Tag: continuing medical education

behaviour changeeducation & learningsystems thinking

Learning fails in bad systems

2348137226_2d6536745e_o_Edits.jpgEnormous energy is spent on developing strategies to accomplish things with comparatively little paid to the systems that they are being deployed in. A good strategy works by design and that means designing systems that improve the likelihood of their success rather than fight against them and this is no truer than in the effort to learn on the job.

 

A simple search of the literature — gray or academic — will find an enormous volume of resources on how to design, implement and support learning for action in organizations. At an individual level, there are countless* articles on personal change, self-improvement, and performance ‘hacks’ that individuals can do to better themselves and supposedly achieve more in what they do.

Psychology and related behavioural sciences have spent inordinate time learning how individuals and organizations change by emphasizing specific behaviours, decision processes, and data that can support action. A close inspection will find that relatively few strategies produce consistent results and this has to do less with execution, skill or topic and more with the system in which these strategies are introduced.

To illustrate this, consider the role of learning in the organization and how our strategies to promote it ultimately fail when our systems are not designed to support it.

Knowledge integration: A case study

Consider the example of attending a conference as a means of learning and integrating knowledge into practice.

Surajit Bhattacharya published a primer for how to get value from conferences in medicine, pointing to tips and strategies that a medical practitioner can take such as arriving a day early (so you’re not groggy), planning out your day, and be social. These are all practical, logical suggestions, yet they are premised upon a number of things that we might call system variables. These include:

  • The amount of control you have over your schedule week-to-week.
  • The availability of transportation and accommodation options that suit your schedule, budget, and preferences.
  • The nature and type of work you do, including the amount of hours and intensity of the work you perform in a typical week. This will determine the amount of energy you have and the readiness to be attentive.
  • The volume of email and other digital communications (e.g., messages and updates via social media, chat, project management platforms) you receive on a daily basis and the nature of those kinds of messages (e.g.urgency and importance).
  • The amount and nature of travel required to both attend the event and the amount you had prior to attending the event.
  • The level of rest you’ve had. Sleep amount, timing, and quality all factor into how much rest you get. Add in the opportunity to engage in an activity like walking, exercise or stretching that one might do and we see a number of factors that could influence learning performance.
  • The setting. The lighting, air quality and air flow, seat arrangement, room acoustics, and access to some natural light are all factors in our ability to attend to and engage with a learning event.
  • The quality and format of the content and its delivery. Speaker quality, preparation, content and overall performance will all contribute to the ability to convey information and engage the audience.
  • Food and drink. Are you eating the kinds of foods and beverages that enable your body’s performance? Do you have access to these foods and drinks? Are they served at times that suit your body?
  • Your level of comfort and skill at engaging strangers. This matters if you’re more introverted, dislike small talk, or are not energized by others.

These are all platform issues: those in which motivation and energy can be channeled to focus on and engage with learning content. The fewer of these factors present the greater the energy expenditure needed on the part of the learner.

Learning within systems

W. Edwards Deming noted that most of the issues of performance in any organization were due to processes and systems (estimated to be up to 85% or more) rather than individual employees. While Deming was referring largely to manufacturing contexts, the same might be said for learning.

Consider our example from earlier about the conference. We’ve already outlined the factors that could contribute to learning at the conference itself, but let’s extend the case further to what happens after the conference. After all, a surgeon, engineer, computer programmer, law clerk, or carpenter isn’t going to practice her or his craft at the conference; they’ll do it when they return to regular work.

Now consider what our attendee encounters after they have made the trip home to apply this newfound learning:

