Adult Learning Theory: Teaching Techniques to Enhance Learning

1. Adult Learning Theory: Teaching Techniques to Enhance Learning Caroline Harada, M.D. Division of Gerontology, Geriatrics, and Palliative Care University of Alabama at Birmingham

2. A scenario from real life… • You are precepting a student. You suddenly find yourself with 15 minutes with no patient care responsibilities. You would like to teach the student something during this down time, but you haven’t planned anything specific…

3. Guerilla Geriatrics • Every time you get a teaching opportunity, you want it to have as big an impact as possible! • How can you create high quality learning experiences with limited resources?

4. Educational methods must be feasible • We all have limited resources: • Time • Technology • Money • Space • Faculty • Today’s teaching activities will be instructor-friendly: • LOW TECH! • LOW STRESS! !

5. Learning Theory • Behaviorist theory: Learning is done TO the learner • Filling an empty vessel • Constructivist theory: Learning is done BY the learner • Learner Centered Learning How People Learn. National Research Council, 1999

6. Learner Centered Learning • New knowledge is constructed from prior knowledge • Must activate prior knowledge in order to build upon it • Learners must be actively engaged • Learning is WORK! • Metacognition is encouraged • Know what you know How People Learn. National Research Council, 1999

7. Miller’s Pyramid • Miller GE. The assessment of clinical skills/ competence/ performance. Acad Med (1990);65:s63-s67.

8. Multiple Learning Styles • Kolb’s model for experiential learning 2 dimensions: • Perception (grasping) • Processing (transformation) Concrete Experience Active Experimentation Reflective Observation Conceptualization Kolb, DA. Experiential Learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall; 1984.

9. Armstrong’s Curriculum Planning Framework 1. Activate prior knowledge 2. Add new knowledge 3. Try out new knowledge 4. Use new knowledge Concrete Experience 4 1 Active Experimentation Reflective Observation 2 3 Conceptualization Armstrong E, Parsa-Parsi R. Academic Medicine, July 2005

10. Operationalizing this Framework Reflective journaling Practice audits Academic detailing Concept mapping Games Exit tickets Concrete Experience 4 1 Active Experimentation Reflective Observation 2 3 Conceptualization Armstrong E, Parsa-Parsi R. Academic Medicine, July 2005

11. Work Audits

12. What is an audit? • An evaluation of a person, organization, system, process, enterprise, project or product

13. Geri Audit

14. Academic Detailing

15. Possible applications • Potentially inappropriate medications (pocket card) • Pain medications (pocket card) • Appropriate use of Foley catheters (pocket card) • Asthma management- use of peak flow meters (patient handout)

16. Concept Mapping

17. Concept Map • A concept map is a diagram showing the relationships among concepts. It is a graphical tool for organizing and representing knowledge. • We plan to use them here to: • Provide an initial conceptual frame for subsequent information and learning • Increase meaningful learning • Enhancing metacognition (thinking about what you know and what you need to learn) Wikepedia, “Concept map” Accessed Sept 4, 2009

18. Example of a Concept Map Applies to FSP Accepted to FSP Comes to FSP workshop Becomes an expert in geriatrics

19. Example Concept Map Tired person Skips exercise Drinks lots of coffee Eats muffins Doesn’t sleep well at night Gains weight

20. Patient: Mrs. T • 75 year old woman with a history of hemorrhoids and depression admitted for blood in stools on Monday evening • She is very weak and there is concern she will fall, so she is put on bedrest and a Foley is placed • She is made NPO, IVF are started, she gets prepped for colonoscopy by drinking a gallon of GoLytely • She has a colonoscopy on Tuesday afternoon • Tuesday evening she becomes very agitated, she starts fighting caregivers, pulling out her IV and Foley • She is placed in restraints • She is now extremely confused

21. Draw a Concept Map • How did Mrs. T get so confused? Blood in stools Confusion

22. How did this patient get so confused? GIB Weak, fall risk Depression Colonoscopy Anesthesia Bed rest Lots of meds Confused patient Foley Haldol Restraints Preexisting Alzheimer’s Pain

23. Games • Taboo • Health Literacy Limbo • Card sorting games • Role play

24. Enhancing Metacognition • Warm ups • Pre tests • Reflective journaling • Debriefing • Group discussion • Exit tickets

25. Wrap Up • Debriefing • Exit tickets • Yellow card: • One thing you learned about adult learning theory • Blue card: • One new teaching technique you want to try