Multiple Intelligences in Undergraduate Medical Education

Our interest in this area was initiated from varied student responses to alternative active learning strategies as part of the curriculum redesign for undergraduate pathology classes at the University of Saskatchewan. Over the last two years, in an attempt to understand these varied responses, information has been gathered from the students (88, 90) about their intelligences, using a readily available and accessible multiple intelligences inventory.

This Multiple Intelligences Inventory revealed that the disengagement of approximately one third of students from the process of learning may have been linked to active learning strategies incongruent with their preferred intelligences. The instructor used this information to redesign lessons incorporating different active learning strategies with the hope of engaging more students and fostering student self-awareness of their preferred intelligences.

Students differed substantially in their intelligences from year to year (highlighting the varied multiplicity of intelligences present in a student population) and because of this, no one teaching strategy or method is ideal necessitating the ongoing negotiation of instructional methods. There is a richness that occurs with incorporating varied strategies. Awareness of multiple intelligences and students’ unique intelligences will enable the educator to design/redesign lessons that will improve the learning environment.

Current State
In our medical school, medical education instruction is predominantly a “one size fits all” approach. Generally an instructor enters the class or lecture theatre, moves to the front of the room, and begins the Power Point slide show. The topic for the day is “covered” and the students leave for the next class where another instructor moves to the front of the room, introduces another topic, and refers the students to the handout of the overheads to follow along with the upcoming presentation. Occasionally an instructor may ask a question or invite students to take a few minutes to discuss an idea with their colleagues. This format, with small variations, has been traditionalized over the years to the point that students and instructors have come to expect this as the norm and template for instruction. However, it is time to question whether didactic lecture, with or without its variations, is the best template for medical education today.^1-8

Changing roles
The physician’s role in the 21st century has expanded to address the public’s expectations of a qualified doctor, technological advances, and competencies advocated for all physicians as is regulated, in Canada, by the Royal College of Physicians and Surgeons’ CanMEDS competencies.⁹ Herein, the medical “expert” (i.e. the doctor) has to be fluent in many other skill sets and appropriate attitudes that include health advocate, manager, communicator, collaborator, professional, and scholar to have an understanding of disease prevention, health promotion, information technology and other new aspects of medical practice. The role of undergraduate medical education today has to evolve to provide the appropriate education for future physicians who are but one facet in a multi-disciplinary health management team as it is evolving in UK, Canada, USA, and Australia. In view of this, it is well-recognized in today’s world that undergraduate medical education needs to be revisited and revised to include instruction to develop and incorporate these other skills and competencies as described above.^1-9

Learning and memory
Specific parts of the brain related to making different and various memories including working memory, long term memory, procedural memory, and episodic memory may be stimulated in different ways.^10,11 The value of the existing instructional paradigm of the lecture format is challenged given this information about how we learn and remember. This then raises the possibility of incorporating varied instructional strategies for the delivery of medical education to enhance and strengthen these memories. In 1983, Howard Gardner introduced his theory of Multiple Intelligences.^12-14

Dr. Gardner suggested that the traditional notion of intelligence based on intelligence quotient (I.Q.) testing was far too limited. The tenets of Gardner’s theory^12-14 are that a) each intelligence can be symbolized, b) each intelligence has its own developmental history, c) each intelligence is vulnerable to impairment through insult or injury to specific parts of the brain, and d) each intelligence has its own culturally valued end state.

He has proposed, to date, nine different intelligences to account for a broader range of human intelligence potential in children and adults. These intelligences are:
1) linguistic intelligence (“word smart”),
2) logical-mathematical intelligence (“number/reasoning smart”),
3) spatial intelligence (“picture smart”),
4) bodily-kinesthetic intelligence (“body smart”),
5) musical intelligence (“music smart”),
6) interpersonal intelligence (“people smart”),
7) intrapersonal intelligence (“self smart”),
8) naturalist intelligence (“nature smart”), and
9) existential intelligence (“‘big picture’ smart”).

Such varied intelligences are important to recognize in planning for the classroom experience. This information has been used in elementary and secondary educational settings,¹⁵ but has not been explored at the post-secondary level, including medical education.

Unconscious learning. Students gravitate to their preferred modes of learning unconsciously when they study.¹⁵ These preferential styles of learning may be closely linked to their personalized effective memory tools which in turn could be related to their preferential intelligences. Over time, students most likely have figured out how they learn best from their previous experiences in formalized education. They may then use this information, perhaps unconsciously, to self-guide and maximize their study time. This understanding of student learning styles may be used when developing curricula, planning specific course instruction in medical education, and providing guidance to students on how to study effectively given the voluminous medical content.

