MEDICAL EDUCATION

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Notes for Primary Care Teachers

SELF-DIRECTED LEARNING: WHAT IT IS, AND HOW TO PROMOTE IT

THE MIND-MAP APPROACH

This technique could be effective for study when used to improve factual recall of written material. This was made popular by Tony Buzan who developed ‘mind-mapping’ as an alternative to traditional note taking, which is usually time-consuming to create and review. He recommended mind-mapping as an efficient way to take notes from lectures or books. Mind-maps can be drawn by hand, either as rough notes, for example, during a lecture or clinical meeting, or can be more complex. Mind-maps can also be produced using software packages. You can learn how to do a mind-map from various sources.^{10 , 11}

In recent years, educational material to improve memory for medical information in the form of mind-mapping has surfaced.¹² With this technique, information from a variety of sources is converted into a visual illustration of the important key words associated with a study topic. Mind-mapping (or concept-mapping) involves writing down a central idea and thinking up new and related ideas which radiate out from the centre. The student could focus on key ideas written down in their own words, and then look at other levels of ideas that can branch out. As they create connections between the ideas, they are mapping knowledge in a manner which will help them understand and remember new information. Thus, mind-maps could provide an alternative, effective study technique.^{12, 13}

SUPPORTING THE LEARNER: LEARNING RESOURCES

In order to undertake effective independent study, it is important to encourage a learning environment that is conducive and possesses relevant learning resources. It is said that learning which is reinforced by various stimuli is likely to be retained longer.⁴ For example, to learn the current therapeutics of hypertension, individual learners may learn best in different ways. Some may prefer to learn from a current therapeutic textbook whereas others may prefer case discussions with a senior doctor or to use multimedia material, e.g. an educational DVD or internet websites with interactive case discussions, e.g. gplearning.¹⁴

Students can also be supported in their learning with study guides (SGs). SGs could be paper-based or electronic material which is carefully designed to include the learning objectives and other relevant activities to motivate the learner in a particular area of study. The SGs could also list the relevant core text and other recommended reading as well as useful websites. Refer to the AMEE guide on this topic to obtain further information on SGs and their preparation and use.¹⁵

An essential skill for life-long continuing education in this present era of information explosion is the ability to seek, retrieve and store the necessary information. Learners who have not have learned this skill adequately should attain guidance and training in this area. One way is to visit the nearest medical library to seek guidance from the librarian on how best to locate information from the various sources including web-based resources. Although the use of electronic media, e.g. computers and the internet, provide a simpler and inexpensive method for learning than conventional libraries, there is evidence that on-site librarians are still needed to support better clinical use of these resources. ¹⁶

SUPPORTING THE LEARNER: ROLE OF THE TEACHER

For an adult learner, the role of a teacher is to be a facilitator or manager of the learning process and not merely a transmitter of information.^{4, 5} As teachers, we can help students identify the way they learn best. Most importantly, students should be encouraged to reflect on their learning style and ask “Is the method employed effective in gaining the relevant knowledge or skill?” Students could adopt useful strategies to aid the learning process. Most students, depending on the level of maturity, are usually not equipped to be entirely ‘self-directed’. As teachers, we need to provide the necessary guidance and motivation.

Learners should not be left completely on their own. Regular interactions between the learner and teacher either face-to-face, via telephone or by e-mail could enhance the learning process. When done face-to-face, there may be opportunity to directly observe clinical interactions of the learner (preceptor), e.g. to see if the patients are being offered current and best-evidence treatment options. Direct observation and feedback though ideal is usually not feasible due to time pressures.

Alternatively, the learner could have on a regular basis either lunch time or after-clinic clinical meetings on a topic of interest with a mentor or senior work colleague. Medical audits or patient record reviews by a senior doctor can provide similar feedback to the learner. Patient record review could involve lessons that one can learn from a particular patient. A significant event could be either ‘good’ or ‘bad’. Examples of such events could include an acute asthma attack in which a patient had to be admitted to hospital, a request for termination of pregnancy or a patient being rude to a nurse. Learning in the workplace emphasises problem-solving and learning skills, such as how to find relevant answers fast and not just learning the facts. Lessons are learned faster and recalled more reliably when they originate in everyday experience. Teachers could encourage regular learning in the clinical workplace as this can be powerful stimuli for learning.^{18, 19}

RESPONDING TO THE LEARNER’S NEEDS

Another key principle of SDL is that the specific needs of individual trainees must be recognised and appropriately responded to. As a teacher you will realise that each of your trainees may have varying learning needs. The challenge is to identify and appropriately respond to their diverse requirements. For example, if one of your trainees is a fast learner it is important to recognise this and provide adequate stimuli to keep this learner’s enthusiasm. On the other hand, a slower learner would need the necessary attention to raise the trainee’s capability to acceptable standards.

CONCLUSION

In conclusion, teachers could provide regular motivation and guidance to the learner to encourage effective learning. Putting together what is required for study and organising oneself is the first step in studying in a smarter way. Students need to be guided to be organised, well-prepared and to be active learners who constantly review new information as well as reinforce previously learned information.

Furthermore, as learning styles vary among students, it is equally important to encourage students to identify the best method for a particular area of study based on the student’s learning style, type of learning objective as well as time available for study.

Teachers must also be aware that students may fail to identify true deficits in their knowledge or skill. The student may continue to identify and learn what they are already familiar with or what they view as interesting while disregarding new areas that they may view as complex. However, when a student fails to recognise his or her exact needs, the teacher must step in and guide him or her accordingly. Thus, the role of a teacher is mainly that of a facilitator i.e. to guide rather than direct learning.

“Medical education is not completed at medical school, it has only begun.” William H. Welsh, 1850-1934

References

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11. Calder A. How to do a Mind Map. Available from here.
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14. Royal Australian College of General Practice. gplearning. Available from here.
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