  • A backlog of emails, phone messages and other correspondence that has either been left untouched, scantly attended to, or fully managed. In the first case, the backlog might be high and requires a considerable amount of time and energy to ‘catch up’ on upon return, however at least the learner was fully present to perform the many activities suggested byBhattacharya in the earlier article. In the second case, there is a higher than usual amount to attend to and the learner might have been selectively disengaged from the learning event. In the third, the learner returns to usual life without a backlog but may have sacrificed considerable attention toward the usual correspondence than actually learning.
  • A backlog of meetings. Scheduled meetings, calls or other events that require a co-presence (virtual or physical) that were put off due to travel are now picked up.
  • A backlog of administrative tasks. Submitting receipts and conference expenses, regular accounting or administrative tasks are all things that either was left untouched or, in the case of submitting expenses, unlikely or impossible to do until the trip has returned.
  • Fatigue. Sitting in a conference can be exhausting, particularly because of the conditions of the rooms, the volume of content and the break in the routine of every day (which can be energizing, too). Add in any travel issues that might arise and there is a reasonable chance that a person is not in an optimal state to take what they have been exposed to and apply it.
  • The usual organization processes and structures. Are there are opportunities to reflect upon, discuss, and process what has been learned with others and spaces to apply those lessons directly with appropriate feedback? How often have we been exposed to inspiring or practical content only to find few opportunities to apply it in practice upon our return in enough time before the details of the lessons fade?

It’s not reasonable to expect to have optimal conditions in our work much of the time, if ever. However, as you can see there are a lot of factors that contribute to our capacity to learn and the required energy needed to take what we’ve been exposed to and integrate it into our work. The fewer of these situations in place, the greater the likelihood that the investment in the learning experience will be lost.

An organization or individual requires a platform for learning that includes systems that allow for learners to be at their best and to provide a means for them to take what they learn and apply it — if it’s valuable. Otherwise, why invest in it?

This isn’t to say that no good can come from a conference, but if the main focus is on actual learning and the application of knowledge to the betterment of an organization and individual why would we not invest in the platform to make use of that rather than discarding it.

Rethinking our systems

When I was doing evaluation work in continuing medical education I was amazed to see how often learning events were held at 7 or 8 am. The rationale was that this was often tied to shift changes at hospitals and were the one time of day when most physicians were least likely to have other appointments. This was also the time when physicians were either highly fatigued from a night shift or having battled traffic on their commute to work or were planning the rest of their day ahead — all circumstances when they might be least focused on actually learning.

This choice of time was done for scheduling purposes, not for learning purposes. Yet, the stated purpose of continuing education was to promote learning and its various outcomes. Here, the strategy was to expose medical professionals to necessary, quality content to keep them informed and skilled and doing it at a time that appeared most convenient for all is an example of an idea that had logic to it, but ultimately failed in most regards.

How? If one looked at the evaluation data, typically the results suggested this strategy wasn’t so bad. Most often post-event surveys suggested that the overall ratings were consistently high. Yet a closer look at the data yields some questions.

For example, the questions asked to assess impact were things like: did the presenter speak clearly? or did the presenter provide the content they said they would? In most cases, participants were asked if the speaker arrived on time, presented what they said they would, were intelligible and whether there was a chance the learner might find useful what was presented. It had little to no bearing on whether the content was appropriate, impactful or applied in practice. This is because the system for evaluation was based on a model of knowledge transmission: content is delivered to a person and, assuming the content is good, the lesson is learned.

We know this to be among the weakest forms of moving knowledge to action and certainly not something suited to more complex situations or conditions, particularly in health systems. This is still what prevails.

Design for learning

If you’re seeking to promote learning and create a culture where individuals across an organization can adapt, develop, and grow learning requires much more than simply sending people to conferences, hosting seminars, providing books and other materials or watching some instructional videos. Without a means to integrate and promote that new knowledge as part of a praxis, organizations and individuals alike will continue to get frustrated, lag in their efforts to anticipate and respond to changing conditions and will ultimately fail to achieve anything close to their potential.

Designing for learning is as much about a curriculum as the context for how that curriculum is delivered and how learners are set up to engage with it all in their organizations and everyday lives.

*This is literally the case because the volume of new articles being published daily is so high.

If you’re looking to create learning systems in your organization, visit Cense to explore what it can do for you in shaping your strategy and evaluation to support sustainable, impactful learning for complex conditions. 

Image credit: “Platform” by Martin L is licensed under CC BY 2.0

 

design thinkingeducation & learningevaluationinnovation

The Job Market Metric In Education

UniversityDoors

Post-secondary and continuing education is continuing to be rationalized in ways that are transforming the very foundation of the enterprise. Funding is a major driver of change in this field: how much is available, when it flows, where it comes from, what is funded, and who gets the funding are questions on the minds of those running the academy.

