6
Tltr Joirrtiul of Cottritrirtyq Edumttorr itt rlie Hdrh Profe,s.session,s. Volume 12, pp, 99-104. Printed in the U.S.A. Copyright 0 1992 The Alliance for Continuing Medical Education and the Society of Medical College Directors of Continuing Medical Education. All rights reserved. Theory and Practice Self-Directed Learning: A Pragmatic View P. A. JENN ETT, PH . D. Associate Professor Faculty of Medicine The University of Calgary Calgary, Alberta Adapted jrom a presentation to the jull meeting ($the Society of Medical College Directors oj Continuing Medical Education, Washington, D.C., November, 1991 Abstract: The literature about self-directed learning (SDL) is re- viewed. The concept is examined from five vantage points: definition, importance, categories, characteristics (of learners and of activities), und implications fbr the CME arena and its workers. Recommend- ations are o ~ e r e d for enhancing SDL activities. What do we know about self-directed learning? How can we package current views of self-directed learning in a practical manner? Five themes provide insight into these questions: (1) a definition of self-directed learning (SDL), (2) the importance of SDL, (3) categories of SDL, (4) characteristics of SDL activities and learners, and (5) the implications of SDL for CME and cur- riculum planners. Definition of Self-Directed Learning A number of formal definitions of self-directed learning have been offered. Tough’ emphasizes that there is an ongoing and responsible process for the learner; the major responsibility rests with the learner, even though assis- tance may be sought from various persons and materials. It is up to learners to decide their learning needs, the resources to be used, and the sequence in which tthey will learn. Knox2 reinforces these points and adds that the learner is also responsible for evaluating outcome. Knowles3 states that SDL is “a dynamic process in which the learner reaches out to incorporate new experiences, relates present situations with previous experiences, and reor- ganizes current experiences based upon this process.” Schon4 has developed this concept of the reflective practitioner; according to him, the reflective art of practice is central to SDL. 99

Self-directed learning: A pragmatic view

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Page 1: Self-directed learning: A pragmatic view

Tltr Joirrtiul of Cottritrirtyq Edumttorr itt rlie H d r h Profe,s.session,s. Volume 12, pp, 99-104. Printed in the U.S.A. Copyright 0 1992 The Alliance for Continuing Medical Education and the Society of Medical College Directors of Continuing Medical Education. All rights reserved.

Theory and Practice

Self-Directed Learning: A Pragmatic View P. A. JENN ETT, PH . D. Associate Professor Faculty of Medicine The University of Calgary Calgary, Alberta

Adapted jrom a presentation to the jull meeting ($the Society of Medical College Directors o j Continuing Medical Education, Washington, D.C., November, 1991

Abstract: The literature about self-directed learning (SDL) is re- viewed. The concept is examined from five vantage points: definition, importance, categories, characteristics (of learners and of activities), und implications fbr the CME arena and its workers. Recommend- ations are o ~ e r e d fo r enhancing SDL activities.

What do we know about self-directed learning? How can we package current views of self-directed learning in a practical manner? Five themes provide insight into these questions: (1) a definition of self-directed learning (SDL), (2) the importance of SDL, (3) categories of SDL, (4) characteristics of SDL activities and learners, and (5) the implications of SDL for CME and cur- riculum planners.

Definition of Self-Directed Learning A number of formal definitions of self-directed learning have been offered. Tough’ emphasizes that there is an ongoing and responsible process for the learner; the major responsibility rests with the learner, even though assis- tance may be sought from various persons and materials. It is up to learners to decide their learning needs, the resources to be used, and the sequence in which tthey will learn. Knox2 reinforces these points and adds that the learner is also responsible for evaluating outcome. Knowles3 states that SDL is “a dynamic process in which the learner reaches out to incorporate new experiences, relates present situations with previous experiences, and reor- ganizes current experiences based upon this process.” Schon4 has developed this concept of the reflective practitioner; according to him, the reflective art of practice is central to SDL.

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P.A. Jenneti

Two recent works provide further understanding of the term. Candy’s Self-Direction for Lifelong Learnings portrays SDL as both a process and a product. Each dimension has two levels-formal and informal control and ownership, and personal autonomy and self-management. All SDL occurs within a social context and results from the interaction between an individ- ual and a situation. Coldeway6 describes the connection between SDL and the concepts of other-directed and lifelong learning. The learner plans and initiates SDL activities, while others initiate and plan other-directed projects. The SD learner selectively chooses both types of activities while learning throughout a lifetime. This ongoing process is essential to keeping current.

Importance of SDL SDL is central to maintaining competence. Sir William Osler7 emphasizes this point, writing, “The hardest conviction to get into the mind of a begin- ner is that the education upon which he is engaged is not a college course, not a medical course, but a life course for which the work of a few years un- der teachers is but a preparation. . . . The most hurtful thing a practitioner can do is to fail to realize, first, the need for a life long progressive personal training and secondly, the danger lest, in the stress of practice, he sacrifices that most precious of all possessions, his mental independence.”

