Education for Health

: 2022  |  Volume : 35  |  Issue : 1  |  Page : 26--30

The application of the constructivism learning theory to physician assistant students in primary care

Sanjeef Thampinathan 
 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

Correspondence Address:
Sanjeef Thampinathan
155 College Street, Toronto, ON, M5T 3M7


When examining different clinical programs, educators must incorporate the most appropriate educational theory to the learners, especially in a clinical setting. The implementation of constructivism learning theory will help preceptors and learners understand and assess educational content appropriately. This literature review covers the key components on the application of constructivism learning theory to physician assistant students in primary care. The history, fundamental principles, and the clinician/educator role in constructivism learning theory are discussed.

How to cite this article:
Thampinathan S. The application of the constructivism learning theory to physician assistant students in primary care.Educ Health 2022;35:26-30

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Thampinathan S. The application of the constructivism learning theory to physician assistant students in primary care. Educ Health [serial online] 2022 [cited 2023 Feb 4 ];35:26-30
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Understanding different learning theories is crucial to providing an adequate method of conveying educational information. When examining different clinical programs, educators must incorporate the most appropriate educational theory to learners, especially in a clinical setting.

Currently, physician assistant (PA) students are trained in three civilian programs across Canada.[1] Initially, PA students have a didactic year of learning, followed by a clerkship year.[2] PA students are exposed to a lot of learning and education in the didactic year which can be overwhelming. Since these PA programs are very intensive in their training process, it is important to incorporate specific educational theories to help learners gain knowledge and skills necessary for practice.

When examining the educational learning theories, constructivism learning theory is a very suitable theory that can be applied to PA students engaging in their rotations. The implementation of this theory will help preceptors and learners better understand and assess educational content. In addition, this will help improve the overall experience for both students and preceptors.

We cover the key components on the application of constructivism learning theory to PA students in their primary care rotation. The history, fundamental principles, and the clinicians/educator's role in the theory are reviewed in detail.

 History of Constructivism

Throughout history, there has always been a tradition in education where teachers taught information to students in a single logical manner. The constructivist view has always been opposed to this tradition. Today, more teachers are applying the constructivist framework to allow students to question and build on existing knowledge. Constructivism has two main historical foundations: one in philosophy and the other in experience/research.[3] Many individuals have developed this theory to apply it to practice. The three key figures for constructivism theory are as follows: Jean Piaget, Lev Vygotsky, and John Dewey.[4]

Jean Piaget developed the foundation of constructivism learning theory. Constructivism theory is linked to Piaget's work on genetic epistemology theory.[4] Piaget emphasized the importance of an individual's cognitive adaptive capabilities which occurs through accommodation or assimilation.[4] It emphasizes that external experiences assimilate into the existing understanding. Piaget's four levels of human development are (1) sensorimotor, (2) preoperational, (3) concrete operational, and (4) formal operational.

Another important individual in constructivism theory is Lev Vygotsky. In his view, constructivism put emphasis on social, language, and cultural aspects, and how all of these played a key role in the learning process. Lev Vygotsky disagreed with Piaget and stated that all learning derives from social interaction and emphasized that students must be engaged and assisted by others for learning to occur. The zone of proximal development and scaffolding was developed by Vygotsky to discuss the importance of working together and assisting students with guided interaction in a learning environment.[5] Although these two prominent theorists had contrasting views, Piaget and Vygotsky played fundamental roles in establishing constructivist learning theory.

Finally, John Dewey played an important role in applying constructivism in a teaching environment,[4] positing that learners should engage in the real-world problems in a classroom setting. Learners should think for themselves and discuss their thoughts as opposed to the use of repetitive memorization to understand the concepts. His notion of “real-life experience” was a fundamental aspect of this educational learning theory.

 Theory and Principles of Constructivism

It was through the work of these foundational figures that the important fundamental principles of constructivism were established. We apply this theory of constructivism to PA learners in a clinical setting, outlining the main assertions of this theory, and reviewing the role of the educator and the clinical learning environment.

