Approaches to Learning - University of Toronto

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Approaches to Learning Konkin J, Janke F, Nichols D Division of Community Engagement Faculty of Medicine & Dentistry University of Alberta

Transcript of Approaches to Learning - University of Toronto

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ApproachestoLearning

KonkinJ,Janke F,NicholsDDivisionofCommunityEngagementFacultyofMedicine&Dentistry

UniversityofAlberta

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Disclosure

• ThisprogramofresearchhasreceivedfinancialsupportfromHealthWorkforceActionPlan,GovernmentofAlbertaintheformofaProgramGrantincludingabudgetforProgramEvaluation.

• Wehavenocommercialconflictsofinterest.

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UniversityofAlberta,Edmonton,Canada

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• ICCcommunities(10)rangeinsizefrom5000to13000

• Studentsspend42weeksintheircommunities

• StudentsmeetthesameobjectivesasRBCstudents

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IntegratedCommunityClerkship

• 3rd yearofa4-yeargradentrymedicalprogram• Physicianteachersareprimarilyfamilyphysicians,

manywithenhancedskills,i.e.generalistenvironment

• ComprehensiveLIC– ClusterC(Worleyetal,2016)

• 150students(2007-2016):• Onsurvey,44%reportruralbackground• 19studentsin9 communitiesin2016-17

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Year4- Rotation-BasedClerkship

• 18weeksofmandatoryrotations• 6weekssubspecialtyinternalmedicine• 6weekssubspecialtysurgery• 4weeksemergencymedicine• 2weeksgeriatrics

• Remainderofyearis2-3weekelectiveblocks,timeoffforCanadianResidencyMatchingService(CaRMS)andreviewclassesattheendofYear4

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ProgramofResearch

Partoflargerprogramofresearch:– Inquiringintohowstudentsmakesenseoftheirlivedexperiencesin

clerkship

– Evaluatingprogramtobetterunderstandwhatworks(ordoesn’twork),whyandforwhom

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Background– ApproachtoLearning

• Approachtolearning:– “waysinwhichstudentsgoabouttheiracademictasks,therebyaffecting

thenatureoftheirlearningoutcomes”(Biggs,1994,p318)

• Motivation– external/internal

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Background–Socio-CulturalLearningTheory

• Participationisthecoreconditionforlearning• Identity,confidence,motivationandsenseofreward(“apositive

stateofmind”)andstudyskills,appliedandtacitknowledgeandclinicalskills(“Practicalcompetence”)informthelearningprocess

(Dornanetal,2007)

• “...teachingasenablingparticipationinknowing...”(Northedge,2003)

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ResearchQuestion

• WhatwasthelivedexperienceofstudentsintheUAlberta IntegratedCommunityClerkship(ICC)?

Furtheranalysisledtotheemicquestion:• HowdostudentsadapttheirapproachtolearninginYear3intheruralICC(LIC)andinYear4intheurbanRBC?

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Methodology

• Reflectiveconversationsusinganopen-endedprotocol• Interpretist frame:phenomenologicalandhermeneutic• Transcriptsreadthroughbyindividualresearchersinitiallyformeaning;thenco-analyzed

• Constantreturntothetranscriptstoavoiddisconnectedsound-bites

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LearninginLIC

InICCyouknoweveryoneandtheyknowyouandthey’recomfortablewithyourlevelofcapabilityandIthinkthatjustmakesthewholelearningprocessandpatientcareprocessalotmorepositive.Andyougettoknowyourpatientsaswell[2011-04-02].

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LearninginLIC

InICCyouknoweveryoneandtheyknowyouandthey’recomfortablewithyourlevelofcapabilityandIthinkthatjustmakesthewholelearningprocessandpatientcareprocessalotmorepositive.Andyougettoknowyourpatientsaswell[2011-04-02].

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LearninginLICandRBC

Therewasdefinitelylotsoflearningtodoinfourthyear,andsome,youknowsomebrilliantpeople…IreallyfeltlikeinfourthyearIwasjustsortofalearner,likeashadoworah,Iguesswhataclerkissupposedtobe,theinterntaggingalongtosorta takealookathowthingsweredone…inICCyoufeltlikeyouwereacolleagueandthatyouknowyourresponsibilitieswererealandledtooutcomes,versuswe’rejustthereforyourownlearningandifyoudidn’tcatchupon‘em,youknowifyoumisssomethinginthefourthyearrotationswellyoujustgobackandreadaboutit.WhereasinICCitfeltlikeifyoumissedsomethingsomebodymightgethurtsoyouhadtobeontheballallthetimeandbeintheredoingstuffright[2013-04-05].

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LearninginRBC

Learninginrotationsisgreatbecauseyou’reconstantlybeingpromptedtolearn,yourconstantlylearninginacollaborativesense,andyou’reconstantlylearning,un,ittendstobe,youknow,quiteabitofcriticism…Ifoundtheacademichalfdaystobeamazing,particularlymysurgicalacademichalfdayswhereIwasableto,youknow,we’dhaveanexpert….notquiteasmuchhands-onastheICC...[2010-04-02]

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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].

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LearninginRBC

Ithinkwhenyoudon’treallyknowyourpatientsandyou’renotreallyinvolvedintheircareit’sdifficulttobeinterested,andsoformewhenIdon’thavethatlevelofconnectednessorinvolvementIloseinterestquitequickly[2011-04-02].

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LearninginRBC

…honestlyallyoureallyhavetodoisshowupontimeandthat’syourresponsibility…yougofrombeingareallyactiveparticipant…andthenyousortofcomebackandgetpushedrightintoobserverroleandyoufeelkindoflikeasecondyearmedstudentagain[2012-04-01].

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LearninginLIC

• Connectedtopatientcare

• Motivatedbydesiretoprovidesafe,qualitycare

• Learningforand withpatients

• Facilitatedbyteachersthatknowstudents

• Groundedinauthenticparticipationasamemberofacommunityofpractice

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LearninginRBC

• Hierarchical• Observer/studentrole• Lessparticipationinpatientcaresolearningmorefrombooksandpresentations

• Learningforexternalrealities– pimping,assessments

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Limitations

• Generalizabilitylimitedby:– Natureofresearchmethod– livedexperienceof5cohortsofstudentsinoneprogram

• Thosewho’ddoneonlyRBCforyears3&4werenotinterviewed

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Conclusion

ICC:

• Longitudinalityà Continuityà Relationships

• Relationshipskeytoauthenticparticipation

• Participationfacilitateslearning

• Learningwithandforpatients

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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

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References

• DornanT,Boshuizen H,KingN,Scherpbier A.Experience-basedlearning:amodellinkingtheprocessesandoutcomesofmedicalstudents’workplacelearning.(2007).MedicalEducation41:84-91.

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ThankYou

Questions???

JillKonkin:[email protected]:[email protected]


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