Learning Theories Learning Theories and and

Interprofessional Interprofessional Education: An Education: An

OverviewOverviewESRC Seminar Series: 26ESRC Seminar Series: 26thth June 2009 June 2009

BackgroundBackground Research evidence underpinning the drive Research evidence underpinning the drive

for IPL is still growing for IPL is still growing (Payler et al., 2007; Thistlewaite, (Payler et al., 2007; Thistlewaite, 2008)2008)

Descriptive, anecdotal & atheoretical? Descriptive, anecdotal & atheoretical? (Freeth (Freeth et al., 2002; Barr et al., 2005; Clarke, 2006)et al., 2002; Barr et al., 2005; Clarke, 2006)

Few interventions identify the educational Few interventions identify the educational theory underpinning the development & theory underpinning the development & delivery of IPE initiatives delivery of IPE initiatives (Cooper et al., 2001; Freeth (Cooper et al., 2001; Freeth et al., 2002; Barr et al., 2005)et al., 2002; Barr et al., 2005)

Kolb’s (1984) experiential learning cycle, Kolb’s (1984) experiential learning cycle, adult learning theory & psychological adult learning theory & psychological theories of group behaviours and teamwork theories of group behaviours and teamwork approaches approaches (Cooper et al., 2001; Barr et al., 2005)(Cooper et al., 2001; Barr et al., 2005) and and learning organisations learning organisations (Freeth et al., 2002)(Freeth et al., 2002)

Theory needed to guide IPE curriculum Theory needed to guide IPE curriculum development development (Eraut, 2003; Clark, 2006)(Eraut, 2003; Clark, 2006)

Families of Learning Families of Learning TheoryTheory

BehaviourismBehaviourism

ConstructivismConstructivism

-cognitive-cognitive

- social- social

Use in IPE?Use in IPE?

Behaviourists consider Behaviourists consider that:that:

Learning outcomes are important as Learning outcomes are important as opposed to the processes underpinning this opposed to the processes underpinning this learning;learning;

All behaviour is learned and all learning All behaviour is learned and all learning involves an observable change in involves an observable change in behaviour;behaviour;

Adopt a positivist approach;Adopt a positivist approach; Students’ own activity in achieving Students’ own activity in achieving

outcomes is pivotal to learning.outcomes is pivotal to learning.(Jarvis et al., 2003; Armitage et al., 2003)(Jarvis et al., 2003; Armitage et al., 2003)

Behaviourism in IPEBehaviourism in IPE

IPE curriculum developers create an IPE curriculum developers create an outcome based curriculum;outcome based curriculum;

Interprofessional competencies Interprofessional competencies (Arredondo et (Arredondo et al., 2004; Norris et al., 2005)al., 2004; Norris et al., 2005)

-learning outcomes assessed and -learning outcomes assessed and evaluatedevaluated

No clear reference to IPE competencies No clear reference to IPE competencies in curriculum designin curriculum design

IPE evaluations- Kirkpatrick’s (1967) IPE evaluations- Kirkpatrick’s (1967) modelmodel

Modified Kirkpatrick's Model of Educational Outcomes for IPEModified Kirkpatrick's Model of Educational Outcomes for IPE

(Barr et al., 2000; Freeth et al, 2002; Hammick et al., 2007)(Barr et al., 2000; Freeth et al, 2002; Hammick et al., 2007)

1 Reaction Learner's views on the learning experience and itsinterprofessional nature.

2a Modifications ofattitudes/perceptions

Changes in reciprocal attitudes or perceptions betweenparticipant groups. Changes in perception or attitudetowards the value and/or use of team approaches tocaring for a specific patient group.

2b Acquisition ofknowledge/skills

Including knowledge and skills linked to interprofessionalcollaboration.

3 Behavioural change Identifies individuals' transfer of interprofessional learningto their practice setting and changed professional practice. *Self report (Kilminister et al., 2004; Pollard et al., 2005;

Pollard and Miers, 2008)

4a Change inOrganizational practice

Wider changes in the organizational and delivery of care.

4b Benefits to patientsImprovements in health or well-being of patients.

Cognitive ConstructivismCognitive Constructivism

Concerned with the process of how Concerned with the process of how learners learn;learners learn;

Adult learning- self directed learningAdult learning- self directed learning Learning is within the learner’s Learning is within the learner’s

control control (Spencer and Jordan, 1999; Kaufman, (Spencer and Jordan, 1999; Kaufman, 2003; Wood, 2003)2003; Wood, 2003)

Application and use of Application and use of developmental theories developmental theories (Paiget, 1973)(Paiget, 1973)

Clark (2006) applied Perry’s Clark (2006) applied Perry’s (1970) theory:(1970) theory:

Commitment to relativism

Relativism: recognise other professions

Dualism: expansion of beliefs beyond own profession

Accepting of the range Accepting of the range of complementary of complementary professions required to professions required to provide holistic care;provide holistic care;

Students recognise the Students recognise the presence and nature of presence and nature of other professions.other professions.

