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Promoting Self-Directed Learning
Developing Clinical
Learning and Problem Solving Skills
Learning
Activities that Promote
Self-Directed Learning*
- Are tied to experience
- Encourage students to learn by reflecting on
experience
- Allow students to define their own learning
objectives
- Include ill-structured problems
- Allow close contact with faculty as
co-collaborators in learning
- Encourage collaboration with peers
- Provide opportunities for deep knowledge
construction (e.g., research)
- Allow students to participate in the
evaluative process.
* Astin, 1993; Chickering,1990; Pascarella
and Terenzini 1991; Candy, 1991; Cross, 1988; Freire, 1993; Kolb, 1984;
Mezirow, 1990; Schon, 1987; Sheckley, Allen, & Keeton, 1993.
© Copyright
University of Connecticut School of Medicine, Arline Edmonds &
Isabella Knox 1997
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Clinical
Learner Transition
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A sensible point of view for the beginning
clinical learner |
---------transition--------> |
A sensible point of view for an expert
clinical learner |
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How much I learn depends mostly on how good my
site is; the preceptor is my most important teacher.
Students who learn the most are those who
"luck out" and get the best placements.
Preceptors are responsible for knowing what I
need to know; they are responsible for telling me.
I know how well I’m doing by what I am told
by my preceptors.
It would be easier to learn if all preceptors
would agree on the same "right way" to practice medicine.
If I take a risk and do something that exposes
how little I know, my preceptor won’t respect me, and may give me
a bad evaluation.
If I risk asking the preceptor to do something
differently, this could destroy our relationship.
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Is Encouraged by:
Supportive relationships
Feeling respected
Trust
A safe environment
Increase in knowledge and competence
Life experience |
How much I learn depends mostly on what I do
in the learning environment. The patients are my most important
teachers.
There’s plenty to learn both from ideal and
from less than ideal placements.
I am responsible for actively figuring out
what I need to learn. Patients and preceptors are both good sources
of this information
I need to actively seek several sources of
feedback to define how well I am doing. Some good ways to find are:
paying attention to patient response, discussing cases with peers
and faculty, getting feedback from my preceptor.
Since there are no single best ways of doing
things I don’t expect preceptors to agree. I need to learn to
construct different solutions for different contexts.
It’s better to risk getting a less than
perfect evaluation by doing things that expose what I don’t know,
than not learning.
It’s better to risk telling the preceptor
what I need to do in order to learn better, than limiting my ability
to learn what I need to know.
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Abstracts on
Supporting Autonomy
- Author: Williams GC. Deci EL.
Institution: University of Rochester, University of Rochester
School of Medicine and
Dentistry, and The
Genesee Hospital, New York 14627, USA.
Title: The importance of supporting autonomy in medical
education.
Source: Annals of Internal Medicine. 129(4):303-8, 1998 Aug 15.
Abstract:
Many thoughtful leaders in medicine have asserted their belief that
when physicians are more humanistic in their interactions with patients,
theirpatients have more positive health outcomes. Consequently, many
advocates have called for the practice of teaching students and residents
to providemore humanistically oriented care. This article reviews research
from motivational psychology, guided by self-determination theory, that
suggests thatwhen medical educators are more humanistic in their training
of students, the students become more humanistic in their care of
patients. Beinghumanistic in medical education can be achieved through
support of the autonomy of students. Autonomy support means working from
the students'perspectives to promote their active engagement and sense of
volition with respect to learning. Research suggests that when educators
are moresupportive of student autonomy, students not only display a more
humanistic orientation toward patients but also show greater conceptual
understanding and better psychological adjustment.
Institution: Department of Psychology, University of Rochester,
New York 14627, USA.
Title: Internalization of biopsychosocial values by medical
students: a test of
self-determination theory.
Source: Journal of Personality & Social Psychology.
70(4):767-79, 1996 Apr.
Local Messages: Some or All Available at UCHC Library - See LYMAN
Holdings
Abstract:
Two studies tested self-determination theory with 2nd-year medical
students in an interviewing course. Study 1 revealed that (a) individuals
with a
more autonomous orientation on the General Causality Orientation Scale
had higher psychosocial beliefs at the beginning of the course and
reported more autonomous reasons for participating in the course, and
(b) students who perceived their instructors as more autonomy-supportive
became more autonomous in their learning during the 6-month course.