Intentional capitalization on the unconscious through instructional variety. Changes in student demographics, (e.g. ethnic background, age, and participation patterns),¹⁶ it is important for instructors to pay attention to the different ways in which students learn. If instructors have a foreknowledge of multiple intelligences, they can provide a richer learning environment for students by using a wider variety of instructional methods (e.g. cooperative and small group learning, incorporating analogy and metaphor, concept mapping, and study guides). Thomas Armstrong indicated, “you don’t have to teach or learn something in all [eight] ways, just see what the possibilities are, and then decide which particular pathways interest you the most, or seem to be the most effective teaching or learning tools. The theory of multiple intelligences expands our horizon of available teaching/learning tools beyond the conventional linguistic and logical methods used in most schools (e.g. lecture, textbooks, writing assignments, formulas, etc.).¹⁷ In this context, little attention has been paid to multiple intelligences in the construction, delivery, and teaching of the undergraduate medical curriculum. In the practice of medicine in North America, using this framework of Multiple Intelligences theory may provide a way to address the expanded objectives for undergraduate medical education while offering more accessibility to complex medical information to students. This in turn will promote education for understanding.

Our interest
Our interest in this area began when we incorporated active learning strategies as part of the mandated curricular change in undergraduate pathology classes at the University of Saskatchewan. The targeted group of Year 2 medical and dental students responded to these changes with varying degrees of enthusiasm that ranged from strongly positive to decidedly negative. We were curious about the possible reasons for this phenomenon. The students, who were very positive about the changes, felt they were benefiting from the strategies that were being incorporated, while others just wanted a “good old stand up traditional lecture.” In this context, we wondered if their personal learning styles were having an effect on their receptivity to these changes. The instructional coach (# Mills), a PhD candidate from the College of Education, suggested using Gardner’s multiple intelligences as a baseline framework for understanding the learning styles in the group.

What we did initially Multiple Intelligences Theory Revisit * Redesign * Renew
Based on this hypothesis, a simple, readily available, and easily accessible Multiple Intelligences Inventory (Appendix A) was distributed in class, explained, and completed by the students halfway into the course. This task was received with curiosity and enthusiasm by the students. We got “buy in” for the completion of the task by showing how a) this could be helpful as a first step of the awareness of their future patients’ varied learning styles, b) this would lead to increased self-awareness of their own personal ways of learning, and c) the instructor could use this information to improve and personalize instruction. The entire class (90 students) completed the survey. These were then collated and analyzed. This information was reported back to the students and used by the instructor to design future lessons incorporating strategies that more closely aligned with their preferred intelligences.

What we found
The results of the Multiple Intelligences Inventory indicated that the strategies being used by the instructor were congruent with the preferred intelligences of approximately one third of the class. However, the primary ways in which students indicated on the inventory that they learned best had not been incorporated. The strategies of analogy and metaphor, concept mapping, small group discussion, creating tables and drawing that had been consciously incorporated by the instructor were slanted towards linguistic intelligence (“word smart”), logical-mathematical intelligence (“number/reasoning smart”), spatial intelligence (“picture smart”), and interpersonal intelligence (“people smart”). Other forms of multiple intelligences such as bodily-kinesthetic intelligence (“body smart”), musical intelligence (“music smart”), and intrapersonal intelligence (“self smart”) were not represented in these innovative techniques yet they could be incorporated in teaching pathology. Analysis of the students’ survey revealed that up to one third of the class showed a preference for the latter group of intelligences. It may be that this group of students felt disengaged from the process of learning although there was no overall difference in their academic performance. However, insight of this knowledge was useful to the instructor in attempting to redesign instruction for the next group.

What we re-did
As other forms of multiple intelligences such as musical intelligence, bodily-kinesthetic intelligence, and intrapersonal intelligence were not represented in the predominantly linguistic, logical-mathematical, spatial, and interpersonal intelligences based teaching strategies, we redesigned lesson plans with changes in instructional strategies hoping to better reflect the preferences indicated by these students. For example, to address the musical intelligences we incorporated audio files (sounds of a fetal heart beat for stem cells, football stadium clips to link to sports analogy for inflammation, and Magic School Bus video series episode dealing with sore throat and inflammation). In addition, the instructor, once aware of the various intelligences such as bodily-kinesthetic intelligence and musical intelligence, was better able to understand and accept behaviors such as knitting in the classroom or students listening to music on headphones during the classroom presentation. When at one time the instructor may have been indifferent or offended by these behaviors, she was now able to capitalize on these preferences and use them to advantage for teaching and learning. To accommodate the intrapersonal intelligence preferences students were encouraged to (a) reflect on their participation in the class by brief questionnaires and (b) summarize each class by listing three key points.