Via IPE students are Via IPE students are offered an opportunity offered an opportunity to expand beliefs to expand beliefs beyond own professionbeyond own profession

Ultimate Goal

IPE Curriculum Developer’s IPE Curriculum Developer’s Role:Role:

• Consider ways to develop students’ knowledge by Consider ways to develop students’ knowledge by activating and building on existing knowledge bases- activating and building on existing knowledge bases- transformative learning transformative learning

• Consider key assumptions underlying the constructivist Consider key assumptions underlying the constructivist origins of adult learning theory (ALT) or androgogy origins of adult learning theory (ALT) or androgogy (Knowles, 1990; Kaufman, 2003)(Knowles, 1990; Kaufman, 2003)

• ALT- key mechanism for well received IPE ALT- key mechanism for well received IPE (Hammick et al., (Hammick et al., 2007)2007)

Teaching methods used to facilitate Teaching methods used to facilitate adult learning:adult learning:

Self-directed learning Self-directed learning (Kaufman, 2003) (Kaufman, 2003)

Problem based learning Problem based learning (Newble, 2002; Wood, 2003); (Newble, 2002; Wood, 2003);

Discovery learningDiscovery learning (Spencer and Jordan, 1999; (Spencer and Jordan, 1999; O’Halloran et al., 2006); O’Halloran et al., 2006);

Case based learning;Case based learning; Portfolio based learning;Portfolio based learning; Project based learning;Project based learning; Peer evaluation;Peer evaluation; Use of learning Use of learning

contracts contracts (Kolb, 1984; Brown (Kolb, 1984; Brown and Atkins, 1988; Spencer and and Atkins, 1988; Spencer and Jordan, 1999). Jordan, 1999).

Use reflective Use reflective practitioner theory practitioner theory (Schon, (Schon,

1984; Goosey and Barr, 2002)1984; Goosey and Barr, 2002) and and experiential learning experiential learning (Moon, 2004; Roberts et al., 2000)(Moon, 2004; Roberts et al., 2000). .

Social Constructivism – Social Constructivism – Vygotsky (1978; 1986)Vygotsky (1978; 1986)

D’Eon (2005): D’Eon (2005): Use of IPE tasks Use of IPE tasks

could become could become progressively more progressively more complex from, for complex from, for example simple paper example simple paper case-based scenarios case-based scenarios with two disciplines with two disciplines to very complex cases to very complex cases in real life settings in real life settings with many disciplineswith many disciplines

•Learning- mediated via socio-cultural instruments e.g. language

•Support systems

Social constructivism & macro Social constructivism & macro level thinking:level thinking:

Used to inform Used to inform evaluations of IPE (see, evaluations of IPE (see, for example Robinson for example Robinson and Cottrell, 2005; and Cottrell, 2005; Payler et al., 2007);Payler et al., 2007);

Why has it not been used Why has it not been used to inform IPE curriculum to inform IPE curriculum development?development?-HE curriculum -HE curriculum developers- focus on developers- focus on micro level of learningmicro level of learning (Hean, Craddock and O’Halloran, (Hean, Craddock and O’Halloran, 2009)2009)

-Critics of activity theory -Critics of activity theory (Fuller et al., 2005; Payler et al., (Fuller et al., 2005; Payler et al., 2007)2007)

•Communities of practice (Wenger, 1998)

•Activity systems (Engestrom, 1999; 2004).

•Expansive learning –to create new knowledge & practice

SummarySummary

Insufficient rigorous research Insufficient rigorous research identifying the theoretical identifying the theoretical underpinning of IPE initiatives;underpinning of IPE initiatives;

Implications of overlooking IPE Implications of overlooking IPE theorising; theorising;

Benefits of IPE theorising Benefits of IPE theorising Catholic approach to a whole range Catholic approach to a whole range

of theoretical doctrines is needed of theoretical doctrines is needed (Meads et al, 2003)(Meads et al, 2003). .

Time for ReflectionTime for Reflection How can learning How can learning

theory be used to theory be used to inform your own inform your own work?work?

How can you evaluate How can you evaluate its use in practice?its use in practice?

How can we work How can we work together to advance together to advance knowledge in this knowledge in this field?field?

Our overview of contemporary Our overview of contemporary learning theories used in IPE:learning theories used in IPE:

BEHAVIOURISMinterprofessional competencies

A

CONSTRUCTIVISMB

CognitiveDevelopmental/stage theorySelf directed, experiential,

problem based, discovery

B-1

SocialSocial conflict theory

Socio-cultural learningSituated learning

Collaborative learningInterprofessional learning

B2

Expansive learning

B3

ADULT LEARNINGSelf directed, experiential,

problem based, discovery

interprofessional, collaborativeB-1-1

MICRO

MACRO

(Hean, Craddock and O’Halloran, 2009)