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Applying Adult Learning Principles Alliance for CME Annual Meeting January, 2003 Dallas, TX Does Your Medical School CME Office Contribute to the Continuum of Medical Education ? ( ) Have never thought about it ( ) Have considered it, but have never done anything ( ) Have started to contribute ( ) Have on-going project(s) with either UME or GME or both ( ) Have absolutely no idea what you are talking about Why is there a need to Collaborate Across the Continuum of Medical Education? Closer tie to the primary mission of a medical school Adds value to the contribution of the CME Office Allows more visibility for the CME Office for other contributions later Brings experience with Adult Learners to the undergraduate curriculum Characteristics of Adult Learners Duke School of Medicine Curriculum Revision Project Joseph S. Green, Ph.D. Associate Dean, CME January, 2002 The Setting UME Curriculum Revision Project Committee Meeting 45 physician faculty committee members Chair of Curriculum Committee moderated session 1 and ½ hours Started at 5:30 pm Light snacks and soft drinks provided No „advance warning‟ Learning Objectives At the conclusion of this session, members of the curriculum committee should be able to: Articulate the implications of the new vision of physician lifelong learning Provide a rationale for shifting the paradigm of how a medical school curriculum is designed, implemented and evaluated Articulate differences between learning for children (pedagogy) and adults (andragogy) Learning Objectives (con‟t) At the conclusion of this session, members of the curriculum committee should be able to: Discuss the theoretical foundations of adult learning principles. Recognize best practices in current curriculum Create practical suggestions for enhancing the new, new curriculum based on ten characteristics of adult learners The New Vision for Clinician Life-Long Learning and CME Joseph S. Green, Ph.D. Associate Dean, Kathryn M. Andolsek, M.D. M.P.H. Medical Director, Duke University School of Medicine Office of CME (DOCME) January 16, 2002 Forces in Health Care Pushing Accountability Evidence-based care Intolerance of variation Demanding customers The information revolution Systems awareness Increased Societal Accountability and Scrutiny Certification, Licensure and Credentialling WWW & patients HCFA, JCAHO, NCQA Public reporting of healthcare outcomes and clinician performance IOM Reports Two Landmark IOM Reports To Err is Human: Building a Safer Health System--1999 Crossing the Quality Chasm: A New Health System for the 21st Century-- 2001 Why is „life-long learning‟ important to physicians and other clinicians? Physician Education 40 Medical School 35 (UGME) 30 Residency (GME) 25 UME Life-long (CME) 20 GME 15 CME 10 5 0 UME GME CME Maintenance of Certification Will require evidence of: Professional standing Lifelong learning and periodic self-assessment Cognitive expertise Practice performance evaluation Adopted by ABMS March 2000 Competencies Expected Throughout Physician‟s Career Patient Care Professionalism Interpersonal and communication skills Medical knowledge Practice-based learning and improvement Systems-based practice Adopted by ACGME 1999 Evidence of Lifelong Learning “Certified” CME--some specialty specific Self-assessment examinations Participation in quality improvement Self-directed learning Documentation of competence NEXT PARADIGM SHIFT: Medical Education From: Treating medical students as dependent, young learners needing constant oversight and direction To: Working with medical students as colleagues and helping them become lifelong, adult learners Goal of Curriculum Revision Project Design learning centered around not only faculty interests, expertise and a curriculum, but also on the needs and experience of the learners... Descriptors of Your Early Education as a Child How would you characterize it?? Descriptors of Your Continued Learning as a Professional How would you characterize it?? Theoretical Foundations Pedagogy: Teacher-centered learning for children Andragogy: Self-directed learning for adults Fluid intelligence: making new neural connections without any base (children) Crystallized intelligence: new learning grows like crystals on existing knowledge Theoretical Foundations AGE Fluid Crystal 9 85% 15% 20 62% 38% 40 40% 60% 60 25% 75% Ten Characteristics of Adult Learners Acronym to remember them: KUDE SULDAT K Link new Knowledge to previous experience Growing reservoir of experience-basis of learning Connected to physical and psychological maturity Target of learning must be part of integrated whole-how it fits with current situation of learner U Need