The following year, curious about the whole area of multiple intelligences in undergraduate medical education, we distributed the inventory twice; once at the beginning of the pathology class to establish a baseline to guide planning, and then again distributed the survey at the midway point to see if the intelligence patterns changed in the class within one group and to increase the students’ exposure to and awareness to multiple intelligences theory. We hope such reflective exercises may contribute to developing self-awareness and self-assessment to aid in self-directed approaches to learning.

What we then found
The responses to the Multiple Intelligences Inventory varied greatly from one year to the next. In the second group of students, having done the initial survey and then encountering the survey a second time, there seemed to be an increase in awareness and interest. Several students asked for more information on multiple intelligences while others were curious about other ways of discovering learning preferences. It appeared that this activity contributed to enhancing self-awareness and self-assessment, tools required for self-directed approaches to life-long learning.

The instructor incorporated a self-directed independent learning component in the course by assigning the reading of two journal articles related to the course content introduced in class. Knowledge of the material was tested both formatively by students handing in article summaries and summatively with questions at the midterm exam. This activity was not favorably received by approximately 30% of the students; some indicated that this was too much work outside of class and that this information should have been included by the instructor in the traditional lectures. The response of the students may indicate a need for more activities that encourage, engage, and foster the skill of self-direction for independent learning as the assigned contact time with students is shrinking in the current climate of medical education.

By introducing self-directed activities at the undergraduate level, it is hoped that when these students become physicians, these skills will have become internalized and implicit in their day to day practice. The transmission of medical content is only one of the multiple objectives for today’s medical education program due to the democratization of information through technology and the ever-changing roles of the physician; thus the transmission of medical content solely by “the good old stand-up lecture” is no longer tenable.

Summary and Suggestions
Multiple intelligences have been incorporated in teaching methods and curriculum design in elementary and secondary education. 15 This commentary contributes another perspective for consideration. Knowledge of multiple intelligences could enhance medical education by incorporating varied instructional strategies such as cooperative and collaborative group activities, analogy and metaphor, concept mapping, small group discussion, and creating tables and drawing. This will broaden the horizons and spark discussions about the redesigning of medical education curricula. Further research may include the study of the link between the incorporation of various instructional strategies and multiple intelligences, and/or a longitudinal study to track trends of intelligences in the medical student population. In summary (Figure 1), we suggest that:

1. Knowledge of Multiple Intelligences theory can be used in the design of undergraduate medical curricula by encouraging a variety of instructional methods “to achieve more personalized curriculum, instruction, and assessment.”¹⁸ This can help foster undergraduate medical education students’ skills of self-awareness, self-assessment, and self-direction in becoming
2. effective life-long adult physician learners. Instructional variety will also aid and nurture CanMEDS competencies⁹ through the processes used to teach these complex medical concepts. While the content of medical education remains the same, it is the process of instruction that is the variable.
3. Varied and appropriate assessment tools and evaluating methods will need to be designed to mirror and complement the varied instructional strategies utilized in the classroom setting to address the expanding physicians’ roles.
4. Use of a wide variety of instructional strategies may promote effective dissemination of complex medical concepts with better understanding by students (“Education for understanding”).¹⁸ Administrative and infrastructural support is crucial to achieve this instructional change.

REFERENCES

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9. The Royal College of Physicians and Surgeons. CanMEDS (Canadian Medical Education Directions for Specialists). Available at URL (accessed May 2, 2005) htpp:// rcpsc.medical.org/canmeds/index.php CanMeds Project Summary 2003; CanMEDS 2000 Project.
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11. Shreeve, J. Beyond the brain. National Geographic 2005 March; 207 (3) 2-31.
12. Gardner, H. Frames of mind: The theory of Multiple Intelligences. New York: Basic; 1983.
13. Gardner, H. Multiple Intelligences: The theory in practice. New York: Basic; 1993.
14. Gardner, H. Intelligence reframed: Multiple Intelligences for the 21st Century. New York: Basic; 2000.
15. Hsieh, Ming-Fang. Multiple Intelligences: Theory and Practice in the K-12 Classroom Available at URL (accessed May 12, 2005): http://www.indiana.edu/~reading/ieo/bibs/multiple.html
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17. Armstrong, T. Multiple Intelligences. Available from URL (accessed May 12, 2005) http://www.thomasarmstrong.com/multiple intelligences.htm
18. Garner, H. Copyright 2003 by the President and Fellows of Harvard College. Available from URL (accessed May 12, 2005) http:/pzweb.harvard.edu/PIs/HG.htm

NOTE: Please refer to the complete PDF file for the referenced Figures.

APPENDIX A
)Multiple Intelligences Inventory Sample)
A Simple Multiple Intelligence Inventory (http://homepages.wmich.edu/~buckleye/miinventory.htm)