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Individualized Learning Plans:
A Construct to Promote More
Effective Learning
Ann E. Burke, MD
Associate Professor
March 16, 2011
OBJECTIVES: Participants should
be able to:
�Describe why Individualized Learning Plans
(ILPs) are becoming increasingly important in
medical education.
�Describe the unique needs and attributes of adult
learners.
� Indentify the benefits and challenges of ILPs and
Self-Assessment.
�Describe the various components of ILPs and
how to effectively facilitate an ILP with a learner.
Individualized Learning Plans
�Background-Why the shift to self-directed
learning and ILPs?
�The History-Where did this come from?
�Adult Learners and ILPs: good synergy
�What are the components of ILPs?
�What we know and don’t know about ILPs
�Tips for facilitating ILPs
�Discussion…
Background: Why the Shift?
Background: Why the Shift?
�Broader concepts of CME:
- Continuous Professional Development (CPD)
- Residency training now with emphasis on competency based education
- Life long learning is recognized as crucial (Practice Based Learning and Improvement-PBLI)
- Maintenance of Certification (MOC)
Maintenance of Certification
�American Board of Pediatrics: requires
pediatricians to “assess and enhance
knowledge in areas important to their
practice” for MOC 2
�Royal College of Physicians and Surgeons
requires a variation of ILPs for MOC in
Canada
2
Reflective Practice: Moving
away from old notions of CME
�“Rather than assimilating a store of largely
irrelevant information, doctors now need to
develop learning skills which enable them
to sift out and acquire information as and
when the need arises.”
• Parsell G. Contract learning, clinical learning and
clinicians. Postgrad Med J. 1996;72:284-289
Why the Shift?
�Continuous Professional Development
– Not didactic
– More individualized
– Meets needs of adult learners
�CPD: In Practice
– Seeing patients, asking clinical questions
– Searching the literature
– Teaching
Assess
practice
I want
more
details
I have a
question/
problem
Adjust
current
practice
MOC Practice-
based Model for
CPD
MOC 2
Self-assessment
Lifelong Learning
MOC 4
Enhance performance
Optimize outcomes
Model developed by the PediaLink Editorial Board.
The History
Donald Schon- Learning Cycle
�Clinical problem
�Reflection-in-action
�Reflection-on-action
�Improvement in practice
�Level or Zone of expertise
Donald Schon. Educating the Reflective Practitioner. Jossey-Bass Publishers, 1987
Self-Directed, Lifelong Learning
�Important tenet of medical professionalism
�Integral to maintaining professional
competency
– ABIM. Medical professionalism in a new millennium: a
physician charter. Ann Intern Med. 2002;136:243-246.
– Fallat ME, Glover J. Professionalism in pediatrics: statement of
principles. Pediatrics. 2007;120:895
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Self-Directed, Lifelong Learning
�Relationship between clinical experience
and quality of care is NOT straightforward
�Physicians in practice longer than 20 years
have declining knowledge and provide
lower quality of care
Choudry NK, Fletcher RH, Soumerai SB. Systematic review:the
relationship between clinical experience and quality of health
care. Ann Intern Med. 2005; 142:260
Self-Directed, Lifelong Learning
�Theoretically, continued lifelong learning
could prevent deterioration of medical
knowledge & patient care
�Identification of Lifelong Learning as
essential:
– ACGME
– LCME
– ABMS
The History-Where did this
come from?
�Increasing knowledge and information
�Donald Schon: “Practice related learning”
�“Reflective practice”
�Self-directed learning: identifying learning
needs, finding resources to meet those
needs and evaluating their achievement
The History-Where did this
come from?
�“In the practice-learning environment, a
physician will begin an educational activity
not by entering a conference room but by
reflecting on his or her practice
performance.”
Barnes BE. Creating the practice-learning environment:using
information technology to support a new model of CME. Acad
Med. 1999; 73:278-281
White and Gruppen. Self Regulated Learning in Medical Education. ASME. 2007.
Why ILPs: The Adult Learner
�Adults learn best when they are actively
engaged in the learning process and self-
direct their own learning goals and
activities.