At the centre of the focus of this funding issue is the job market. Training qualified professionals for the job market in various forms has been one of the roles a university has played for more than a century. Now that role has become central.

Let’s consider what that means and what it could do in shaping the various possible futures of the university. This second in a series looking at the post-secondary and continuing education focuses on the metrics of jobs.

“What are all these people going do?”

The employability of graduates is now the holy grail of education industry statistics. Earlier this year I was sitting on the stage at an academic convocation with a senior colleague staring out at a sea of soon-to-be-graduates when he leaned over and asked the question quoted above. Staring at a sea of masters and doctoral graduates numbered in the hundreds and knowing that this ceremony was held twice per year, the question stuck and remains without an answer.

Maybe there were enough jobs for that cohort, but this process gets repeated twice each year at universities around the world and each year that I’ve been a professor those numbers (of graduates) seem to go up. Some of our programs in the health sciences are admitting three times the number of students than they were just ten years ago. There is much demand for education (as judged by departmental applications), but are there jobs demanding this kind of education in its current form?

Yes, the Baby Boom is moving into an age of retirement and increasing needs for health services, but do we need to graduate 80+ Physical or Occupational Therapists to meet this need this year? Do we need a few dozen more epidemiologists or health promotion specialists to add to the pool? How about psychologists or social workers: how many of those do we need? The answer from my colleagues in these fields is: We don’t know.

Chasing the Wind

Jobs are a red herring. It’s one thing to have a job, but is it the job that you trained for? (And is having that job even a reasonable goal?) Being employed is not the same as building a career. What if you were trained perfectly for a job that no longer existed? Imagine a Blacksmith in the 20th century or a Bloodletter. These questions are not asked, nor is much asked about quality of education relative to the pressures of recruitment, cost-cutting and educational rationalization. Most of us don’t know what quality education is in real terms because we are measuring it (if we are measuring anything at all besides jobs) by standards set for the jobs of the past, not the future (or even the present?).

“Skate where the puck is going, not where it’s been.” – Wayne Gretzky

Jobs are living things and very few in 2013 will resemble what they did even 10 years ago. The citizens of the developing world are entering this rapidly changing job market ready for change (See also McKinsey Global Institute report on future of work in advanced economies) because they don’t have the old ways to rely on. They are primed for change and if professional education is to meet the needs of a changing world, it needs to change too. It means getting serious about learning.

If education is rationalizing itself to focus more on jobs, then it also needs to get serious about clarifying what jobs mean, defining what ‘success’ looks like for a graduate, and whether those jobs are designed for where the proverbial puck is now or for where it is going.

Disruptive Learning / Disturbed Education

“The Only Thing That Is Constant Is Change -” ― Heraclitus

I’ve pointed out that learners have an uneasy relationship with learning principally because it means disrupting things. This is a topic I’ll  be covering in greater depth in a future post, but if one considers how our social, economic, and environmental systems are changing it is not unreasonable to call this the age of disruption .

Change in complex systems is often logarithmic, not linear. It may be massively punctuated like a Lévy Flight or it could be closer to a random walk. In environments with a change coefficient that is large the level of attention must be more fine-grained than 5-year reviews. It requires developmental evaluation methods and learning organizations, not just conventional approaches to generating and assessing feedback. It requires mindful attention and contemplative inquiry to guide a regular reflective practice if one is to pay attention to the subtleties in change that could have enormous impact.

For example, if journalists and news media waited every five years to assess the state of their profession, they would have missed out on Twitter and come late to blogging, two of their (now) powerful sources of competition and tools of the trade. Some have waited, which is why they are no longer around. Metrics for journalism education today might consider the amount of exposure and proficiency in social media use, digital photography, use of handheld tools for communication, and real-time reporting skills. Metrics of the past might focus on newspapers and radio broadcasting. Which mindset, skillset and toolset would you rather be trained in today?

Questions for educators, learners (and evaluators):

Whether health sciences, journalism, human services or any field, what might some questions be that can help determine the role of job training in professional education? Here are five starters:

1. What is the state of your profession right now and are you training people for existing in this state? Are you preparing people for the next evolution?

2. Where is your field of practice going? What are the possible futures for your profession in the next 5, 10, and 20 years? Will it still exist? Are you a blacksmith looking for more horses in the automobile age or Steve Jobs waiting to attract people to a new graphical user interface?

