning and learning environments.

The first account of embodied cognition treats all perceptions, actions and cognitions as occurring from how learners experience and conceptualise their environment, with the experience and conceptualisation being co‐determined by the nature of the human body (e.g. the way we use our eyes, see, smell, touch). Shapiro calls this the conceptualisation account of embodied cognition, stating that concepts arise from physical experiences rather than beginning with the acquisition of cognitive knowledge. It seems that Kelly et al.1 embrace this account, following Shilling2 in their explanation of body pedagogics, by referring to: (i) institutional means (i.e. the context that mediates embodied experiences);(ii) embodied experience, and (iii) embodied outcomes.

… embodied cognition treats all perceptions, actions and cognitions as occurring from how learners experience and conceptualise their environment, with the experience and conceptualisation being co‐determined by the nature of the human body (e.g. the way we use our eyes, see, smell, touch)

In the second account, embodied cognition includes the idea that cognition is a dynamic interaction between brain, body and the world. Shapiro calls this the replacement account because the notion of mental representations is replaced by dynamic interactions in which learning occurs fully through the connection between body and world.5 In this view, health professionals do not make (static) representations in their mind, but shape their learning in the workplace based on motion or dynamic interaction. From a dynamic systems perspective, learning has been described as a reinforcement of associative relationships. The pattern and strength of these relationships are hardly accessible for conscious control and are heavily driven by chance and predictions. This model can be hard to appreciate in health professions education because learning is often focused on consciously seeking particular observations when explicitly analysing, diagnosing and assigning meaning and interpretations. However, there are several examples of studies and educational designs that show how learning can be developed by internalisation of sensorimotor actions, without making cognitive representations.6, 7

… health professionals do not make (static) representations in their mind, but shape their learning in the workplace based on motion or dynamic interaction

Finally, several proponents of embodied cognition take the notion a step further still in what Shapiro calls a constitutional discussion, also known as the ‘extended mind thesis’.8 This account follows the idea that the mind is distributed in the surrounding context. For instance, the use of paper and pencil to take notes to remember things can be seen as an enlargement of the cognitive process and makes the environment (i.e. the notes) a component of cognition. From a radical perspective, this implies that if the environment has a (extended) function that is considered to facilitate cognition, that part of the environment should be considered as cognition as well. A milder perspective assumes that the purpose of constitution is not to distribute cognition in an outer world, but to provide insight into how interactions between brain, body and world take place. After all, cognitions are always a bodily human construction and interpretation, rather than an objective reflection of reality. Both constitutional perspectives imply that learners need opportunities to discover, practise and refine their senses.

… cognitions are always a bodily human construction and interpretation, rather than an objective reflection of reality

In conclusion, the concept of body pedagogics indicates a need to deliberately attend to and improve health professionals’ learning environments, but it also necessitates that underlying notions about learning are made clear. Learning, after all, does not automatically take place when learners carry out bodily activities or mimic the bodily movements of their supervisor. Neither does adopting the concept of embodied cognition imply that all learning should be based on body pedagogics. Shapiro's notions of conceptualisation, replacement and constitution may add to positions about learning and learning environments.

… the concept of body pedagogics indicates a need to deliberately attend to and improve health professionals’ learning environments, but it also necessitates that underlying notions about learning are made clear

These concepts may become increasingly important as today's multimedia learning environments and robotics offer opportunities for further development of embodiment and body pedagogics.9, 10 To bring this field forward, a corresponding research programme is needed that may pre‐eminently be phenomenological and multidisciplinary in nature. The programme should be driven strongly by learning theory to gain insight into how bodily actions, perceptions and cognitions are related to each other and how embodied expertise can be enhanced in health professions education.