– Knowles MS, Holten EF, Swanson RA. The Adult Learner: The
Definitive Classic in Adult Education and Human Resources
Development. 6th Ed. Burlington, Mass: Elsevier; 2005
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The Adult Learner
�Ancient teachers of adults perceived
learning to be a process of active inquiry
�Pedagogic education began to dominate in
Europe in the seventh century
– Monastic Schools and Pedagogy
– Greek words meaning “paid/ped”= “child” and
“agogus”= “leader of”
Adult Learners
�Eduard C. Lindeman’s The Meaning of
Adult Education published in 1926 in the
New Republic laid the foundation for a
systematic theory about adult learners
�“The adult learns to become aware of and
to evaluate his experience”
Adult Learners: Principles
�1. Adults are motivated to learn as they experience needs and interests that learning will satisfy
�2. Adults’ orientation to learning is life-centered; life situations, not subjects
�3. Experience is the richest resource for adults’ learning; therefore the core methodology is analysis of experience
Knowles M. The Adult Learner: A Neglected Species. 4th Ed. 1990.
Adult Learners: Principles
�4. Adults have a deep need to be self-
directing; therefore the role of the teacher
is to engage the learner
�5. Individual differences increase with age;
therefore there must be optimal provision
for differences in style, time, place, etc.
Knowles M. The Adult Learner: A Neglected Species. 4th Ed. 1990.
Adult Learners
�“That is too important to be taught; it must
be learned” - Carl Rogers
�“I’m always ready to learn, although I do
not always like to be taught”
- Winston Churchill
Adult Learners
�“The best way to learn about it,
is to play about it!”
-Mister Rogers
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Learning Contracts
�“Without question the single most potent
tool I have come across in my more than
half-century of experience with adult
education”
Knowles M. The Adult Learner: A Neglected Species. 4th
Ed. 1990:139
Learning Contracts
�“Without question the single most potent
tool I have come across in my more than
half-century of experience with adult
education”
Knowles M. The Adult Learner: A Neglected Species. 4th
Ed. 1990:139
ILP Components in Pediatrics
�Define goals
�Self-assessment
– Personal attributes
– Clinical competency
�Summarize learning needs
�Define learning objectives and strategies to
accomplish them
ILPs: Adult Learning Skills
�ILPs may improve development of self-
directed, lifelong learning skills by actively
engaging learners to take ownership of
their own learning
�Lifelong learning includes learner
identification of learning needs and
determination of how to meet those needs– Hojat M, Nasca TJ, Erdmann JB, et al. An operational measure of physician
lifelong learning: its development, components and preliminary psychometric
data. Med Teach. 2003;25:433
Pediatric ILPs- Goals
�Learning contract
�Self-assessment
�Exercise in self reflection
�Formulated by the individual (resident)
�Guided by teacher…focus on learner
driven needs
�A RC requirement
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Why ILPs
�Getting a commitment in a written form?
– Radiology students with written learning
contracts were more likely to have participated
in CME courses and read instructional
materials in the last 6 months
– Compared with those without written learning
contracts
Renner JJ, Stritter FT, Wong HD. Learning contracts in clinical
education. Radiol technol. 1993; 64:358
Pros and Cons
PROS
�Enhanced awareness of learning needs
�Ownership of learning
�Step towards life long learning
�Ongoing feedback-ideally
Stuart et al. Are Residents Ready for Self-Directed Learning? A Pilot
Program of ILPs in Continuity Clinic. Ambulatory Pediatrics. 2005;
5 (5):298.
Pros and Cons
CONS
�Time limitations
�Coming up with goals can be difficult
�A change…
Stuart et al. Are Residents Ready for Self-Directed Learning? A Pilot
Program of ILPs in Continuity Clinic. Ambulatory Pediatrics. 2005;
5 (5):298
Pros and Cons
“Although the theoretical power of the ILP
approach lies with its emphasis on self-direction
and individualization of learning, both residents
and faculty in our program wanted more
guidance, standardization, and structure.”
