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Archives
of
Disease
in
Childhood
1996;
74:
357-359
MEDICAL
EDUCATION
Self
directed
learning
Angela
Towle,
David
Cottrell
Why
self
directed
learning?
It
is
now
recognised
that
medical
education
has
to
be
a
lifelong
process.
The
practice
of
medicine
and
its
underlying
knowledge
base
change
so
rapidly
that
it
is
essential
that
doctors
continue
to
learn
throughout
their
professional
career.
However,
continuing
professional
edu-
cation
is
not
simply
a
matter
of
keeping
up
to
date,
but
also
entails
reflection
on
practice
in
order
to
incorporate
new
experiences,
to
relate
present
situations
with
previous
experiences,
and
to
reorganise
current
experiences
based
upon
this
process.
Self
directed
learning
enables
the
learner,
whether
student
or
practitioner,
to
do
these
important
things.
As
defined
by
Knowles,1
self
directed
learn-
ing
is
a
process
in
which
individuals
take
the
initiative,
with
or
without
the
help
of
others,
in
diagnosing
their
learning
needs,
formnulating
learning
goals,
identifying
human
and
material
resources
for
learning,
choosing
and
imple-
menting
appropriate
learning
strategies,
and
evaluating
learning
outcomes,
that
is,
they
take
responsibility
for,
and
control
of,
their
own
learning
(see
box
1).
If
self
directed
learning
skills
are
a
prerequi-
site
for
the
good
doctor,
then
we
should
ensure
that
those
entering
the
profession
are
encour-
aged
and
helped
to
develop
these
skills
as
part
of
their
education.
Medical
education
has
traditionally
relied
on
didactic
and
teacher
dominated
methods
of
teaching,
which
have
done
little
to
help
students
develop
either
the
skills
or
the
right
attitudes
for
lifelong
learning.
Although
the
widely
accepted
definition
of
teaching
is
'helping
someone
to
learn',
medical
teachers
have
too
often
concentrated
on
what
they
teach
(for
example,
the
urge
to
'cover
the
subject'
in
lectures)
rather
than
how
to
help
students
learn
most
effectively
and
efficiently
(not
to
mention
enjoyably).
Fortunately
progress
is
now
being
made
to
introduce
more
active,
student
centred
methods
of
education,
and
to
focus
attention
on
the
needs
and
aspira-
tions
of
the
learners
rather
than
those
of
the
teachers.
The
latest
recommendations
on
the
undergraduate
curriculum
from
the
UK
General
Medical
Council
specifically
state
that
learning
through
curiosity,
the
exploration
of
knowledge,
and
the
critical
evaluation
of
evidence
should
be
promoted
and
should
ensure
a
capacity
for
self
education.2
The
medical
education
literature
provides
guidance
as
to
what
will
facilitate
learning
as
well
as
help
cultivate
the
critical
skills
of
lifelong
learning.
Schmidt,
for
example,
gives
three
principles
which
will
make
teaching
more
relevant
and
effective,
based
upon
what
is
known
about
adult
learning.3
(1)
Building
on
prior
knowledge:
students
use
the
knowledge
they
already
possess
to
understand
and
structure
new
information.
(2)
Learning
in
context:
the
closer
the
resemblance
between
the
situation
in
which
something
is
learned
and
the
situation
in
which
it
is
applied,
the
more
likely
it
is
that
transfer
of
learning
will
occur.
(3)
Elaboration
of
knowledge:
information
is
better
understood
and
remembered
if
there
is
opportunity
for
elaboration
(this
includes
discussion,
answering
questions,
teaching
peers,
critiquing).
Examples
of
applications
that
are
currently
being
used
to
cultivate
skills
of
self
directed
learning
and
reflection
are:
problem
based
learning;
small
group
learning;
self
and
peer
evaluation;
self
study
materials;
library
work
and
projects
(both
literature
reviews
and
research);
learning
contracts;
profiling;
simu-
lated
patients;
and
computer
assisted
learning.
Course
features
which
can
enhance
self
directed
learning
are
highlighted
in
box
2.
As
examples
of
how
self
directed
learning
can
work
in
practice,
we
shall
focus
on
two
con-
trasting
methods:
problem
based
learning
and
self/peer
evaluation.