Fundamental components of constructivism

There are five key attributes of constructivism learning theory. The first principle is that the construction of knowledge occurs on already existing knowledge.[6] It should be built on new experiences rather than knowledge being passively absorbed. This is a very important goal and can be applied to PA learners in the clinical setting. Having a needs assessment before clinical rotations will help show the gaps in knowledge that exist in students.[7] This can help in tailoring students' experiences.

The second principle is that learning occurs in an active process.[6] Learners are not blank shells where knowledge is inputted or received. Students need to engage with real examples and experiences to construct the meaning of the educational material. Learning cannot be achieved if understanding is not present. Passively presenting information to a learner will not promote understanding. There needs to be a strong connection made with prior existing knowledge. Piaget's concepts of assimilation and accommodation are fundamental in this process.[6] Assimilation is the cognitive process in which information is built on existing knowledge.[6] Accommodation is the cognitive process in which existing knowledge is changed because new experiences or information is presented.[6] These two processes are important in the adaption of human learning. There will be opportunities for PA learners to adapt and actively learn in a clinical setting with the appropriate application of this theory.

The third principle is that acquiring knowledge is fundamentally a social construct[8] (authors: What happened to reference 7?). This is tailored toward Vygotsky's perspective and his emphasis on social importance.[5] Furthermore, Dewey stated that learning occurs through interaction and prioritizes this in the context of classroom education.[4] Vygotsky stated that the concept of sharing and educating through social engagement is crucial to help guide and cement learning.[8] This principle highlights the importance of the zone of proximal development and scaffolding. Since the current work looks at applying the theory of constructivism in training PA students in primary care, Vygotsky's theories will be focused on to a lesser extent compared to principles discussed by Piaget.

The fourth principle is to value everyone's perspectives and that every learner has a different point of view.[8] Learning is mainly subjective with different interpretations existing for each learner. This principle is crucial to create a constructivist environment in which educators can provide the support necessary for their learners.

Finally, the fifth principle of constructivism theory involves the mental model of learning and that individuals are constantly evolving.[8] Learners are always creating and developing new connections and perceptions of reality. With time, individuals gain new experiences and understand the world in their own unique way. This will allow students to revise their perspectives with each new experience. Furthermore, students reflect on new educational materials to apply to their reality of life.[8] This helps individuals establish strong connections and create a holistic learning plan. Each PA learner must have their mental model about their learning process.

From all these principles of constructivism, it is important to note that learners are the key players in this implementation process. Without engagement and participation from learners, any application of this educational theory will not be successful.

Educator's role in constructivism

Constructivist theory focuses on a learner-centered approach where the emphasis is placed on students being the builders and creators of knowledge.[9] Educators must play a key role in developing an environment where problem-solving activities actively engage the students throughout their learning process. During this process, the educator must act as a facilitator.[9] Facilitating an activity is key to building on students existing knowledge. The educator has a responsibility to understand the baseline knowledge and skill level of the student. Educators must help students learn the required knowledge for proper comprehension.

The process of scaffolding is important for educators. This helps teachers or preceptors tailor their assistance level for the student based on their performance.[5] It is also the responsibility of the educators to change his/her way of teaching to respond to the learners' performance level. Creating an open and collaborative environment will help the student actively engage and discuss with preceptors about opportunities and issues that may arise.

Clinical learning environment

The clinical learning environment plays an important role in establishing and maintaining constructivism theory. There are key factors to creating a constructivist environment in a clinical setting. The first important factor is the idea of authority. Tam states that authority must be shared between the learner and the educator.[10] Students will have a sense of ease to ask the educator any questions/concerns they have with no bias. These questions discussed by the students must be valued by the educator. Second, knowledge must be shared between the student and the educator. Educators will engage with students through dialog and interactive activities.[10] Third, teachers are facilitators that must guide students in the learning process.[10] Providing ownership to learners will give them a voice in the process.[11] It is important to have a wide range of perspectives when interacting with learners. This includes incorporating different modes of learning through videos, presentations, and reflections.

