approaches to learning - university of toronto
TRANSCRIPT
ApproachestoLearning
KonkinJ,Janke F,NicholsDDivisionofCommunityEngagementFacultyofMedicine&Dentistry
UniversityofAlberta
Disclosure
• ThisprogramofresearchhasreceivedfinancialsupportfromHealthWorkforceActionPlan,GovernmentofAlbertaintheformofaProgramGrantincludingabudgetforProgramEvaluation.
• Wehavenocommercialconflictsofinterest.
• ICCcommunities(10)rangeinsizefrom5000to13000
• Studentsspend42weeksintheircommunities
• StudentsmeetthesameobjectivesasRBCstudents
IntegratedCommunityClerkship
• 3rd yearofa4-yeargradentrymedicalprogram• Physicianteachersareprimarilyfamilyphysicians,
manywithenhancedskills,i.e.generalistenvironment
• ComprehensiveLIC– ClusterC(Worleyetal,2016)
• 150students(2007-2016):• Onsurvey,44%reportruralbackground• 19studentsin9 communitiesin2016-17
Year4- Rotation-BasedClerkship
• 18weeksofmandatoryrotations• 6weekssubspecialtyinternalmedicine• 6weekssubspecialtysurgery• 4weeksemergencymedicine• 2weeksgeriatrics
• Remainderofyearis2-3weekelectiveblocks,timeoffforCanadianResidencyMatchingService(CaRMS)andreviewclassesattheendofYear4
ProgramofResearch
Partoflargerprogramofresearch:– Inquiringintohowstudentsmakesenseoftheirlivedexperiencesin
clerkship
– Evaluatingprogramtobetterunderstandwhatworks(ordoesn’twork),whyandforwhom
Background– ApproachtoLearning
• Approachtolearning:– “waysinwhichstudentsgoabouttheiracademictasks,therebyaffecting
thenatureoftheirlearningoutcomes”(Biggs,1994,p318)
• Motivation– external/internal
Background–Socio-CulturalLearningTheory
• Participationisthecoreconditionforlearning• Identity,confidence,motivationandsenseofreward(“apositive
stateofmind”)andstudyskills,appliedandtacitknowledgeandclinicalskills(“Practicalcompetence”)informthelearningprocess
(Dornanetal,2007)
• “...teachingasenablingparticipationinknowing...”(Northedge,2003)
ResearchQuestion
• WhatwasthelivedexperienceofstudentsintheUAlberta IntegratedCommunityClerkship(ICC)?
Furtheranalysisledtotheemicquestion:• HowdostudentsadapttheirapproachtolearninginYear3intheruralICC(LIC)andinYear4intheurbanRBC?
Methodology
• Reflectiveconversationsusinganopen-endedprotocol• Interpretist frame:phenomenologicalandhermeneutic• Transcriptsreadthroughbyindividualresearchersinitiallyformeaning;thenco-analyzed
• Constantreturntothetranscriptstoavoiddisconnectedsound-bites
LearninginLIC
InICCyouknoweveryoneandtheyknowyouandthey’recomfortablewithyourlevelofcapabilityandIthinkthatjustmakesthewholelearningprocessandpatientcareprocessalotmorepositive.Andyougettoknowyourpatientsaswell[2011-04-02].
LearninginLIC
InICCyouknoweveryoneandtheyknowyouandthey’recomfortablewithyourlevelofcapabilityandIthinkthatjustmakesthewholelearningprocessandpatientcareprocessalotmorepositive.Andyougettoknowyourpatientsaswell[2011-04-02].
LearninginLICandRBC
Therewasdefinitelylotsoflearningtodoinfourthyear,andsome,youknowsomebrilliantpeople…IreallyfeltlikeinfourthyearIwasjustsortofalearner,likeashadoworah,Iguesswhataclerkissupposedtobe,theinterntaggingalongtosorta takealookathowthingsweredone…inICCyoufeltlikeyouwereacolleagueandthatyouknowyourresponsibilitieswererealandledtooutcomes,versuswe’rejustthereforyourownlearningandifyoudidn’tcatchupon‘em,youknowifyoumisssomethinginthefourthyearrotationswellyoujustgobackandreadaboutit.WhereasinICCitfeltlikeifyoumissedsomethingsomebodymightgethurtsoyouhadtobeontheballallthetimeandbeintheredoingstuffright[2013-04-05].