We
will
discuss
these
two
areas
in
relation
to
facilitating
undergraduate
learning
but
the
principles
involved
are,
of
course,
equally
relevant
for
postgraduates
and
for
consultants
engaged
in
continuing
profes-
sional
development.
A
further
reading
list
is
provided
at
the
end
of
the
paper
for
those
wish-
ing
to
get
more
ideas
about
teaching
and
learn-
ing
methods
that
foster
student
centred
and
self
directed
learning.
Problem
based
learning
In
the
introduction
to
their
useful
book,
Boud
and
Feletti
identify
problem
based
learning
as
the
most
significant
innovation
in
education
This
is
the
ninth
in
a
series
on
medical
education.
King's
Fund
Centre
for
Health
Services
Development,
London
A
Towle
Academic
Unit
of
Child
and
Adolescent
Mental
Health,
University
of
Leeds
D
Cottrell
Correspondence
to:
Dr
Angela
Towle,
University
of
British
Columbia,
Division
of
Educational
Support
and
Development,
Office
of
the
Coordinator
of
Health
Sciences,
400-2194
Health
Sciences
Mall,
Vancouver,
BC,
V6T
1Z3,
Canada.
Self
directed
learning
activities
*
Setting
own
learning
goals
*
Identifying
appropriate
learning
resources
*
Selecting
appropriate
learning
strategies
*
Selecting
important
from
unimportant
*
Integrating
material
from
different
sources
*
Tirne
management
*
Monitoring
achievement
of
learning
outcomes
*
Monitoring
effectiveness
of
own
study
habits
357
group.bmj.com on March 31, 2017 - Published by http://adc.bmj.com/Downloaded from
Towle,
Cottrell
for
the
professions
for
many
years,
possibly
the
most
important
development
since
the
move
of
professional
training
into
educational
institu-
tions.4
The
principal
idea
behind
problem
based
learning
is
that
the
starting
point
for
learning
should
be
a
problem,
query,
or
puzzle
that
the
learner
wishes
to
solve.
There
are
four
broad
goals5:
integration
and
relevance
of
knowledge;
development
of
clinical
reasoning;
independent
learning;
and
a
more
interesting
curriculum
for
staff
and
students.
Problem
based
learning
originated
at
McMaster
University
in
Canada
in
the
mid-
1960s
and
has
since
been
adopted
by
perhaps
30
medical
schools
throughout
the
world
as
the
sole
or
major
learning
method
and
by
several
hundred
as
one
of
the
methods
in
a
hybrid
curriculum.
In
its
purest
form
(for
example
at
McMaster
and
Maastricht),
a
problem
is
presented
to
a
group
of
students
and
the
group
decides
what
it
needs
to
know
in
order
to
solve
it.
The
learn-
ing
objectives
of
such
an
exercise
are
generated
by
the
students
and
several
groups
of
students
simultaneously
encountering
the
same
prob-
lem
will
end
up
learning
different
things.
A
more
structured
problem
based
learning
system
might
entail
a
list
of
learning
objectives
generated
by
the
teachers
or
course
organisers
to
which
students
are
guided
gently.
Some
medical
schools
(such
as
Harvard)
mix
prob-
lem
based
learning
with
more
traditional
forms
of
teaching
such
as
lectures
and
seminars
which
are
related
to
the
problems
being
studied.
Comparisons
of
different
curricula
suggest
that
students
perform
as
well
following
problem
based
courses
as
students
receiving
traditional
courses,
but
do
indeed
acquire
a
more
inquisitive
and
self
directed
style
of
learning.6
Problem
based
learning
typically
occurs
in
small
tutorial
groups
of
five
to
10
students.
The
teacher's
role
is
to
facilitate
the
learning
process,
not
to
give
the
students
information.
Students
are
presented
with
a
problem
and
encouraged
to
ask
themselves
questions,
the
answers
to
which
will
help
solve
the
initial
problem
and
increase
their
understanding
of
the
underlying
processes
involved.
Some
of
the
answers
will
come
from
the
prior
knowledge
of
group
members,
others
will
need
to
be
researched.
In
its
commonest
form
in
the
early
years
of
medical
programmes,
a
problem
is
progressively
unfolded,
with
additional
information
becom-
ing
available.
The
problem
can
be
simple
or
elaborate,
written
on
paper,
introduced
by
a
video
or
in
some
combination
of
formats.
