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Thoughts on Self-Directed Learning in Medical Schools: Making Students More Responsible

by K.Ramnarayan and Shyamala Hande

Self-directed learning (SDL) has been identified as an important skill for medical graduates. To meet the challenges in today's healthcare environment, self-directed learning is most essential. Several health care institutions have made SDLs a part of the curriculum. In self-directed learning, learners take the initiative in making use of resources rather than simply react to transmissions from resources, thus helping learners to learn more and learn better. The main purpose of education must now be to develop the skills of inquiry, and more importantly to go on acquiring new knowledge easily and skilfully the rest of his or her life.

The concept of self-directedness in learning was first discussed in educational literature as early as 1926 (Brookfield, 1984). From these writings, a preliminary description of self-directed learning emerged. Self-directed learning, in its broadest meaning, describes a process in 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 learning strategies and evaluating learning outcomes (Knowles, 1975). It is no longer practical to define the purpose of education as transmitting what is known. In a world in which the half-life of many facts and skills may be ten years or less, half of what a person has acquired at the age of twenty may be obsolete by the time the person is thirty. Thus it is important attain new knowledge easily and skillfully the rest of his or her life. Lifelong, self-directed learning (SDL) has been identified as an important ability for medical graduates (Harvey , 2003)

Why Self-Directed Learning ?
One reason is that there is convincing evidence that people who take the initiative in learning, learn more things and learn better than people who sit at the feet of teachers passively waiting to be taught. The second reason is that self-directed learning is more in tune with our natural processes of psychological development; an essential aspect of maturing is developing the ability to take increasing responsibility of our own lives to become increasingly self-directed. The third reason is that many of the new developments in education put a heavy responsibility on the learners to take a good deal of initiative in their own learning. To meet the challenges in today's healthcare environment , self-directed learning is most essential. Several health care institutions have made SDLs a part of the curriculum (Peplow 1990; Majumdar, Roberts, Knechtel, Noesgaard, Campbell and Tkachuk , 1998; Trevena and Clarke , 2002; Shokar , Shokar, Romero and Bulik, 2003).

The main characteristic of such learning is that students take some significant responsibility for their own learning over and above responding to instruction (Boud, 1981) . Educators have an important role to play in assisting students to acquire the skills for self-directed learning, and to do this they need to understand the concept of self-directed learning.

An important benefit of the self directed approach is that it can tackle one of the most enduring problems in medical education: the exponential growth in knowledge. It is a fact that the course cannot teach everything that doctors consider relevant, and continued additions can lead to what Abrahamson (1978) describes as "curriculum hypertrophy." Educators have been trying to accommodate the extra knowledge, including lengthening the course and introducing postgraduate and continuing medical education, but none has solved the problem.

In addition, the obsolescence of knowledge means that much of what is important today may be irrelevant tomorrow. Given this, teaching today's facts seems less important than ensuring that students have the skills to learn and relearn as knowledge develops. This has led to an emphasis on "lifelong learning skills." These include the ability to analyze problems, define what needs to be learnt, know how and where to access information, evaluate information, and be aware of the one's own limitations. The rationale is that students who develop such skills will be equipped for whatever the future holds and will keep up to date when they are no longer on formal training programs. Self-directed learning (SDL) skills are thought to be associated with lifelong learning and students in an integrated medical curriculum had scores on the self-directed learning readiness scale SDLRS that correlated with clinical performance and probably represented a readiness for SDL (Shokar, Shokar , Romero and Bulik , 2003) .

The results of a qualitative study that explored faculty and student perceptions of self-directed learning (SDL) and investigated factors that facilitate or impede it. The themes that emerged provide insight into the educational strategy of self-directed learning and can be summarized by the following major points: (1) commitment to SDL requires students and faculty to understand the value of empowering learners to take increased responsibility for decisions related to learning; (2) students engaged in self-directed learning undergo a transformation that begins with negative feelings (i.e., confusion, frustration, and dissatisfaction) and ends with confidence and skills for lifelong learning; and (3) faculty development is important to ensure high levels of competency in facilitating self-directed learning (Lunyk-Child, Crooks, Ellis, Ofosu, O'Mara. and Rideout, 2001)

Self-Directed Learning Strategies For the learner:
'Learning to learn' is a crucial skill. SDL starts with learners becoming aware of some need for learning. Through self-directed learning you can control what you want to learn, how you want to learn and when you want to learn. The following skills help you succeed at being a self-directed learner. Study them and think of your own abilities. Are you able to question, inquire and solve problems, keep an open mind to others' points of view, scan data and quickly choose relevant resources, collect data on your performance through self-observation and feedback from others, assess your present performance using that data, set goals to improve your personal performance, observe and model others' performance to improve your own, make a firm commitment to working on your goals, move through the full learning cycle, continually motivate yourself ? Take note of the skills that you feel comfortable with and also note which ones you would like to strengthen. Think of how you can work on them and improve them. Then make a conscious effort to do it.

