Physician learning and individualized CME

Abstract

he theme of this conference, Individually Tai-T lored CME, is both timely and important. Let us begin our examination of the theme by contrasting two definitions: Education -a formal structure within which learning is supposed to occur; Learning-a process resulting in some modification of the behavior, way of thinking, feeling or doing of the learner. Although these definitions can be challenged, they suggest that education originates outside the individual and that learning is a self-directed process. In looking at teaching and learning, then, a central question arises: is the process primarily self-directed or other-directed? Who is in control?Control as a teacher/learner issue may be visualized as a continuum, with varying degrees of teacher/learner control depending on the learning mode. The lecture is the classic example of teacher control, especially if reinforced by exams on the lecture's content. On the other end of the continuum, the ultimate in learner control is autonomous learning, with the learner pursuing a goal on a trial and error basis. Between these two extremes are several other approaches: individualized instruction, in which the teacher retains control of content and format but the learner chooses when to study and controls his or her own pace; learning contracts in which the teacher and learner agree on what is to learned, how it is to be learned and how to evaluate it; and individual learning projects in which the learner retains control of the process but draws upon many resources, including teachers and written materials.How does the issue o f control relate t o CME? Let's visualize the field of CME as an iceberg. Above the surface, traditional CME-courses, conferences and scientific meetings -are familiar t o all o f us. Then comes hospital-based CME, which has grown immensely since the mid-1970's, bringing CME activities closer to the physicianlearner, better tailoring CME to local needs and preferences and involving the physician more actively. The third level, individualized instruction, includes computer-assisted case problems and home-study programs that physicians can pursue at their own pace.A major fallacy within the CME field is to assume that education, the top half of the iceberg, is the only area with which CME professionals should be concerned. I hope to convince you that below the surface lies a rich process of self-directed learning related to the physician's practice. The bottom level of the iceberg represents random learning -the hallway conversation, scanning a journal, a patient's tough question, the nurse's suggestion -all potential learning stimuli for the physician, but certainly not characterized by a planned approach. The next higher level, self-planned learning, is quite different from random learning, and in the remainder of my presentation, I will describe physicians' pursuit of systematic learning projects. Tailored CME, I believe, can be developed by better coordinating physicians' self-planned learning and CME sponsors' efforts to individualize instruction...

Educational responses to practice‐based learning: Recent innovations in medicine

“…First, they can help practitioners make the transition from dependent learners to self-directed learners by involving them in the identification of learning needs and the selection of methods, resources, and evaluation approaches (Knowles, 1990). They can provide guidance on how to phrase questions (Covell, Uman, and Manning, 1985), prepare validated reviews and expert networks (Williamson and others, 19891, assist in techniques that permit them to examine their own performance (Knowles, 1990), help them to identify learning needs, and assist them in clarifying what they want to learn (Knowles, 1990;Richards, 1984).…”