Lifelong Learning: Styles and Approaches

THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINEEducating and developing exemplary physicians who practice patient-

centered health care

Lifelong Learning: Styles and Approaches

Nancy Clark, MEdDirector of

Medical Informatics Education

Class 1 1

Carol Painter, PhDDirector of

Student Counseling Services



Objectives

Students will • Demonstrate knowledge of learning styles, preferences or

strategies to facilitate lifelong learning• Identify his or her learning styles and describe how this

applies to your preferences of study strategies• Utilize reflection to identify areas of needed growth and

development and establish clear learning goals• Establish a method of ongoing self-assessment of learning

needs which includes constantly and accurately assessing the state of his or her knowledge and experience base

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FSU CoM Competency• Practice-based learning and improvement:

– Demonstrate knowledge of learning styles, preferences or strategies to facilitate lifelong learning.

• Professionalism– Formulate and use strategies to support life-long learning

to remain current with advances in medical knowledge and practice (e.g., medical information data bases), utilizing technology to record, research, present, critique and manage medical information.

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What is Medical Informatics?

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Health (Medical) Informatics• Medical Informatics is the branch of science

concerned with the use of computers and communication technology to acquire, store, analyze, communicate, and display medical information and knowledge to facilitate understanding and improve the accuracy, timeliness, and reliability of decision-making. Warner, Sorenson and Bouhaddou, Knowledge Engineering in

Health Informatics, 1997

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Longitudinal Theme of Integrated Informatics Curriculum

• Information management and Computer skills to support– Lifelong Learning– Education– Research – Communications– Patient Care

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Goals of Informatics Curriculum

• Create independent, lifelong learners– Who keep up to date– Excellent problem solvers– Who integrate evidence into clinical decision making– Who practice information mastery– Value instant access to latest, high quality information– Who practice continuing quality improvement

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Computer Skills Survey Results

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Class Demographics Class 1 10



Learning Styles and Approaches

How is this a predictor of your success in medical school and long

term as a physician?

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Learning Styles and Approaches• Learning Styles Inventories

– http://www.med.fsu.edu/informatics/ – Lifelong Learning

• Where did these inventories originate?• What are some learner characteristics?• What are your characteristics?• How can you leverage your characteristics for

success?Class 1 12



Physicians Reactions to LS• Think non-judgmentally• Appreciate differences• Patient Care and education• Practice management & administration• Medical Education

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Thompson, H. & Bing-you, R. (1998) Physicians’ reactions to learning style and personality type inventories. Medical Teacher



Goals of Understanding LS

• Short Term– Self aware– Succeed in med school– Form cohesive,

productive study groups– Adapt to new learning

situations– Maintain Sanity

• Long Term– Life long learning– Select right specialty – Work well with

healthcare team– Teach students– Educate patients– Clinical competence

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Development -- Piaget

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ToddlerToddler AdultAdult



Adult Learning Theory• Learning Theory

– http://tip.psychology.org/index.html• Adult Learning preferences

– Uses experiences of learner

• Learning takes place – in context of work [patient care]– when questions are answered– the issues are applicable to work– when it doesn’t take too much time

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Transfer of Learner Control

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Time

High

Low Co

ntr

ol

of

Lea

rnin

g

Faculty

Student



Guess Which are Most Effective

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At changing physician behaviors

0%

0%

0%

0%

0%

0%

0% 1. Attending conferences?2. Reading journal articles?3. Consult a colleague?4. Drug rep academic detailing?5. Looking up answers?6. Making mistakes?7. EMR guideline prompts?



Which method is most practical for keeping up?

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0%

0%

0%

0%

0%

0%

0% 1. Attending conferences?2. Reading journal articles?3. Consult a colleague?4. Drug rep academic detailing?5. Looking up answers?6. Making mistakes?7. EMR guideline prompts?



Lifelong Learning• Old method: read a few journal articles per

week, go to conference 1/yr• Reality: Primary care docs would need over

17 hrs/day just to review reasonable and pertinent material

• Even in one narrow specialty would need 6+hrs/wk• Practicing docs (all specialties) average 1-1.5 hrs/wk

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How to Keep Up-to-Date• Effective:

– Look up answers to questions as they happen on Intranet or PDA. Applicable to your practice.

