University of Virginia School of Medicine
Clinical Medicine Committee,
Principles of Medicine Committee
Room 3005A in MR5, 4:00 pm
Present were: Eve Bargmann, Robert Bloodgood, Bruce Cohen, Lisa Coray, Gene Corbett, Alfa Diallo, John Gazewood, Wendy Golden, Pamila Herrington, Allison H. Innes, Donald Innes, Vern Juel, Robert Kadner, Howard Kutchai, Paul McIntosh, Karen Maughan, Nikhil Rao, Mitt Robertson, Jerry Short, Virginia Taylor, Julie Turner, Bill Wilson, Debra Reed (secretary) Guest: Jann Balmer, RN, Ph.D.
- Jann Balmer, Director of the Office of Continuing Medical Education, spoke to the joint meeting regarding Adult Learning - Theories and Influences for Medical Education.
Dr. Balmer outlined general medical education objectives as being: 1) pass the USMLE licensing exams; 2) become skilled clinicians and 3) function as ethical and compassionate physicians. Many factors influence health care such as changing demographics of population, changing patterns of disease, new technologies, health care delivery - financial and organizational and consumerism, patient empowerment.
Societal expectations also effect physician performance with the explosion of the volume of literature, the rapid introduction of new technology, more demanding patients, increased concern over escalating health care costs, and increased attention to quality and outcomes for medical care. The influence of these expectations has been to causea a shift in learning from memorization to a critical analysis model that integrates skills in accessing up to date information with critical analysis of data and facilitates the use of a sound bases into a framework for decision making. Memorization still has a place in building the core knowledge necessary for a physician, however, parameters must be clearly delineated.
Theoretical bases for adult learning:
A. Adult learning theory
- Answers to questions
- Opportunity to participate in ones own learning - increasing autonomy, based on self-assessment
- Demands on time - optimal learning per time unit, applicability, relevance
- Affiliation - professional identity
- Tacit knowledge - body of knowledge use to understand work situations and solve problems
- Artistry - ability to use tacit knowledge to resolve problems with non-obvious solutions
- Familiar problems - easily recognized
- Unfamiliar problems - must construct the problem before solutions are considered
B. Discrepancy Theory
- Motivation plays a central role in learning
- Physicians and medical students place a high premium on objectivity and evidence
- Trained to seek and respond to evidence of competence
- Relationship of motivation of learners to educational design of learning
C. Path-Goal Theory
- Motivation-based theory
- Predicts level of motivation to learn
- Differentiates desire to learn from desire to change behavior
- Anchored in the effectiveness of individual self-reflection and analysis
D. Change and Learning Theory
- Effect of changes in physicians lives
- Relates learning to professional identity
- Relates systems and work environment issues as barrier to change
- Identifies 3 groups - early changers, mid-range changers and late changers
Adult learning implications for medical education include changes/additions to teaching/learning paradigm, reassessment of goals/desired outcomes for medical students within current healthcare environment and increased student participation in the education process.
Dr. Balmer suggested adult learning teaching strategies such as: personalizing your lecture by asking the audience for goals/objectives, asking questions, knowing your audience, incorporation of clinical vignettes video triggers, case scenarios and point-counterpoint and providing self-assessment tools. Avoid unrealistic expectations in regard to volume and depth of detail. Other suggestions included defining parameters - what is the desired outcome and then maintaining consistency with curricular parameters, and determining the relevance factor of information taught.
Faculty should also personify role models as teachers, clinicians, scientists, and maintain enthusiasm as it is infectious. Adults will suspend reality if they think the experience will provide them with desired information - answer a problem.
Adult learners should be given the opportunity to explore on their own within preset parameters. Medical students who choose not to attend small group discussions saying I dont need to be in this group - I learn better by reading the material on my own should be informed of the goals/objectives of such an exercise which include interaction with their peers and colleagues and that the educational goal of small group discussion is not limited to content alone.
- A web site for the new USMLE Clinical Skills Examination has been established at http://www.usmle.org/news/newscse.htm.
The timeline indicates that the Class of 2005 will be the first class required to take the test (2004 after the third year). For information about any of the USMLE sections see http://www.usmle.org/.
- -Don Innes