How Surgical Residents LearnHow Surgical Residents Learn

Concepts in Adult Education in Concepts in Adult Education in a Surgical Residencya Surgical Residency

Deepak Dath MD MEd FRCSCDeepak Dath MD MEd FRCSC

April 8April 8thth 2009 2009

OverviewOverview

JustificationJustification

Effective LearningEffective Learning

Learning DistractionsLearning Distractions

Learning StylesLearning Styles

Learning StrategiesLearning Strategies

Technical SkillsTechnical Skills

Experts discuss their learning skillsExperts discuss their learning skills

JustificationJustification

Why the touchy/feely?Why the touchy/feely?– Level and availability of evidenceLevel and availability of evidence

Why learn about education?Why learn about education?– As a learner, what’s in it for me?As a learner, what’s in it for me?– Primary function for Primary function for 5 years5 years– Make the most of less and less educational Make the most of less and less educational

time with more and more content and time with more and more content and competencies and responsibilitiescompetencies and responsibilities

What constitutes an effective What constitutes an effective learning experience?learning experience?

Effective Learning ExperienceEffective Learning Experience

Comfortable atmosphereComfortable atmosphereConfidence in the teacherConfidence in the teacherMutual respectMutual respectOpen discussionOpen discussionFreedom to express oneselfFreedom to express oneselfEnvironment that encourages questionsEnvironment that encourages questionsEffective modellingEffective modellingDemonstration/didactics/supervisionDemonstration/didactics/supervision

Learning DistractionsLearning Distractions

Fixed ideasFixed ideas– All Whipple operations should have drains placedAll Whipple operations should have drains placed– Open CholeOpen Chole– Are you (and your teacher) open to new ideas?Are you (and your teacher) open to new ideas?

Multiple ResponsibilitiesMultiple Responsibilities– FamilyFamily– ResearchResearch– Seeking a social life (Gavin)Seeking a social life (Gavin)– Sports/HobbiesSports/Hobbies

Learning DistractionsLearning Distractions

Shortage of TimeShortage of Time– OR schedulingOR scheduling– On Call rosterOn Call roster

IntimidationIntimidation– HierarchicalHierarchical– AbuseAbuse

Complex environmentComplex environment

Competition from other learnersCompetition from other learners

Learning StylesLearning Styles

Two Basic DivisionsTwo Basic Divisions

Left BrainLeft Brain– VerbalVerbal– LogicalLogical– AnalyticalAnalytical– DetailedDetailed

The mathematicianThe mathematician

Learning StylesLearning Styles

Right BrainRight Brain– SpatialSpatial– IntuitiveIntuitive– EmotionalEmotional– HolisticHolistic

The artistThe artist

Some Theory To Go With the Some Theory To Go With the Brain ThingBrain Thing

David KolbDavid Kolb

Learning involves two basic steps:Learning involves two basic steps:

Perception of dataPerception of data

Processing dataProcessing data

PerceptionPerception

Concrete ExperienceConcrete Experience

Abstract ConceptualizationAbstract Conceptualization

ProcessingProcessing

ActiveActive

ExperimentationExperimentation

ReflectiveReflective

ObservationObservation

LearningLearning

ActiveActive

ExperimentationExperimentation

ReflectiveReflective

ObservationObservation

Abstract Conceptualization

Concrete Experience

Effective Learning StrategiesEffective Learning Strategies

MotivationMotivation– ControversialControversial

Necessary for effective learningNecessary for effective learning

But..But..

Adult learners are motivated by definitionAdult learners are motivated by definition

– Therefore:Therefore:Try to realize the motivation for a particular activityTry to realize the motivation for a particular activity

How can that motivation be heightened?How can that motivation be heightened?

What What dodo you do to keep learning? you do to keep learning?

Reflection: what is it?

Effective Learning StrategiesEffective Learning Strategies

Reflection (The heart of problem-solving)Reflection (The heart of problem-solving)– Begins with a questionBegins with a question

Feeling of “discomfort”Feeling of “discomfort”

– Occurs after the experienceOccurs after the experience– Leads to a plan to alleviate the discomfortLeads to a plan to alleviate the discomfort– Best if followed-up by putting the plan in action and Best if followed-up by putting the plan in action and

assessing it.assessing it.– IterativeIterative– Long termLong term– ““Assimilative”Assimilative”

Effective Learning StrategiesEffective Learning Strategies

Learning PartnershipsLearning Partnerships– A PactA Pact– Two or more (manageable group size)Two or more (manageable group size)– Usually peersUsually peers– Similar goalsSimilar goals– Open discussion / trustOpen discussion / trust– Prolonged relationshipProlonged relationship– Discuss meaning of the learned items Discuss meaning of the learned items

(process)(process)

Effective Learning StrategiesEffective Learning Strategies

Learning ObjectivesLearning Objectives– At the start of every rotationAt the start of every rotation– Should involve content and conceptsShould involve content and concepts

Think: how, whyThink: how, why

– Should be learner-centredShould be learner-centred– RealisticRealistic– Discuss with supervisor/teacherDiscuss with supervisor/teacher– Revisit with honest feedback (bilateral)Revisit with honest feedback (bilateral)– Modify based on feedbackModify based on feedback

Yeah, But How Do I Learn to Operate?Yeah, But How Do I Learn to Operate?

Practical ExperiencePractical Experience

ObservationObservation

PracticePractice

Its not just about cutting.Its not just about cutting.

Technical SkillsTechnical Skills

– Repetition (Ericson)Repetition (Ericson)

– Automaticity (from novice to expert)Automaticity (from novice to expert)

– Tacit KnowledgeTacit Knowledge

““Knowledge-in-action” (Schon)Knowledge-in-action” (Schon)

Complex activity subdivided into Complex activity subdivided into individual actionsindividual actions

Each action is refined to improve Each action is refined to improve overall outcome (reflection)overall outcome (reflection)

Why study how to learn?Why study how to learn?

Conceptualization of activityConceptualization of activity

Classify the activityClassify the activity

Investigate its componentsInvestigate its components

Refine the activityRefine the activity

Like analyzing your golf swing.Like analyzing your golf swing.

Let’s Hear from you allLet’s Hear from you all(Expert Surgical Learners)(Expert Surgical Learners)

SummarySummary

““Adult learning”Adult learning”– Motivated learnerMotivated learner– States objectivesStates objectives– Uses effective strategies to learnUses effective strategies to learn

Learning partnerships/reflectionLearning partnerships/reflection

– Refines strategiesRefines strategies– Establishes a pattern for lifelong learningEstablishes a pattern for lifelong learning