– Use resources that continuously monitor research and constantly update like Epocrates, PEPID, DynaMed, Essential Evidence+

• Ineffective:– Read journals (17 hours/day?)– Consult colleagues (when?)– Attend conferences (least effective)

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Inventory of Learning Styles

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VisualVisual VerbalVerbal

SensingSensing IntuitiveIntuitive

ActiveActive ReflectiveReflective

SequentialSequential GlobalGlobal

Felder-Silverman Model

DecisionDecision

PerceptionPerception

Sensory Sensory ReceptionReception

OrganizationOrganization

Weak Moderate Strong



Active vs Reflective• Tend to retain and

understand information best by doing something with it—discussing, applying or explaining it to others.

• "Let's try it out and see how it works"

• Like to work in group • Sitting through lectures

hard• Usually Extroverts

• Prefer to think about it quietly first

• "Let's think it through first" is reflective learner's response.

• Reflective learners prefer studying alone

• Are quiet in group learning situations

• Usually Introverts

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Active vs Reflective• The majority of undergraduate students are

Active• 83% of college student leaders were active • 65% of Phi Beta Kappas were reflective • Around 62% med students are Active• Majority of university professors are

Reflective

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Classes to Date

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What is Your Active/Reflective Score?

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0%

0%

0%

0%

0%

0% 1. Strong Active (9-11)2. Moderate Active (5-7)3. Weak Active (1-3)4. Weak Reflective (1-3)5. Moderate Reflective (5-7)6. Strong Reflective (9-11)



Sensing vs Intuitive• like learning facts• like solving problems by well-established methods

(logical)• dislike complications and surprises • want step-by-step instructions (linear)• patient with details (detailed)• Like memorizing facts and doing hands-on

(procedures) work• more practical and careful than intuitors• don't like courses with no apparent connection to

real world (concrete)

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Sensing vs Intuitive

• prefer discovering possibilities and relationships• like innovation and dislike repetition• may be better at grasping new concepts • often more comfortable than sensors with

abstractions (abstract)• tend to work faster and to be more innovative than

sensors• don't like "plug-and-chug" courses that involve

memorization and routine calculations Class 1 28



Sensing vs Intuitive• The majority of undergraduates are Sensing • 56% -72% college freshmen Sensing • 83% of national merit scholarship finalists

were Intuitive• 92% of Rhodes Scholars were Intuitive • 75% of first year medical students are

Sensing*

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Classes to Date

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What is your Sensing/Intuitive Score?

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0%

0%

0%

0%

0%

0% 1. Strong Sensing (9-11)2. Moderate Sensing (5-7)3. Weak Sensing (1-3)4. Weak Intuitive (1-3)5. Moderate Intuitive (5-7)6. Strong Intuitive (9-11)



Organization-- Wertheimer Gestalt Theory

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GlobalGlobalSequentialSequentialOrganizationOrganization

Step 1Step 2Step 3Step 4…



Sequential vs Global• gain understanding in linear

steps, with each step following logically from the previous one

• follow logical stepwise paths in finding solutions

• Majority of M1s are sequential

• Detailed• 62%

• learn in large jumps, absorbing material almost randomly without seeing connections, and then suddenly "getting it."

• to solve complex problems quickly or in novel ways, but have difficulty explaining how they did it.

• Want to see Big picture first. Do not like details.

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Classes to Date

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What is your Sequential/Global Score?

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0%

0%

0%

0%

0%

0% 1. Strong Sequential (9-11)2. Moderate Sequential (5-7)3. Weak Sequential (1-3)4. Weak Global (1-3)5. Moderate Global (5-7)6. Strong Global (9-11)



Personality Types -- Jung Myers-Briggs

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TThinkinghinking FFeelingeelingJudgmentJudgment

SSensingensing IINNtuitivetuitivePerceptionPerception

EExtrovertxtrovert IIntrovertntrovertOrientationOrientation

JJudgingudging PPerceivingerceivingOrganizationOrganization



Extrovert or Introvert?

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0%

0%

1 2

1. Extrovert2. Introvert



Sensing or Intuitive?

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0%

0%

1 2

1. Sensing2. Intuitive



Thinking or Feeling?

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0%

0%

1 2

1. Thinking2. Feeling



Judging or Perceiving?