For the teacher (the facilitator of learning):
In most courses, teachers are concerned about helping students in a life-long learning process, so that the student develops an interest in further learning and provide base for concepts and skills that will facilitate further learning and thinking. Modern teachers need to provide a variety of learning experiences for students. In the first place, the concept should change from that of 'teacher' to that of 'facilitator of learning', 'motivator' and 'designer of the learning situation' and sometimes join the students honestly as a continuing co-learner. Creating an environment in which students can learn effectively and efficiently is the core managerial role of teachers. The following skills will help one succeed at being a 'facilitator of learning' (Knowles, 1975).

  1. Climate setting: Get learners to become acquainted with one another as persons and as mutual resources for learning. Help them to understand the concept of self-directed learning, provide simple practicing skills and above all create an atmosphere characterized by both mutual caring and support and intellectual rigor. SDL can flourish only when learners and teachers see one another as mutually helpful human beings.
  2. Planning: Develop 'your' model of competencies (knowledge, skills, attitudes and values) regarding the content of the course namely: a. The list of 'given' objectives of the course , b. List of references containing information relevant to these objectives, c. A list of 'inquiry units' specifying the kinds of questions with which the course deals. Organize the contents needed to be covered into manageable units, arrange these units in a logical sequence and introduce the most efficient means of transmitting each unit (by assigned reading, audio-visual presentation etc.). Decide about the procedures to be used, invite learners' suggestions at certain points, involve them in the decision-making process, and delegate responsibilities to subgroups or elected committees.
  3. Diagnosing needs for learning: Start with a model of the competencies the particular learning experience should be concerned with. Present it in such a way that the learners will feel free to change it or build upon it, realistically and non-threateningly assess gaps between their present level of development of the competencies and the level required by the model.
  4. Setting goals: Translate the diagnosed needs into learning objectives that are clear, feasible, meaningful and appropriate by suggesting changes constructively.
  5. Designing a learning plan: Propose guidelines for designing a learning plan, expose them to resources and strategies, for using resources that they may not know about, suggest mechanisms (e.g. Consultation teams) to facilitate their helping one another in designing their plans.
  6. Engaging in learning activities: Make yourself available to subgroups and individuals as a consultant and resource as they plan and carry out their learning activities. Take up the responsibility of assuring quality performance of the learning activities.
  7. Evaluating learning outcomes: Evaluation is done not primarily by the teacher but by mutual assessment of self-controlled evidence. Make the right judgments about the adequacy of the evidence of accomplishment of the learner's objectives and the adequacy of their criteria and means for validating their evidence. Present these judgments in such a way that they will enhance rather than diminish the learner's self-concepts as self-directed persons.

Developing Self-Directed learners

Self-direction can be learned and it can be taught. Regan (2003) recommends that it is necessary to examine what motivates students towards self-directed learning. Students need specific guidance and feedback to motivate them towards SDL, which is not consistent with the philosophical basis of SDL and may lead to inconsistency amongst teachers in the facilitation of this process.

The first responsibility of a facilitator of learning is to help students develop competence as self-directed learners. Different students have different abilities to be self-directed. Many students find that the idea of self-learning for the first time is so strange that they become over anxious. They have been so conditioned to having teachers tell them what they are to learn and how, that they become confused and worried when confronted with the responsibility of thinking through what they want to learn and how they will go about learning it. A good teacher is one who motivates students and encourages student to develop on their own.

Optional strategies you might use for doing this:

  1. Ask the students individually (preferably, before classes start) to study a topic on their own coming to you only when they want help.
  2. You could team the students up into small groups and ask them to pursue the topic independently as teams, coming to you only when they need help.
  3. You could involve all of a given group of students to pursue the specified subject coming to you only when they need help and having them analyze their experience.

Given below are two SDL exercises:
SDL with an exercise in reading a book proactively
Objectives: To help the learner to 1. Gain an understanding of proactive use of resources and 2. Have an initial experience in practicing the skills of reading a book proactively.
Exercise: In advance, ask the learners to bring the required book. Ask them to open the page of contents concerned with the course curriculum and study it, then let them put the book down, get out a sheet of paper and write down three questions about things they have become curious about. Now ask them to turn to that part of the book that deals with the question and get the answer. If the author refers to material in other parts of the book, ask them to follow his leads until they have all information relevant to the questions.

SDL by using human resources proactively
Objective: To gain an understanding of the concept of proactive use of human resources and have an initial experience in practicing the skills of using a human resource proactively
Exercise: Ask each participant to pair off with one of the other participant he or she knows least about. Ask participants in each pair to take fifteen minutes each describing to the other what he or she perceives to be the principal resources he or she possesses (as a result of experiences, previous training, reading etc) that might be useful to others. Ask each participant to take five minutes to formulate three questions he or she would like to get answers to from his or her partner. Give each participant fifteen minutes to get the answers to his or her questions from the partner. Engage the participants in an analysis of the experience by asking questions.