Learning theory indicates that when there is a personal commitment to learning, as in SDL, there is a much greater potential for high-quality learn- ing and effective outcomes. With the given enthusiasm, motivation and prac- tical nature inherent in this type of learning, practitioners are much more willing to alter practice patterns and to impact patient care-two critically important outcomes of CME. In addition, SDL has a dynamic appeal be- cause it provides the practitioner with a mechanism for responding to changes in medicine, the medical profession, and the health care system. For the learner, SDL provides efficiency and convenience: the learner selects and controls learning activities, learning time and pace, learning site, and learn- ing style.6

Categories of SDL Self-directed learning activities can be divided into three subsets, varying to some degree in structure. The three categories are: ongoing self-initiated se- lected updates, responses to patient/practice issues, and planned projects. Each type, irrespective of structure, stems from a self-directed, self-man- aged, deliberate, and systematic inquiry. It is selective, focused learning and offers an experience that is neither isolated nor passive.

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Selj-Directed Leasning : A Pragmatic View

Richards9.IO cites several sources that address ongoing self-initiated se- lected updates, such activities as reading; discussions with colleagues, con- sultants, or allied health professionals; searching bibliographic databases; and attending CME updates. The second SDL category, patient/practice is- sues, has been described by Manning et al.,I2 Covell et al.,” and Jennett et a1.14 It consists of such endeavors as addressing questions arising in practice, participating in quality care projects, using practice databases to identify and pursue educational needs, and chart audit. The third and most structured cat- egory, planned projects, has been described by Tough,’ Richards,’ ’ and Hummell. I 6 Tough defines a learning project as “a systematic, deliberate ef- fort to learn something consisting of a series of clearly related deliberate learning episodes adding up to at least seven hours of effort within a six- month period and designed to obtain new information, develop new skills, or to re-examine existing attitudes or beliefs.”’

Characteristics of SDL activities and learners The characteristics of self-directed activities and learners have been de- scribed by Schon,4 Candy,s Coldeway,6 Hummel,’6 Gibbons et al.,” Houle,I8 Rogers,Ig Richards,20 and Fox et aL2I SDL activities are planned, self-managed, focused, active, dynamic, and ongoing. According to Knowles,22 they are processes “in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choos- ing and implementing appropriate learning outcomes.” Contrary to con- ventional thought, he points out, SDL “usually takes place in association with various kinds of helpers, such as instructors, tutors, mentors, resource people, and peers.”

Self-directed learners are open, curious, organized, motivated, and en- thusiastic. They value learning on an ongoing basis and are comfortable with self-managing this activity. In addition, SD learners are comfortable with un- certainty and change, are skilled in recognizing gaps and limitations, are re- sponsive to surprise, and knowledgeable about self-appraisal. Candy5 characterizes such learners as being skilled in critical thinking, goal defini- tion, and time management. SD learners are comfortable with content and quietly in control of their learning situations.

Implications for CME and curriculum planners The literature contains much in the way of practical guidelines. Candy5 points out that educators can foster SDL by introducing learning formats that emphasize learner control and varying levels of learner independence.

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Richards20 indicates that “self-planned learning is likely to be inefficient if learners are not clear about what they want to learn, or if they experience dif- ficulty in locating the relevant resources.” CME planners can assist profes- sionals to clarify what they wish to learn, can locate and provide relevant resources for them, and can guide and assist practitioners with evaluation techniques. Williamson et al.23 point out that “primary practitioners require substantial help in meeting current science information needs.” Resources, such as “validated reviews” or “expert networks,” will help meet those needs. In addition, practicing physicians require assistance in framing ap- propriate questions. Cove1113 notes that “better methods are needed to pro- vide answers to questions that arise in office practice.”

To the degree possible, educators should try to ensure that the resources and expertise are available locally to assist practitioners to respond-prac- tically and independently-to their self-identified educational needs. Techniques should be made available that physicians can use at work or home to organize, store, and manage information for educational decision making. Coldeway6 emphasizes that needs assessment processes, such as practice profiles and medical audit, need to be taught and fostered. Hardware and software tools should be accessible to practitioners to assist them with clinical decision making and critical appraisal (decision support/expert sys- tems), to help them acquire information in response to day-to-day questions, and to provide them with networking communication opportunities with col- leagues and peers. Jennett et al.24 point out the need for ongoing courses that enhance physicians’ skills in using these tools.

Finally, CME planners play a critical role. They can strive to provide ad- equate rewards for SDL. They can foster and try to ensure that, through ap- propriate learning experiences in undergraduate and graduate clinical programs, future practitioners will cultivate lifelong learning habits.

Conclusion This paper provides a pragmatic view of self-directed learning by address- ing five pertinent themes. It is time to reflect, carefully and systematically, upon the characteristics of SD learners and activities, and to guarantee that the planning, conduct, evaluation, and reward of ongoing and future CME activities are based upon a committed appreciation of these observations. Appropriate role models, facilitators, and resources must also be in place.

References 1. Tough A. The adult’s learning projects. Toronto: The Ontario Institute for Studies

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2. Knox AB. Lifelong self-directed education. In Fostering the growing need to learn. Monograph and annotated bibliography on continuing education and health man- power. Rockville, MD: Health Resources Administration, Public Health Service, U.S. Department of Health, Education, and Welfare, 1973.

3. Knowles M. Self-directed learning: A guide for learners and teachers. New York: Association Press, 1975.

4. Schon DA. The reflective practitioner: How professional’s think in action. New York: Basic Books, 1983.

5. Candy PC. Self-direction for lifelong learning. San Francisco: Jossey-Bass, 1991. 6. Coldeway N. Self-directed learning”. In Continuing medical education: A primer,

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