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0%

0%

1 2

1. Judging2. Perceiving

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Sensory Reception Preferences

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AuditoryAuditory VisualVisual

KinestheticKinesthetic

Reading/Reading/WritingWriting



On the Sensory Preference test, which was your strongest preference?

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0%

0%

0%

0% 1. Reading/Writing2. Listening/Aural3. Interactive/Kinesthetic4. Visual/Sight



Visual vs Verbal

• Visual learners remember best what they see--pictures, diagrams, flow charts, time lines, films, and demonstrations

• 80% students are visual

• Verbal learners get more out of words--written and spoken explanations

• 20% are verbal

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Tablet PC as Visual Learning Aide• Case Solver for

Windows Journal• Pelley’s model• Link on LLL web page

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Classes to Date

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What is your Visual/Verbal Score?

Class 1 48

0%

0%

0%

0%

0%

0% 1. Strong Visual (9-11)2. Moderate Visual (5-7)3. Weak Visual (1-3)4. Weak Verbal (1-3)5. Moderate Verbal (5-7)6. Strong Verbal (9-11)



We need a Group, Now What

Carol A. Painter, PhD

Class 1 49



Review of Group Benefits

• Everyone brings something to the party• Promotes active learning => mastery• Supports long-term memory and understanding• Allows for monitoring and assessment of knowledge• Develops problem-solving and critical thinking skills• Encourages collaboration

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Review of Best Group Practices

• Utilize the Godfather Principle• Limit the size• Members have basic similarities and

preferences• They have structure and purpose• They don’t add more to your plate

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Compatible Learning StylesActive Learners

• Meet regularly to process information verbally, draw pictures on white board

• Reinforce and insure ongoing mastery

• Process/study individually after class

• Prep for tests

Reflective Learners• Prepare before class• Summarize materials at

home and read• Meet weekly with group to

reinforce and assess mastery of week’s learning

• Prep for tests

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Compatible CircumstancesStructured (Js) – Unstructured (Ps)

Morning person – Not morning personNot Married –Married (with children?)

Need mix of sensing/intuitives, global/ sequential

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Group Forming Exercise



Strategies and Process• Establish goals (personal and group)• Establish a schedule (when and how long)• Set an agenda• Establish a purpose ( reinforce learning; test

preparation)• Share responsibilities and resources• Don’t add to what you’re already doing: use

what you haveClass 1 54



Study Smart, Not Hard• Promote intuitive/integrated versus sensing/linear

learning style– Look for connections between concepts and facts– Compare and contrast different concepts– Tend to do better on multiple-choice exams in medical school

(most do not test recognition and recall of facts and concepts)

• One of the best way to assess how well you are doing: evaluate yourself and each other– Case scenario – problem solving– Practice test questions…

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Effectiveness versus efficiency• Changes to study methods must move toward

effectiveness ( smart study), getting the right things done in the time available

• Efficiency is the ability to get a lot done in the time available

• Question analysis is effective– Focuses on exam material– Increases your chances of answering correctly

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Questions as a Study Tool• Available from several sources

– Active learning- prepare your own possible test questions from lecture objectives and content

– Board review books– Library online sources

• Train your brain to think in an exam mode; create the performance environment

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Using Practice Questions to Enhance Integrated Learning

• To analyze each practice question ask:– How would I have had to study to know that the right

answer was right?– How would I have had to study to know that each wrong

answer was wrong (integrated understanding)

• Approach the practice question as a study topic; don’t worry about the correct answer

• Does the question require memorization (<1/3), comparison, or deduction of cause and effect?

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Using Practice Questions to Enhance Integrated Learning

• Notice that relationships between material are not in strict linear order = change learning in a very important way

• See the linkages in knowledge• Begins to see that it isn’t just memorization of

facts but interconnection of facts• Begins preparation for Step 1

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See the linkages in knowledge…



Sample Group Plan• Goals: reinforce class and lab learning, prepare for

test, improve study methods and learning strategies• Members: five• Meeting time: Sunday, 3:00-5:00• Plan:

– members summarize lectures daily; include information from objectives, readings and slides not discussed in class

– Each member responsible for compiling lists of possible exam questions from one lecture and distributing to group members

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Additional Group Plans• For exam prep, group schedule additional time

for:– Practice lab practical– Practice checklists in CLC– Practice exam questions– Integrated questions from external sources– Additional review

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Resources from Dr. Painter

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Back to Learning Styles

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Class 1 65

Left BrainLeft Brain Right BrainRight Brain

Hemispheric DominanceHemispheric DominanceHerrmann Herrmann



Which is your prominent side?

