Applying Adult Learning Principles by jizhen1947

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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
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mail address)
Thank You!

								
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