Goal Setting and Self Assessment:

Teaching Lifelong Learning Skills

Stacy Potts, MD

Allison Hargreaves, MD

Objectives

By to the end of the session, participants will be able to:

1. Describe SMART goal setting techniques in clinical education settings

2. List practical methods for teaching lifelong learning strategies

3. Formulate a plan to incorporate goal setting and learner self assessment into clinical teaching

Background

• Self assessment and self-directed lifelong learning are essential to medical practice

• Knowledge doubles every 3 to 10 years

• Medical trials rose from 500 to 10,000 in the last two decades of the 20th century

• Ability to engage in lifelong self-directed learning is the single most important competence

Integrated Competency Diagram (H. Bell)

Medical Medical KnowledgeKnowledge

Patient Care

Professionalism Interpersonal and CommunicationSkills

Practice-based Practice-based Learning

System-based System-based PracticePractice

Integrated Competency Diagram

Medical Medical KnowledgeKnowledge

Patient CarePatient Care

ProfessionalismProfessionalism

Interpersonal Interpersonal and and CommunicationCommunicationSkillsSkills

System-based PracticeSystem-based Practice

Practice-based Learning

Practice Based Learning and Improvement

• Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

Lifelong Learning

• Continuous• Supportive• Stimulating and empowering• Incorporating knowledge, values, skills,

and understanding• Spanning a lifetime• Applied• Incorporating confidence

"The hardest conviction to get into the mind of a beginner 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 under teachers is but a preparation." - William Osler

Experiential Learning

Concrete Experience

Reflective Observatio

nAbstract

Conceptualization

Active Experimentation

Kolb Learning Cycle

Observed Behaviors

What? So

what?Now what?

Private Learning Process

Goal Setting

Individual + Motivation = Commitment

• Active participation includes:– Defining the accomplishment– Determining the specific, measurable

outcomes– Creating the timeline – Identifying the necessary resources

Collaborative Goal Setting

• Discussion

• Compromise

• Agreement

• Bottom Up Goal Setting

Goal Creation

• Identify opportunities for goals

• Write goal statements

• Develop goals

• Formulate action plans

Goal Types

• Essential goals

• Problem-solving goals

• Innovative goals

SMARTER Goal Writing

• Specific

• Measurable

• Action-Oriented

• Realistic

• Time- and resource-constrained

• Energizing

• Relevant

Goal Setting Opportunities

• Specific learning interaction

• Rotation specific

• Advising meetings

• Semi Annual Reviews

• Portfolio development and review

Specific Learning Interaction

• Discuss learner’s past experiences

• Discuss expectations

• Develop goals for interaction

• Provide feedback

• Develop next steps

Rotation Specific

• Initial meeting to discuss goals– Include inquiry of past experiences– Co-identify needs– Document goals and action steps

• Mid rotation feedback– Review current experiences and progress towards

goals– Consider resources – Adjust goals as necessary

• End of rotation feedback– Reassess progress towards goals– Develop next steps

Advising Meetings

• Regular, scheduled meetings with

pre-identified agenda

• Long(er) term goal setting

• Calibration of self assessment

• Identifying resources

• Develop next steps (for both learner and advisor)

Semi Annual Review

• Pre-meeting preparation– Self Assessment– Goal setting– Stage of training guided

• Calibrate self assessment• Review of goals

– Develop into SMARTER goals– Discuss resources to meet goals– Develop next steps

Portfolio-based Learning

• Values past learning and experience

• Recognizes learners ability to learn and act independently

• Centrality of reflection to the learning process

• Allows meaningful links between experiences

Challis 1999

Portfolio Spectrum

Teacher Centered

Teacher Driven

Teacher Centered

Teacher DrivenLearner Centered

Learner Driven

Learner Centered

Learner DrivenMixed Model

Teacher and Learner

Collaboration

Mixed Model

Teacher and Learner

Collaboration

Little or no learner involvement

Little or no learner involvement

Learner completely in

control of design and content

Learner completely in

control of design and content

Mixed Model

Administration Driven• Biographic data*

• Test scores• Picture

• Evaluations*• Documents

• Written evals/OSCEs• Chart reviews• Precepting summaries

• Procedure logs*• Conference attendance*

Resident Driven• Reflections• Presentations• Community activities• Committee involvement• Projects

* Automatic from EValue Data

Purpose

• Development of Skills in:– Goal Setting– Self Reflection– Self Assessment– Lifelong learning

• Development of Advising System which:– Focuses on Whole

Learner

(Past, Present, and Future)

– Accesses Resources

(About learner, for learner)

Calibrating the Self Assessment

• Reviewing self assessment– Strengths– Opportunities for improvement

• Reviewing external evaluator’s assessment

• Building upon themes

• Reconciling incongruence

Collaborative Goal Setting

• Negotiate priorities

• Develop action steps

• Develop follow up plan

• FOLLOW UP

Self Reflection

What?

So what?

Now what?

Achieving Goals

• Implement the plan

• Monitor Progress

• Revise Objectives

• Restart the cycle

Take Home

• Set a goal for incorporating goal setting into your home learning environment– Make it:

• Specific• Measurable• Action Oriented• Realistic• Time and Resource Constrained• Energizing• Relevant

References

• Rouillard L. Goals and Goal Setting. 3rd edition. Oklahoma City, OK: Crisp Learning; 2003.

• Westberg J and Jason H. Fostering Learner’s Reflection and Self-Assessment. Fam Med 1994; 26:278-82.