Self-Directed Learning in Family Medicine

Self-Directed Learning in Family Medicine

Theresa J. Barrett
DOI: 10.4018/978-1-4666-6260-5.ch009
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Self-directed learners are able to recognize their learning needs, set their learning goals, identify the resources necessary to accomplish those goals, implement learning strategies, and evaluate the results of their efforts (Brockett & Hiemstra, 1991). Self-directedness is a skill that many adult learners possess. In an age when biomedical knowledge is increasing at a pace never before seen in human history, being a self-directed learner is not just a necessary skill, it is a critical one for family physicians. This chapter provides a brief overview of several self-directed learning models and the characteristics of self-directed learners, discusses self-directed learning in the context of continuing medical education, and provides an assessment of family physicians as self-directed learners.
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Framework For Learning

Constructivism asserts that learning is an active process that facilitates the construction of learning through personal experiences, dialogue, and social interactions (Merriam, Caffarella, & Baumgartner, 2007). Cognitive change and learning occur when a situation or an action does not produce the expected result and causes perturbation, that is, disturbance or disequilibrium, which then leads to a change that will eliminate the perturbation and create a new equilibrium (von Glasersfeld, 1989).

Constructivism had its origin in two philosophical roots; ontology, the nature of being, and epistemology, the origin, limits, foundation, and validity of knowledge (Oxford, 1997). The central elements linking these philosophies is the assumption that because no two people can have the same understanding of an experience, each actively constructs a personal version of reality and knowledge of the world (Cobb, 2000; Owen, 2002).

The idea of constructivism was first presented by the 18th-century Italian philosopher Vico (Cobb, 2000), whose central argument was that in order to know something, an individual had to build knowledge of it through experience. This argument was advanced by Kant, an 18th-century German idealist who put forth the notion that the world exists only in people’s perceptions of it (as cited in Oxford, 1997). Kant laid the groundwork for Piaget, the most significant contributor to the theory of constructivism (as cited in Cobb, 2000).

Key Terms in this Chapter

CME Professional: A person working in the field of CME who adheres to the ethics and standards of the profession and practices the competencies relating to his/her job or volunteer position (NCCMP, 2013 AU41: The in-text citation "NCCMP, 2013" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).

Family Physician: Physician specialists who possess distinct attitudes, skills, and knowledge that qualify them to provide continuing and comprehensive medical care, health maintenance, and preventive services to each member of the family, regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as patient advocates in all health-related matters, including the appropriate use of consultants, health services, and community resources (AAFP, 2009 AU44: The in-text citation "AAFP, 2009" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).

CME Activity: The actual learning activity that contains all the elements of the course: learning objectives, faculty, program content, assessment materials, and so on.

Maintenance of Certification (MoC): MoC measures the six core competencies adopted by the ABMS and the American College of Graduate Medical Education in 1999: interpersonal and communication skills, professionalism, systems-based practice, practice-based learning, medical knowledge, and patient care. Involvement in MoC activities demonstrates a physician’s commitment to lifelong learning and competency in a specialty and/or subspecialty ( ABMS, 2012 ).

Self-Directed Learning Readiness Scale (SDLRS): A quantitative tool of 58 Likert scale questions used to measure a person’s level of SDLR. It also is known as the LPA. The scale was developed by Guglielmino in 1977.

Accreditation Council for Continuing Medical Education (ACCME): The ACCME sets and enforces standards in physician continuing medical education within the United States.

Self-Directed Learning Readiness (SDLR): Term describing an adult’s ability to engage in SDL. Guglielmino (1977) identified eight factors necessary for SDLR:, (a) openness to learning, (b) self-concept as an effective learner, (c) initiative and independence in learning, (d) informed acceptance of responsibility for one’s own learning, (e) love of learning, (f) creativity, (g) positive orientation to the future, and (h) ability to use basic study skills and problem-solving skills. Because there are different definitions of this construct, for the purposes of the study, Guglielmino’s definition was used.

Board Certification: Board certification in the United States is a voluntary process that demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice (ABMS, 2011 AU40: The in-text citation "ABMS, 2011" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ). Family physicians are board certified by the American Board of Family Medicine.

Clinical Practice: The practice of medicine by medical practitioners that involves the diagnosis, treatment, and management of patients’ medical conditions.

Family Medicine: The medical specialty that provides continuing, comprehensive health care for the individual and family. The specialty integrates the biological, clinical, and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity (AAFP, 2010 AU43: The in-text citation "AAFP, 2010" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).

Self-Directed Learning (SDL): The process by which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes ( Knowles, 1980 ).

American Board of Family Medicine (ABFM): The ABFM promotes excellence in medical care through educational and scientific initiatives. Through certification and maintenance of certification programs the ABFM establishes, maintains, and measures the high standards of excellence in the specialty of Family Medicine.

Patient Outcomes: The study of the quality and effectiveness of health care, as measured by a specified result.

American Board of Medical Specialties (ABMS): The ABMS assists the 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians.

Continuing Medical Education (CME): The process within the scope of family medicine that provides information and activities designed to maintain and improve the ability of family physicians to provide high-quality patient care. CME encompasses all the areas usually encountered by family physicians necessary to carry out these responsibilities (AAFP, 2008 AU42: The in-text citation "AAFP, 2008" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).

Federation of State Medical Boards (FSMB): The FSMB (2010) represents the 70 medical and osteopathic boards of the United States and its territories. The FSMB leads by promoting excellence in medical practice, licensure, and regulation as the national resource and voice on behalf of state medical and osteopathic boards in their protection of the public.

Maintenance of Licensure (MoL): As a condition of license renewal or MoL, a physician must demonstrate commitment to lifelong learning that is objective, relevant to his or her area of clinical practice, and contributory to improved health care ( FSMB, 2010 ).

CME Provider: The entity responsible for creating the CME activity.

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