Study 2, a 30-month longitudinal study, revealed that students who
perceived
their instructors as more autonomy-supportive became more autonomous in
their learning, which in turn accounted for a significant increase in both
perceived competence and psychosocial beliefs over the 20-week period
of the course, more autonomy support when interviewing a simulated
patient 6 months later, and stronger psychosocial beliefs 2 years
later.
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Levels of Clinical
Thinking
The following is a description of the levels of
clinical thinking students progress through to develop expertise:
1. REDUCED
Does not have adequate knowledge. Makes little or
no meaning-based connections between patient’s clinical findings and
stored chunks of medical knowledge.
Is usually unable to analyze the problem in
relation to relevant knowledge
2. DISPERSED
Has abundant knowledge, but has not developed
enough meaning-based connections to chunks of knowledge to establish a
path to correct diagnosis.
Typically takes a prolonged history and physical
but misses important associations such as time (e.g. constant,
intermittent) or quality (e.g. smooth, opaque). Tends to suggest myriad
diagnoses, often misses the obvious.
3. ELABORATED
Understands patient’s signs and symptoms in
relation to their connection to a well-elaborated meaning-based storage
of knowledge.
Carefully sifts through knowledge stores to elicit
path to solution. Histories, physicals and case presentations are
focused and pertinent. Findings are usually complete and clearly stated.
Demonstrates accurate resolution of complex problems about 75% to 80% of
the time.
4. COMPILED
Quickly recognizes patterns and associates them
with compiled terms such as "isoimmunization." Knowledge is
encapsulated into large, easily retrievable chunks of meaning-based
knowledge. Sets of symptoms provide "threads" to stored chucks
of information. Uses patterns to search for missing elements to confirm
diagnosis.
Histories, physicals and case presentations are
focused and pertinent. Important information is usually not missed.
Problem resolution is most often accurate.
Students may have difficulty following compiled
thinker’s series of connections without explicit elaboration.
*Adapted from: Bordage, G. Elaborated Knowledge: A Key to Successful
diagnostic Thinking. Academic Medicine. 69 (1994) 11.
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Supporting the Development
of Clinical Thinking
- Use the context. Involve students as active
participants.
- Assist students in formulating "connection"
questions
- Expect students to find own answers and
solutions.
- Encourage focused, independent reading.
- Give students choices about goals and self-study.
- Encourage students to acknowledge feelings.
from:
University of Connecticut
School of Medicine SCP Retreat Nov 13-15, 1998
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Teaching
and Learning in Medicine
The Explanation of Clinical Concepts by Expert Physicians, Clerks, and
Advanced Students
van de Wiel, Margaretha W. J.; Boshuizen, Henny P.
A.; Schmidt, Henk G.; Schaper, Nicolaas C.
Department of Educational Development and Research, Maastricht University,
Maastricht, the Netherlands
Faculty of Psychology, Maastricht University, Maastricht, the Netherlands
Department of Internal Medicine, Maastricht University, Maastricht, the
Netherlands
Abstract
Background: Research has shown that medical
expertise is the result of changes in the nature and organization of
knowledge.
Purpose: This study investigated the content and
organization of medical knowledge in participants with different
clinical experience.
Methods: Advanced students, clerks, and internists
were required to explain 20 current clinical concepts in
approximately 2 min per concept. The explanations were
analyzed on elaborateness, quality, and fluency with which
they were provided.
Results: The more experienced participants generally
provided more elaborate, qualitatively better, and more fluent
explanations. For some concepts, the explanations of
students and clerks equaled those of experts in quality, but these
were less fluently and coherently formulated. Conclusions:
Practical experience is an important mediator for meaningful integration
of biomedical and clinical knowledge.
Pathophysiological knowledge relating causes and consequences of disease
does not decay with experience, but rather forms a
coherent knowledge structure that can be easily accessed. This supports
the hypothesis of
knowledge encapsulation.
Copyright (c) 1999, Lawrence Erlbaum
Associates, Inc
Teaching and Learning in Medicine , v.11, n.3, p.153, 19990701
Article ID: 10401334S10401334Tl110306
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