Effective
problems
can
be
based
on
a
variety
of
questions
-
an
individual
patient,
a
puzzle
in
normal
function,
an
ethical
dilemma,
or
an
issue
of
community
concern.
Supplementary
materials
may
include
further
written
informa-
tion,
laboratory
data
or
pathology
slides,
read-
ing
lists,
and
computerised
databases.
A
typical
problem
in
paediatrics
might
be
as
follows:
'An
11
year
old
girl
has
not
attended
school
for
three
weeks
because
of
recurrent
episodes
of
central
abdominal
pain.
A
full
history,
examination
and
relevant
special
investigations
have
failed
to
reveal
any
organic
cause'.
Initial
discussion
of
the
problem,
usually
with
a
tutor
present,
is
used
to
identify
gaps
in
knowledge
and
learning
goals
are
set
for
later
individual
or
small
group
study.
This
problem,
with
some
guidance
from
the
tutor,
may
lead
the
students
to
explore
the
organic
causes
of
abdominal
pain
and
their
appropriate
investigation
and
management,
psychological
and
sociological
theories
concerning
the
mechanisms
of
'non-organic'
pain,
methods
of
psychiatric
assessment
of
children
and
families,
the
role
of
services
dealing
with
special
educa-
tional
needs,
psychological
treatments
and
many
other
related
areas.
In
subsequent
sessions
the
tutor
will
have
to
be
prepared
to
provide
more
information
to
the
students
about
the
problem,
for
example,
the
results
of
the
child's
physical
investigations
or
the
family
background.
When
planning
problem
based
learning,
attention
must
be
given
to
the
resources
that
will
be
needed
by
students
in
between
tutorials
to
answer
the
questions
they
have
set
them-
selves.
These
will
include
library
and
audio-
visual
materials,
but
may
also
include
staff
who
will
need
to
be
warned
that
a
group
of
questioning
students
may
descend
on
them
to
seek
explanations
that
will
help
their
learning.
While
no
two
problem
based
learning
ses-
sions
are
the
same,
most
proceed
through
the
following
stages:
(1)
Analysis
of
the
problem.
(2)
Identification
of
the
information
required
in
the
form
of
questions.
(3)
Study
to
formulate
the
answers
to
ques-
tions.
(4)
Application
of
the
newly
acquired
knowledge
to
the
initial
problem.
Thus,
much
of
the
work
carried
out
by
the
students
will
be
in
between
the
tutorial
sessions
facilitated
by
the
teacher
when
the
group
meets
to
review
progress.
Teachers
are
required
to
operate
in
very
different
ways
to
facilitate
this
kind of
learning:
clear
learning
objectives
need
to
be
set
for
each
problem
presentation
and
tutors
must
learn
skills
in
small
group
teaching
to
facilitate
the
analysis
and
questioning
which
should
occur
in
the
initial
session.
They
also
have
to
resist
the
temptation
to
control
the
direction
of
the
discussion
and
to
provide
information
instead
of
encouraging
students
to
find
out
for
themselves.
Studies
have
shown
that
tutors
with
expert
knowledge
of
the
problem
being
discussed
are
more
directive,
speak
more
frequently
and
for
longer,
provide
Course
features
that
enhance
self
directed
learning
*
Clear,
advance
information
about
tasks
*
Specific
performance
goals
for
assignments
*
Intrinsic
rewards
for
task
completion
*
Timetabling
that
allows
sufficient
time
for
task
completion
*
Trust
that
learners
will
remain
on
task
*
Support
for
student
learning,
for
example,
personal
tutors,
study
skills
courses
*
Formative
assessment
and
feedback
that
enables
students
to
monitor
and
modify
their
own
learning
*
Appropriate
summative
assessment,
that
is,
that
tests
problem
solving
rather
than
rote
repetition
of
facts
*
Appropriate
staff
development/teacher
training
358
group.bmj.com on March 31, 2017 - Published by http://adc.bmj.com/Downloaded from
Self
directed
learning
359
more
direct
answers
to
questions,
and
suggest
more
topics
for
discussion
than
do
non-expert
tutors.7
These
effects
may
discourage
the
development
of
active,
self
directed
learning.
Teachers
and
students
involved
in
problem
based
learning
curricula
overwhelmingly
sup-
port
the
process.
