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Our current understanding of learning cannot be conceptualised by a single theory.
Over the last century many ideas have been proposed. These are the thoughts of ‘Big Thinkers’, visionaries who intentionally or not have shaped educational policy.
Psychologist Lev Vygotsky is responsible for the Social Development Theory.
Here the concepts of his theory and possible application in dental education will be discussed.

The Social Development Theory
Lev Vygotsky (1896-1934) was a Developmental Psychologist who proposed that social interaction preceded cognitive development in children. He believed that there were two levels of learning, learning socially, interpyschological followed by intrapyschological, learning taking place within ourselves (Vygotsky, 1978). He also viewed language as a vital tool for the transmission of information, and intellectual adaptation (Vygotsky, 1962).

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The term the More Knowledgeable Other (MKO) is discussed in the literature as a person who has more information and higher ability regarding a specific task than the learner. The MKO with the necessary knowledge may be a teacher, parent, sibling or even the internet.

Vygotsky discussed the Zone of Proximal Development (ZPD), the area where the student is able to progress further but requires assistance and social interaction to fully develop (Briner, 1999), assistance will be from a MKO. The term ‘proximal’ suggests that this development is within the learner’s reach and fits in with their current ability (Cole and Cole, 2001). Ideally, a child should be in an environment where the MKO is able to help with tasks that fall within their ZPD.

To understand how Vygotsky came about these views his own upbringing needs to be examined. He grew up in Tsarist Russia where his father opened the first public library in their town (Yaroshevsky, 1989). He was educated by a private tutor who encouraged critical enquiry and thought through a ‘Socratic Dialogue’ (Wertsch, 1985).
It is likely his thoughts were influenced by the radical changes taking place in his own environment at the time. Russia had become increasingly socialist with the notion that the success of an individual was linked to the success of the culture.

On the contrary, one of Vygotsky’s contemporaries was Psychologist Jean Piaget (1896- 1980) who believed that cognitive development was not driven by socialisation, took place in stages and was due to the learner’s innate self-discovery and ability to adapt.
Vygotsky died young with his work incomplete, it was many years later that his ideas were translated and began to influence our understanding of cognitive development and education.

Reflective Thoughts
I believe the Social Development Theory may be relevant to dental education. We need to consider not only how society influences us, but how we affect society. Vygotsky’s thoughts are in line with the learner playing a role in serving society.
I am educating students who are going to be of service to their communities and work for at least part of their career in the National Health Service, which can be viewed as a predominantly socialist institution.
This is supported by the Dentist Act 1984 which requires Dentists ‘protect the public, maintain professional standards and public confidence in the profession’ (GDC, ****). Social responsibility has to be considered in dental education, this includes teaching professionalism, probity and holding students accountable for their actions.

I have mixed thoughts regarding the importance of social interaction in learning. The theory is mainly concerned with social interaction in child development, what happens later in life? When teaching students do I really need to consider the social environment or culture which students have already been educated?
I encounter students from diverse backgrounds who may have been raised with different levels of social learning, teaching may have been very paternalistic and not encouraged discussion yet they are on the same course. An example is an international student who may have been brought up in a society where there is minimal social learning- the teacher spoke and student obeyed, however, the student appears to have more or less the same level of knowledge as indigenous students. Though research is available to suggest that language which Vygotsky viewed as vital in learning may be an issue for foreign students. Ryan and Viete (2009) discuss international students perceived barriers to learning in Australia, a number feel that reduced proficiency in English effects how well they can express themselves and participate in a session.

For Vygotsky’s ideas on social interaction to work in dental education and thus generate Dentists of the same standard, the learning environment and MKOs have to be of the same quality and equal across the country. This is near impossible. A number of tutors at an institute will have biased thoughts, so students may not graduate with a well-rounded view on certain topics. In addition I work in an area where there are a number of social issues and poverty, there is a risk that my students are gaining in-depth knowledge in relation to managing decayed teeth, however not so much about aesthetic dental treatment. The converse may be the case for MKOs working in affluent areas of the country.

I do strongly believe that the ZPD fits in with constructivism. Ausubel (1968) states ‘the most important factor influencing learning is what the learner already knows’. New information has to be rearranged and incorporated into existing knowledge. In my role as an MKO to be effective in constructivist learning I need to know how much my student knows- gage their ZPD, which will be unique to each student. This maybe be achieved by having less of a didactic, and more of a heuristic approach to teaching. I have started to send resources via email to students prior to a session, inviting them to generate their own learning objective, as well as asking opened ended questions which encourage my students to express themselves.

Working within the ZPD with an MKO leads to the understanding of the term Scaffolding. Not discussed by Vygotsky but added later. Where a student is given support to reach an endpoint. This support is short term, just enough to enable them to do the task on their own. To have the optimal outcome of scaffolding the MKO should tailor the assistance to fit the learner.
On reflection, I find that I have been actively scaffolding, particularly when I am undertaking one-to-one clinical teaching in oral surgery, where I can give prompts or assistance to students. I have noticed that within a group there will be different levels of competency and confidence. In some cases, I have had to provide substantial assistance to a student that has hit the upper limit of their ZPD. Another student maybe more advanced and I am able to be passive and intervene very minimally.
Such a technique works best in one-to one sessions or small group learning. If working in a big group and I just assumed that all students were at the same competency in oral surgery whilst helpful to some learners, others would not progress further. In ideal world we would scaffold for the majority of education, however it is time consuming.

Despite its merits, I feel that the ZPD may not always be relevant, there may be times where a student will not need to interact socially to learn. The ZPD is applicable in the clinical years which are skills based, but not the preclinical years which are predominantly lecture based. Some students do not even attend the lecture and can learns solo and pass exams.
To get the most out of a student I the MKO would have to build a strong rapport with my students. If I am not able to ‘connect’ with a student our social encounters will be minimised, if the theory is correct this student may nor their full potential. This could be the result in a small proportion of cases, however, there are numerous occasions where a student may dislike a teacher but perform well in that subject. In addition the theory does not explain how students who have received the same social interaction have different ZPD’s. These gaps may be better explained by Piaget’s theory that a student is able to adapt.

I am not completely convinced by the theory as it does not explain why different students have different levels of cognitive development despite receiving the same social input, or able to learn without any social interaction at all.
I believe elements of Vygotsky’s theory relate to dental education as dentistry is in part a social science. I feel it will be best utlised in small group or one on one teaching similar to what Vygotsky experience himself.

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