Learning on the Job: Do We Need to Teach Trainees How to Learn

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Learning on the Job Do We Need to Teach Trainees
How to Learn?
Fiona Lake Margaret Potter Gerard Ryan
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Background

• Clinical setting is an excellent place to learn
• Learn in rather than from
• Contextual learning
• Clinical setting can be challenging for learning
• Sick patients high patient turnover
• Multiple clinical and non-clinical demands
• Variable supervision and feedback
• Poor resources
• Variable teaching

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Medical Training

• Australia
• Canada

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Do you think clinical trainees need instruction
as to how to best learn in the clinical
environment?
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What do they need?

• Orientation
• Clinical work
• Admin
• Outcomes/assessment/resources
• Structured learning programme
• Supervisor and feedback

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Responsibility

• Australia
• University Health Dpt Colleges ()
• PGME

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Response

• We get a very poor deal used and abused
• JDCF
• Great, about time
• Should drive teaching and learning
• Should not be used for assessment
• Should be provided with more teaching programmes
  formal, paid

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Educational environment

• Exposure adequate
• Registrars informal 90
• Consultants informal 56
• Registrars formal 20
• Consultants formal 22
• Simulation 11
• Usefulness
• Registrars informal 70
• Simulation 65
• Consultants formal 57
• Registrars formal 57
• Consultants informal 45

• Want? - gt 80 want more formal teaching from
  registrars and consultants, simulation and in
  other tutorials

Dent, MJA, 2006
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Educational environment

• Survey 22 LOTR participants
• Time use
• Pt care 34
• Teaching and Learning 9.4
• Marginal 45.7
• Other 10.9
• Want - 21.4 of time on teaching and learning

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Homey Mumford Learning Wheel
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Learner Focus?

• Gordon J, Cambridge Conf 2003
• Cognition (what to learn), Affect (why should I
  learn), Meta-cognitive regulation (how to learn)
• Guidance external shared internal
• Survival skills use several methods of coping,
  reflection, assertiveness, time management,
  resource management

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Learning on the Run

• 3 X 1 hr small group sessions over lunch
• PGY1 (4th attachment)
• Interactive, explored ideas, build confidence,
  activity
• Linked to JDCF
• Resource book

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Content - 1

• What do I need to learn?
• JMO perspective
• Outcomes, JDCF (write their own)
• Learning
• background/foreground,
• just in case vs just in time,
• deliberate practice learning is affected by how
  much and how you practice Ericsson, 2004,
• Formal and non-formal instruction
• Task Behavioural Styles Q

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Content- 2

• How do I learn it?
• BSQ
• Learning environment
• Learning opportunities (case scenarios)
• Link to clinical reasoning/clinical error
• Time management
• Resource management

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Content-3

• How do I know when I have learnt it?
• Self assessment
• Seeking feedback
• Dealing with common challenges

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Results

• 22 PGY1, 10 F, 12 lt25y, range of work areas and
  workloads

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Results
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Observations

• Participants
• 60 - cynical, survival mode, victim
• 30 pro-active, long term planning and thinking
• 10 no particular interest, no real engagement
  but might if reason to change understood
• Pagers disturbed many, some very busy, those not
  busy in general not willing to do anything else

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Further trial

• In progress with PGY1 students, started during
  orientation so far feedback excellent (4.3 ).

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Plans

• Repeat with more PGY1 groups at the beginning of
  the year
• Trial in Y4 medical students
• Link outcomes to activity with their supervisor
  or DCT
• Add depth to time management, reflection,
  resource management
• Consider time of day run/on or off site

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Comments?