to Understand what they don‟t know and have a clear vision of what should be achieved „I don‟t know squared‟ syndrome Test about what is valued—application to medical practice, not esoteric facts Gap between current and ideal performance is motivation for learning Too large a gap= aversion to learning Too small a gap= no motivation Goal: Medium size gap= achievable D Desire involvement in the learning process For learning to occur, learner must be: Alert Attentive Engaged in the process How to assure engagement? Involve learner in tasks that require application of knowledge to patient care Learning by Doing “ He has to „see‟ on his own behalf…the relation between means and methods employed and results achieved…Nobody else can see for him and he can‟t see just by being told…” The Theory of Inquiry John Dewey, 1938 E Seek Environment that encourages critical self-reflection & peer collective inquiry Adults use self-diagnosis model Identify desired competencies Engage in objective self-assessment Measure the difference Evaluate peers‟ performance Peer collective inquiry-safe and effective Reflection Return to experience Attend to beliefs, feelings and values Re-evaluate experiences The Reflective Practitioner Donald Schön “Knowing in action” Dynamic execution of work Similarities with similar cases “ Reflection in action” Spontaneous experimentation to solve problem Use of knowing, acting and reflecting “Reflection on action” Reflection on prior performance Outside immediacy of work S Have moved self concept from dependence to Self-directedness in the pursuit of knowledge Taking responsibility and being accountable for one‟s own learning Need to move away from unequal status of teacher and student Major goal needs to be to help students become professionals and lifelong learners “Autonomy and paternalism are wrong…” Frankford, 2000 Extensive indoctrination in one problem- solving strategy… Medical Model History & Physical Evaluation Diagnosis Implement Rx Treatment Plan Professional Educational Model Needs Assessment Evaluation Objectives Implementation Design Curriculum Design Process Strategic Goals (Competencies) Needs assessment of learners Learning objectives Content and faculty Sequencing Formats, methods and media Assessment of learning/evaluation of curriculum U Undertake mechanisms for obtaining feedback on performance and reinforcement of learning Success in achieving objectives facilitates further learning Require performance and give timely feedback Performance measures need to be objective, valid, reliable and important Major learning objectives need to be reinforced over time L Have an innate ability to Listen, Learn and remember Effect of stress levels Respond negatively to artificial time pressures Learning enhanced by moderate levels, but reduced by excessive stress and anxiety Multi-tasking-smaller bits of information Memory:sensory,short-term,working and long-term D Process information through multiple sensory channels with Different cognitive styles Two continua of approaches: Conceptual vs. problem specific Deliberative vs. experiential Styles related to senses: auditory, tactile, visual Learning style inventories (LSI) A Address practical problems with useful and immediate Applications Have problem orientation; need immediate application Affected by current situational role Relevance of information to practice of medicine is critical T Need skills to learn outside of structured Teacher-centered settings Need to endow students with motivation and skill to maintain competencies, acquire new ones and commit to values Learning how to deal with new situations never before seen (zone of indetermanance) Independent decision-making is the ultimate goal Questions? Multi-Stage Physician Change Process Rogers, 1983 Physician learns about innovation- Opinion Leaders MD is persuaded to think about it Decides to “try” the change Confirms the change was appropriate Continues to use it Curriculum Implications Modeling behavior Use of case-based approach Standardized patients Patient simulator Role-playing Audio and videotape feedback Peer review Learn to teach/teach to learn Curriculum Implications (con‟t) Testing to facilitate and evaluate learning Self-assessment instruments Pre-tests and advanced organizers Articulated goals and objectives Problem-based learning Provide opportunities for practice Use multiple formats, methods and media Acronym: KUDE SULDAT Or… DUKE ADULTS How could you use this information to assist in your collaborating across the continuum of medical education? Resources: Handout Power-Point Presentation (Leave a card or note with e- mail address) Thank You!
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