The
energy
and
shared
sense
of
purpose
in
the
tutorials
is
often
infectious;
the
opportunity
to
test
ideas
and
use
the
language
clearly
improves
cooperation
and
fluency;
students
are
actively
engaged
and
have
the
time
for
self
study
(and
to
pursue
other
interests).
The
evidence
about
whether
prob-
lem
based
learning
is
worthwhile
is
still
frag-
mentary,
partly
because
good
comparative
studies
are
difficult,
but
what
is
known
without
doubt
is
that
graduates
from
problem
based
learning
curricula
perform
no
worse
than
others
and
that
both
staff
and
students
have
a
more
interesting
and
enjoyable
experience.
Selilpeer
evaluation
The
ability
to
evaluate
one's
own
work
and
that
of
others,
is
a
skill
which
all
doctors
should
acquire
and
one
which
is
essential
if
students
are
to
continue
to
set
learning
objectives
for
themselves
after
qualification
and/or
con-
tribute
to
the
learning
of
others.
Despite
this,
there
are
often
few
opportunities
to
develop
this
ability
in
traditional
curricula.
Whether
such
assessments
should
be
summative
(con-
tributing
to
decisions
about
the
student's
future)
or
formative
(providing
guidance
about
future
study)
is
open
to
debate.
What
is
clear,
however,
is
that
such
assessment
helps
stu-
dents
to
develop
skills
of
critical
analysis
and
constructive
feedback,
and
promotes
openness
about
the
assessment
process.8
Self
or
peer
assessment
is
often
a
key
com-
ponent
of
problem
based
learning
but
can
be
introduced
as
part
of
the
learning
process
in
conjunction
with
most
forms
of
teaching.
For
example
students
might
be
set
the
task
of
assessing
their
own
ability
to
examine
the
cardiovascular
system
at
the
mid-way
point
on
a
paediatric
firm.
To
do
this
they
would
have
to
consider
what
constitutes
good
practice,
what
would
be
a
minimal
acceptable
perfor-
mance,
how
much
variation
is
allowed
between
students
while
still
performing
an
'acceptable'
examination
and
so on.
The
process
of
decid-
ing
on
these
criteria
and
standards
would,
of
itself,
be
an
important
learning
experience
as
would
the
subsequent
experience
of
participat-
ing
in
the
assessment,
observing
and
judging
the
skills
of
others,
and
receiving
feedback
on
one's
own
performance.
Students
may
involve
staff
in
discussions
about
setting
standards
and
staff
may
be
involved
in
the
assessment
of
some
or
all
of
the
students.
Discussions
about
the
possible
reasons
for
differences
between
marks
awarded
by
themselves,
by
peers,
and
by
teachers
provide
further
useful
opportunities
for
learning.
Students
are
increasingly
expected
to
work
in
groups
on
projects
and
assignments.
Similar
principles
can
be
applied
to
self
and
peer
assessment
of
this
kind
of
work.
Assessment
of
group
work
is
often
difficult
for
teachers
as
it
is
not
clear
which
students
within
the
group
are
responsible
for
the
work.
Within
the
frame-
work
of
self
assessment,
groups
can
be
asked
to
provide
a
mark
for
the
piece
of
work
produced
but
also
marks
for
the
relative
contributions
of
the
members
in
their
group.
Advance
knowledge
of
this
form
of
marking
can
have
interesting
effects
on
the
motivation
of
group
members
to
collaborate
and
contribute!
For
those
wishing
to
find
out
more,
a
useful
series
of
papers
on
self
and
peer
assessment
in
higher
education
has
been
collected
by
Brown
and
Dove.9
Conclusion
The
ability
to
acquire
skills
in
self
directed
learning
may
be
the
key
link
between
under-
graduate
education,
postgraduate
training,
and
continuing
professional
development.
If
future
and
current
practitioners
are
to
adopt
an
ongoing
reflective
and
critical
approach
to
practice,
we
should
aim
to
provide
learning
opportunities
that
promote
self
confidence,
question
asking
and
reflection,
openness
and
risk
taking,
uncertainty
and
surprise.
Teaching
techniques
that
encourage
these
skills
are
being
introduced
widely
and
have
been
shown
to
be
at
least
as
effective
as
traditional
methods
of
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Self directed learning.
A Towle and D Cottrell
doi: 10.1136/adc.74.4.357
1996 74: 357-359 Arch Dis Child
http://adc.bmj.com/content/74/4/357
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