Within the constructivist clinical environment, preceptors must play a leading role to (1) promote and create an environment in which learners have autonomy, (2) be able to shift teaching strategies when necessary, (3) have a better understanding of what the student knows about the concept, (4) allow students to ask open-ended questions with appropriate wait times to allow them to elaborate on their responses, and (5) promote curiosity and discuss contradictions that exist in the clinical learning environment.[12]

 Applying Constructivism Learning Theory into Practice

In a primary care setting, these principles need to be applied with the creation of an instructional design type that will engage the student. To accomplish this, it is important for a learner to have collaboration, exploration, experimentation, construction, and reflection in the learning environment. A problem-based, issue-based, question-based, project-based, or case-based experience with multiple support systems must be in place for the successful application of constructivism theory.[13]

Physician assistant preceptors in supporting primary care training of physician assistant learners

Constructivism learning theory highlights three roles that the PA educator should incorporate to support students in the clinical environment: coaching, modeling, and scaffolding. Coaching is a process in which an educator improves a student's understanding and knowledge through motivation, performance advice, feedback, and reflection. This will help students feel supported if struggles arise with specific learning concepts. Some methods of coaching can be elicited through providing motivational prompts, performance regulation by clues/hints to direct students, and reflections.[13] There will be an increase in confidence levels for students by providing motivational prompts. It may be necessary to increase these prompts when learners are performing more difficult tasks. Through this process of completing activities, discussing related cases, making inferences, and providing feedback, students can achieve the important clinical skills required for the rotation.[13] Asking students to reflect on their experiences and performances is key to building comprehension and producing meaningful relationships.

Modeling is another way in which PA educators can assist their learners in both behavioral modeling and cognitive modeling. Behavioral modeling is how to perform an activity, while cognitive modeling discusses the reason behind the performed activity.[13] An example is to ask the student to reflect on the questions asked by the preceptor during a specific patient encounter. With a case-based example, PA educators can articulate the reasoning behind each step in a clinical examination.

Scaffolding can help support students by guiding them on specific tasks to provide support and improve student performance.[13] The term “scaffolding” means temporary support for building structures in construction projects. The key to scaffolding is to use the technique of modifying task complexities, reorganizing the task to help support learning for students, and providing alternative assessments for students that have difficulty.[13] It is important to accommodate students who have difficulties on specific tasks by providing a learner-specific assessment or readjusting the task difficulty.

Assessment of learners in the primary care setting

Preceptor assessments are important to determine the level of competency gained throughout rotations. The use of mind mapping is an important assessment tool. Mind mapping is a multisensory tool that assists learners to formulate, retain, and organize information.[14] Previous research has shown that mind mapping assists and improves learners' critical thinking abilities.[15] With this, students will build strong learning connections.

Oral discussion is another way to assist students in their process of learning. In these discussions, it is important to give case-based examples and provide clinical exercises to complete at home to build on the students' knowledge.

In addition, in the primary care rotation, conducting pre/post-tests to PA trainees through e-mail can be an effective way to assess and retain knowledge. A posttest at the end of the primary care rotation will provide the educator with information about whether the learner successfully retained knowledge.

With hands-on activities incorporated in the primary care rotation, PA learners will have the opportunity to build on the clinical skills aspect of medicine. It is important to use hands-on activities on materials such as physical examinations. The process of modeling and coaching by the PA educator will help students feel comfortable and at ease when doing these skills on their own. A checklist will be an effective way to help build on and retain these skills.

The last two activities that can be included in assessments are role-playing and research projects. Role-playing with simulated cases will help students build confidence and pick up on crucial information in a patient encounter. In a primary care rotation, a supplementary research project on commonly seen conditions will help learners improve their experience and knowledge.


Based on the information provided, constructivism learning theory will be an effective theory if there is appropriate buy-in from preceptors, educators, learners, and program directors. With proper implementation, constructivism learning theory will create highly competent students as they enter and complete their rotations in primary care. This theory will be effective in establishing a good learning environment for students/trainees. The investment needed for the successful implementation of this learning theory is high, but the results will be worth it.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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