LearninginRBC
Learninginrotationsisgreatbecauseyou’reconstantlybeingpromptedtolearn,yourconstantlylearninginacollaborativesense,andyou’reconstantlylearning,un,ittendstobe,youknow,quiteabitofcriticism…Ifoundtheacademichalfdaystobeamazing,particularlymysurgicalacademichalfdayswhereIwasableto,youknow,we’dhaveanexpert….notquiteasmuchhands-onastheICC...[2010-04-02]
LearninginLICandRBC
Ireallyrealizedthatinthecityit’ssoeasytojustgetbyinmedicine,it’ssoeasytojustpass,justdothebareminimum,showupyouknowand,andIwasn’tusedtothathavingdoneICC.[In]ICCyou’retheonlystudentsoit’sonyouandyouhavetoshowup,youhavetoworkhard,…bytheendoftheyear[Year4RBC]Iwasn’tevenworkingashardbecauseIdidn’thaveto,…itwasn’texpectedofmeandIjustfeltlikethebarwasalotlower…Ifeltmoredumbbecause,youknow,becausetherewasn’tasmuchexpectedofme[2012-04-07].
LearninginRBC
Ithinkwhenyoudon’treallyknowyourpatientsandyou’renotreallyinvolvedintheircareit’sdifficulttobeinterested,andsoformewhenIdon’thavethatlevelofconnectednessorinvolvementIloseinterestquitequickly[2011-04-02].
LearninginRBC
…honestlyallyoureallyhavetodoisshowupontimeandthat’syourresponsibility…yougofrombeingareallyactiveparticipant…andthenyousortofcomebackandgetpushedrightintoobserverroleandyoufeelkindoflikeasecondyearmedstudentagain[2012-04-01].
LearninginLIC
• Connectedtopatientcare
• Motivatedbydesiretoprovidesafe,qualitycare
• Learningforand withpatients
• Facilitatedbyteachersthatknowstudents
• Groundedinauthenticparticipationasamemberofacommunityofpractice
LearninginRBC
• Hierarchical• Observer/studentrole• Lessparticipationinpatientcaresolearningmorefrombooksandpresentations
• Learningforexternalrealities– pimping,assessments
Limitations
• Generalizabilitylimitedby:– Natureofresearchmethod– livedexperienceof5cohortsofstudentsinoneprogram
• Thosewho’ddoneonlyRBCforyears3&4werenotinterviewed
Conclusion
ICC:
• Longitudinalityà Continuityà Relationships
• Relationshipskeytoauthenticparticipation
• Participationfacilitateslearning
• Learningwithandforpatients
References• BiggsJ.(1994).StudentLearningResearchandTheory- wheredowecurrentlystand?InGibbs
G.(ed.)ImprovingStudentLearning- TheoryandPractice.Oxford:OxfordCentreforStaffDevelopment.
• WorleyP,Couper I,Strasser R,GravesL,CummingsB-A,WoodmanR,StaggP,HirshDonbehalfoftheCLICResearchCollaborative (KennyBanh,AmandaBarnard,MaggieBartlett,KathleenBrooks,GillesBrousseau,DavidCampbell,Narelle Campbell,Hoffie Conradie,ByronCrouse,DawnDeWitt,MichaelDouglas,Rejean Duplain, JayErickson,DebFearon,DavidGarne,JenneneGreenhill,LoriHansen,AlexHarding,BillHeddle,WesJackson,May-Lill Johansen,DeborahJones,ScottKitchener,ScottKnutson,JillKonkin.SarahMahoney,HelenMalcolm,LindsayMazotti,BridgetO’Brien,DarylPedler,BrucePeyser,WilliamPieratt,Denese Playford,AnnPoncelet,LeonardReeves,Torsten Risor,LambertSchuwirth,BarbaraSheline,Branko Sijnja,RuthStewart,SarahStrasser,RobertTrowbridge,RichardVanWylick,Lucie Walters,HenryWeil,SarahWood,LeaYerby). Atypologyoflongitudinalintegratedclerkships.MedicalEducation 2016;50(9):922-932DOI:10.1111/medu.13084
References
• DornanT,Boshuizen H,KingN,Scherpbier A.Experience-basedlearning:amodellinkingtheprocessesandoutcomesofmedicalstudents’workplacelearning.(2007).MedicalEducation41:84-91.