Optimal methods of learning for military medical education

Military Medicine, Sep 2003 by Turner, Martha, Wilson, Cindy, Gausman, Karen, Roy, Michael J

Overview of Teaching and Learning

To develop a systematic plan for relevant changes in military medical education, the 16th Military Medicine Conference considered appropriate content, methods to facilitate learning, methods of assessment and evaluation, and the certification process. Prerequisites to recommending learning methods for the changing educational needs of health care professionals are first to understand learning and second to discuss learning methods. Understanding key concepts helped to establish a common framework for the discussion of learning methods. The concepts discussed were knowledge, behavior, outcomes, timing, levels of competence, barriers, and retention. Elements of learning methods that need to be considered were identified. These elements were places and spaces, time, relationships, and self.

Places and spaces create a learning environment. According to London,1 the environment should support teaching. When creating an environment, faculty must address location, availability, access, amount of space, lighting, acoustics, climate control, ambiance, seating plans, furniture, and technology support. The size of classes or number of students may dictate a need to change methods.2 Distance learning methods, classrooms, and clinical settings in medical treatment facilities and deployed environments were discussed, with emphasis on factors unique to military medicine.

Time, a key element, includes the following: duration of lectures; courses and programs of study; sequencing; "just in time" training; the learning continuum; day, evening, night and weekend classes; scheduling of learning activities; and breaks. Synchronous or asynchronous issues particularly apply to web-based methods of teaching. Synchronous methods require everyone to be on-line at the same time and asynchronous methods allow students and teachers to participate at their convenience. The amount of content and effort to complete assignments in the context of time were set aside for discussion at another time.

The relationships within the learning environment are important from the perspectives of both the faculty and the student.3,4 Competition, formality/informality, trust, support, various roles, mutual respect, and familiarity were all explored during the discussion. The patient's perspective was highlighted as significant and it must be included in all discussions of methods in the clinical setting. The concept of self includes a full range of topics from self-esteem and ego strength to use of senses. Novice and expert were presented as described by Benner.5 Personality preferences, individual values, sex, age, and cultural and language variation were also mentioned as significant considerations when discussing learning methods.

Since the work of teachers is to facilitate learning, the next task was to describe how learning can be facilitated.4 The curricular elements identified at the 15th Conference can all be clustered into four areas: knowledge, skills, critical thinking, and attitudes.6 It is also important to distinguish between a "need to know" and simply needing to know "where to find it," between assessment and evaluation, and between being a "sage on the stage" or a "guide by your side" (D. Seibert, personal communication and P. Hinton-Walker, personal communication).

Methods

There were 20 members in the working group led by a skilled facilitator. Initially, ground rules were established to promote good group dynamics and an agenda was drafted. The group made a commitment to follow the planned agenda each day. To assure productivity, the following outcomes were defined: to develop a "toolbox," to describe the learning needs of faculty so they can operationalize the methods in the "toolbox" and then to describe the continuum of learning for military health care professionals.

The group began by reviewing the findings of the four subgroups of the 15th Conference: Emerging Threats, Changing Missions and Operations, Emerging Technologies, and Ethics and Society. The particular features within the last of these were thought to be more easily achieved. These features included Ethical Competency, Patient Culture and Changing Demographics, Societal Expectations, Team Work, Technology, Politics of Medicine, and Military Service Changes and Culture.

Then the members in small groups used the technique of mind mapping to identify the various methods of learning currently available and to illustrate the relationships to students and their environment. This activity took place predominantly in smaller subgroups of four to five members each. Guided discussion and reflection were used to cluster similar ideas and to identify themes. This consolidation preceded the presentation of the small group findings to the large group.

The group facilitator arranged for expert briefings to complement the work of the group when clarification or introduction of new material was needed. Some of these briefings were determined in the preparatory phase of planning for the conference. This enabled the participants to venture beyond what was familiar and to consider newer concepts that seemed to have potential. From the beginning the group had in mind the costs and benefits of including additional content into the lifelong learning of military health professionals.