3. Is your mindset, skillset or toolset in need of re-consideration? Does it still do the job you’ve hired it to do?

4. What do people need that your skills can help with? What unfilled needs and expectations are there in the world that your mindset, skillset and toolset could solve?

5. What would happen if your field of practice disappeared? How else could you apply what you know to making the contribution you wish to make and earn a living? What other skills, tools and ways of thinking would you need to adapt?

Design thinking can greatly help shape the way that one conceives of a problem, works through possible options, and develops prototypes to address the needs of the present and the future. Foresight methods help lay additional context for design and systems thinking by providing ways to anticipate possible futures for any given field. Lastly, knowing what the state of things are now and how they got to where they are now can help determine the path dependencies that education may have fallen into.

We can’t change what we don’t see and better foresight, hindsight and present sight is critical to better ensuring that education outcomes are not imagined, but based on something that can actually improve learning.

complexitydesign thinkingeducation & learningsocial systemssystems thinking

Designing Education for Learning

Injecting Knowledge or Foolishness?

Education strives to prepare learners to meet the social, scientific and technical demands of a changing world, yet does so in a manner that seems antithetical to change. We put people in rows, we create arbitrary time horizons and rules, and rely on a model that looks more like a factory than a place of learning. What gives?

As a new academic term begins, the old one closes, and all those year-end lists and year-beginning previews flood the media world I’ve found myself asking the twin questions: what did we teach/learn/discover and what did it matter?

In a previous post I discussed the problem with grades and their lack of fit with learning in complex systems. Here, I want to continue that thread, with a focus on post-secondary education (although it most certainly applies to all forms of structured learning) and knowledge translation in professional practice.

Feedback is critical to adaptation and the emergence of new patterns of order in complex systems. Adaptation comes from the incorporation of this feedback into new cognitive, social or physical structures. This is learning.

Yet consider the manner in which we structure our educational environments. They are not really designed for learning much at all. At least, they aren’t if you believe that people learn at different times, in different ways, using a complex array of media that requires multiple literacies, through interaction with other people, fail and fail often in a manner that is safe, in settings that allow for “mess” and promote ways to structure or unstructure their environment.

A colleague of mine and I were walking back from a meeting of a continuing medical education committee and stopped in front of the hospital to chat about the kind of challenges she faces in professional education in the hospital with doctors.

The only time I can get people in the same room is to do continuing education is 7am. There is one hour when the night shift (which is usually 12 or 24 hours long) is ready to go home and the new shift is ready to start. And we expect people to actually learn? Nearly everyone is asleep and everyone’s mind is on something else. I have to be really entertaining to make this stuff stick.

Is this learning? This continuing education effort is a failure not of the learners, nor the teachers, but of educational design. If 7-8am before/after shift is the only time that the scheduling system will allow for face-to-face learning, then that’s what has to take place first. Shifting the system as a whole must come soon after.

What made this conversation so well timed was that it took place after a meeting in which we spoke for two hours on ways to encourage online learning in effective ways. The problem, as we noted in that meeting, wasn’t that the tools were ineffective, but that they required people to access them from home, in their private time because there were no structured time to do it on the job, and firewalls to prevent access to most Web-based programs in the first place. In this case, the system was designed to thwart learning opportunities except those that require inordinate levels of educational skill, lots of coffee, and an unreasonable level of motivation among learners (the 7am con-ed moment).

The idea of bringing design to education has started to take root. Bruce Mau, who has inspired social design through his Massive Change projects, along with his design firm has teamed with OWP/P Cannon Design and furniture maker VS America to create the Third Teacher collaboration that is aimed at bringing design thinking to education. The work, initially focused on primary schools, has expanded to include the entire Arizona State University campus. The ASU experience has adopted the idea of the purpose-driven university through use of design strategies to help the university and its community find, affirm and commit to their purpose.

The collaboration looks to explore ways to create physical spaces, intellectual spaces, and facilitate the interaction between all spaces to enhance learning. This interaction space creates the feedback potential that ignites creativity, innovation and discovery. This is what an education system for learning could look like.

(Photo credit: Education by smemon87, used under Creative Commons Licence)

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