Self-Directed Learning and Teacher-Directed Learning: A comparison
Learners are more dependent when it comes to teacher directed learning. If a student is asked to work on an assignment, he or she invariably has to explore extensive resources on the subject whereas if a teacher provides the learning material, the student is satisfied with the available material. Orientation to learning becomes subject-centered in a teacher directed learning environment. The readiness to learn , in case of teacher directed learning varies with the levels of maturation, and in case of SDL, develops from life tasks and problems. Students in an SDL scenario show motivation and curiosities.

In terms of lesson planning, in SDLs the learners show participative decision-making, readiness and can evaluate themselves by mutual assessment of self and collected evidence. Majumdar, Roberts, Knechtel, Noesgaard, Campbell and Tkachuk (1998) compared the effectiveness of self-directed learning (SDL) and faculty directed, demonstration-return-demonstration learning (DRD) for psychomotor clinical nursing skills and level of knowledge of second year baccalaureate nursing students. Students using the SDL method received higher grades in only one of the marker stations and , although, the outcome appeared not to differ, more students indicated satisfaction with the faculty-directed (DRD) approach. Mature students may be more self-directing, and learning styles and readiness to learn need to be assessed when judging the appropriateness of using self-directed learning approaches. However, there are many potential benefits, including increased confidence, autonomy, motivation and preparation for lifelong learning (O'Shea, 2003).

A consensus definition of the concept of self-directed learning does not exist, and students and teachers may have different perspectives on it. 'Learning to learn is not just another slogan. It denotes a specific pedagogic approach that teachers must themselves master if they what to be able to pass it on to others. It also involves the acquisition of work habits and the awakening of motivation, which must be shaped in childhood and adolescence by the programs and methods in schools and universities. Each individual's aspiration for self-learning must be realized by providing him - not in school and universities but elsewhere too, under conditions and circumstances of all kinds - with the means, tools and incentives for making his personal studies a fruitful activity' (Faure , 1972). SDL is a model, not a law: Treat it as a tool to dig with. SDL talks not about a new educational fad, but about a basic human competence - the ability to learn on one's own - that has suddenly become a prerequisite for living in this new world.--------------------------------------------------------------------------------

References

Abrahamson, S. (1978) Diseases of the curriculum, Journal of Medical Education, 53(12):951-957.

Boud, F. (1981) Developing student autonomy in learning. London: Kogan

Brookfield, S. (1984). The contribution of Eduard Lindeman to the development of theory and philosophy in adult education. Adult Education, 34, 185-196.

Candy, P. C. (1991) Self-direction for lifelong learning: A comprehensive guide to theory and practice, San Francisco: Jossy-Bass Publishers.

Faure, E. (1972) Learning to be. UNESCO: Paris.

Harvey, B. J., Rothman, A. I., Frecker, R.C. (2003) Effect of an undergraduate medical curriculum on students' self-directed learning, Academic Medicine, 78(12): 1259-65.

Houle, C. (1961). The inquiring mind. Madison, Wisconsin: The University of Wisconsin Press.

Jolly, B. and Rees L. (1998) Medical education in the millennium, Oxford University Press

Knowles, M. S. (1975) Self-directed learning: A guide for learners and teachers, Prentice Hall, Englewood Cliffs, New Jersey.

Lunyk-Child O. I., Crooks, D., Ellis, P. J., Ofosu, C., O'Mara, L. and Rideout, E.(2001) Self-directed learning: faculty and student perceptions, Journal of Nursing Education 40(3):116-23.

Majumdar, B., Roberts, J., Knechtel, R., Noesgaard, C., Campbell, K. and Tkachuk, S. (1998) Comparison of Self- and Faculty-Directed Learning of Psychomotor Skills. Advances in Health Sciences Education: Theory and Practice, 3(1):15-28.

McKeachie, W. J. (1999) Teaching tips: Strategies, research and theory for College and University teachers, Houghton Mifflin Company, Boston New York.

O'Shea, E. (2003) Self-directed learning in nurse education: a review of the literature, Journal of Advanced Nursing, 43(1):62-70.

Peplow, P. V. (1990) Self-directed learning in anatomy: incorporation of case-based studies into a conventional medical curriculum, Medical Education, 24(5):426-32.

Regan, J. A. (2003) Motivating students towards self-directed learning, Nurse Education Today, 23(8):593-599.

Shokar, G. S., Shokar, N.K., Romero, C.M. and Bulik ,R.J. (2003) Self-directed learning: looking at outcomes with medical students, Family Medicine, 35(6):445-6.

Trevena, L. J., Clarke, R.M.( 2002) Self-directed learning in population health. a clinically relevant approach for medical students, American Journal of Preventive Medicine, 22(1):69-70.

About the authors

Professor K. Ramnarayan is Dean of the Melaka Manipal Medical College (Manipal Campus) in Karnataka, India. Email him via: kram.ichs@manipal.edu

Dr. Shyamala Hande is Associate Profesor of Biology at Melaka Manipal Medical College (Manipal Campus) in Karnataka, India. Email her via: shyamalahande@yahoo.com

©September 2005

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