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0%0%0%

1 2 3

1. Left Brain predominantly

2. 50-503. Right Brain predominately



Approach to Learning• More predictive of success in medical school

than learning styles• Three approaches to learning

– Surface– Deep– Strategic

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Newble, DI & Entwistle, NJ. (1986) Learning styles and approaches: implications for medical education. Medical Education. (20);162-171.



Surface Approach• Predominate Motivation

– Passing the course– Fear of failure

• Intention– Fulfill course requirements

by reproduction– Gorge and regurgitate

• Learning Process– Rote Learning: focus on

tasks and pieces of information in isolation

– Uses routine procedures and repetition to memorize facts and ideas

• Outcome– Superficial level of

understanding– Substantial knowledge of

factual information

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Deep Approach• Predominate Motivation

– Interest in subject matter– Career relevance

• Intention– Reach personal

understanding• Learning Process

– Relates evidence to ideas; details to big picture

– Building frameworks to add new information

• Outcomes– Deep level of

understanding– Integrated principles with

facts– Uses evidence to develop

arguments– Excellent problem solving

skills – Success in medical school– Excellent physician with

honed lifelong learning skills

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Strategic Approach• Predominate Motivation

– Making high grades– Competing with others

• Intention– To be successful by any

means

• Learning Process– Whatever it takes to make

good grades

• Outcome– Variable level of

understanding– Shallow, course specific

knowledge– Depth of learning dependent

on assessment strategies of courses and course requirements

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Useful Resources• NBME Subject Exam Samples

http://www.nbme.org/PDF/NBME2008SubjExams.pdf

• Dr. John Pelley’s Talk to CoM Students on the secret to passing Step 1– Video: Intranet > WebCasts > Misc– His PPT– His web site which includes his Book

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Specialty Selection and Types

Results of Specialty Inventory

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Considerations for Specialty Selection

• Lifestyle: call, free time, $, location... • Interest• Detailed versus global• Amount of patient interaction• Decision making style• Seeing results versus long term maintenance

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Types and Specialty Selection

• Women more likely than men to choose primary care.

• Feeling more likely primary care than Thinking.• Intuitive more likely primary care than Sensing.• In non-primary care: more male, extraverts and

thinking types in surgical subspecialties.

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Stillwell, NA, et al. 2000. Myers-Briggs type and medical specialty choice: a new look at an old question. Teach & Learn Med. 12(1), 14-20.



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243 Graduates to date

FSU College of Medicine Match Results to Date334 graduates

Classes 2005-2010



The Academic Portfolio

One strategy for monitoring progress and success in medical school.

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What is a Portfolio?

• Definition: Collection of materials made by a professional which records and reflects on key events and processes in professional’s career.

• Incorporates adult learning principles and reflective learning.

• Model for lifelong learning and continuing professional development

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Uses of the Portfolio• Demonstration mastery of competencies • Evidence of work such as papers,

presentations, posters, research projects…• Reflections on experiences in medical school

such as service learning activities, learning strategies…

• Share with mentor or advisor

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Finding your ePortfolio• Go to Intranet• Look in bottom right corner• Click on Student Academic

Portfolio• Find your Class, then

your name

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Your Portfolio

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Personalizing your Portfolio• Suggestions:• Add your Picture• Add your Hometown, Undergrad institution

and Profile

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Uploading Files• Assignments, Extracurricular Projects,

Research Articles, resume– Click Upload, browse to file, fill out form, save.

• Adding Service Learning activities– Click New, fill out form, save.

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Granting Access

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Assignment• Create a thought paper on your learning styles and

strategies which includes your personal definition of Life Long Learning.

• Limit 3 pages plus a title page• Upload paper and results of inventories [form sent

you] to your Portfolio and by July 25– under Assignments, use Doctoring 1, Professionalism,

• Format- see handout

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References• Articles are available on the Intranet, under

Sites > Academic Affairs > Informatics > Workshop and Teaching files > Learning Styles and Approaches

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Documents

Lifelong Learning: Styles and Approaches