Stuart et al. Are Residents Ready for Self-Directed Learning? A Pilot
Program of ILPs in Continuity Clinic. Ambulatory Pediatrics. 2005;
5 (5):298
Pros
�“Lends focus. Stimulating more purposeful
learning”
�“Allows me to re-evaluate learning needs”
�“Allowed my preceptor an opportunity to
know what I want to get out of the clinic”
�“It is good to have regular discussions
about my goals”Stuart et al. Are Residents Ready for Self-Directed Learning? A Pilot
Program of ILPs in Continuity Clinic. Ambulatory Pediatrics. 2005;
5 (5):298
Cons
�“I often don’t know what to work on”
�“Never enough time”
�“Recommendations for specific goals would be helpful”
�“I’m too tired or busy to focus on my goals”
�“Not easy to discuss how learning relates to goals”Stuart et al. Are Residents Ready for Self-Directed Learning? A Pilot Program of ILPs in Continuity Clinic. Ambulatory Pediatrics. 2005; 5 (5):298
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Learning Contracts: Medical
Students
�Viewed as “less useful” than the clinical
experiences
�“As useful” as lectures and seminars
�Utilized a simple form
McDermott M, et al.Use of learning contracts in an office-based
primary care clerkship. Medical Education. 1999;33:374-381
Learning Contracts: Medical
Students
�Primary care clerkship: four weeks
�187 3rd and 4th year students
�Produced 517 “learner-centered goals”
�60% knowledge goals
�37% skill goals
�3% attitudinal goals
McDermott M, et al.Use of learning contracts in an office-based primary
care clerkship. Medical Education. 1999;33:374-381
Requirements
RRC
Requirements
�A Requirement (January 2006) per The
Pediatric RRC
– “Documentation of an individual learning plan
for each resident must occur annually”
Requirements
�“Companion Document” gives some guidance:
�1. Defines ILP
– Documented personal learning objectives
– Strategies to achieve them
�2. AAP Pedialink
– Resident Center
– Program Director Center
ILP Components
�1) Reflection on long-term career goals
�2) Self-assessment of areas of strengths
and weaknesses
�3) Development of plans/strategies to
achieve the goals
�4) Assessment of progress on goals
�5) Revising goals based on achievement
Li ST, Burke AE. Individualized learning plans: basics and beyond. Acad
Peds. 2010;10(5)289
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The Dreyfus Model
Self-Assessment… Self-Assessment
�Poor to modest correlations with other subjective and objective assessments
�Multitude of psychosocial factors are in play when one self-assesses
�Over-assessment and under-assessment are not predictable
�Relative ranking model may increase reliability
Gordon M. A review of the validity and accuracy of self-assessments in health professions training. Acad Med 1991; 66 762-769
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Self-Assessment
�The value appears to be in its ability to force the learner to reflect on their strengths and weaknesses
�Recognize how these strengths and weaknesses may impact learning and performance
Stewart J et al. Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales. Med Educ 2000; 34:903-909
Self-Assessment
�“ At present our assessment methods stem from
the reductionist philosophy that underpins our
discipline, and we are, thus, trapped by our need
to compare like to like….we will continue to
struggle to measure the unmeasurable, and may
end up measuring the irrelevant because it is
easier.”Snadden D. Portfolios-attempting to measure the unmeasureable?
Medical Education 1999;33:478-479
Study of ILPs
�77% of residents surveyed preferred on-
line submission
�18% have no preference
�5% preferred paper-type ILPs
Jost-Starmer A, Burke AE. Resident Perceptions of Individualized
Learning Plans. Academic Pediatrics 2009.Volume 9, (4) e8-e9.
Study of ILPs
�The most commonly identified barriers
– Competing demands, time
– Balancing lives with residency
– Difficulty with Goal generation
Li ST et al. Successful self-directed learning in medicine: a
conceptual model derived from qualitative analysis of a national
survey of pediatric residents. Acad Med 2010;85:1229
Study of ILPs
�The most common strategies to overcome
barriers:
– Manageable, focused goals
– Establish some sort of tracking system
Li ST et al. Successful self-directed learning in medicine: a
conceptual model derived from qualitative analysis of a national
survey of pediatric residents. Acad Med 2010;85:1229
Study of ILPs: I-SMART
�Important
�Specific
�Measurable
�Accountability
�Realistic
�TimelineLi ST et al. Successful self-directed learning in medicine: a conceptual model
derived from qualitative analysis of a national survey of pediatric residents.
Acad Med 2010;85:1229.
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Facilitation of ILPs
�Do not be too judgemental
�Use Self assessment to highlight abilities
�Actively listen
�Try to encourage I-SMART goals
�Encourage near term and long term goals
�Follow through with timing and follow-up
�Consider maintaining your own ILP
ILPs: Some Suggestions:
�Skill building in self-directed, reflective
learning should be an explicit goal of
working with ILPs
�Offer detailed and user friendly examples
of entries
�Need some dedicated time
Mahatma Gandhi
“Live as if you were to die tomorrow. Learn as if you were to
live forever.”
Discussion…
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