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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 235-239

Triple Cs of self-directed learning: Concept, conduct, and curriculum placement


1 Department of Pharmacology, Department of Medical Education, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Physiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
3 Department of Paediatrics, Christian Medical College and Hospital, Ludhiana, Punjab, India
4 Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission24-Jan-2021
Date of Decision28-Jan-2021
Date of Acceptance04-Feb-2021
Date of Web Publication18-Mar-2021

Correspondence Address:
Hem Lata
Department of Physiology, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_13_21

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  Abstract 


Self-directed learning (SDL) is one of the teaching-learning methods that can be used in medical education at all levels. The use of SDL in undergraduate (UG) teaching is becoming common due to the implementation of competency-based education in many countries. The new competency-based UG medical curriculum in India includes lifelong learning skills as one of the major components. The SDL method is reported to increase the lifelong learning skills of students. The concept of SDL is based on experiential learning and its conduct needs proper understanding of the concept. The conduct can include two contact sessions and an intersession or gap period of few days. The contact sessions focus on introduction, facilitation, and debriefing. The intersession period is the real learning period for the students. SDL also includes the use of various assessment methods. All SDL sessions are followed by an evaluation of various stakeholders. Advancements in information technology (IT) and the advent of many innovations in teaching can be aptly used in SDL conduct and evaluation. The present coronavirus disease 2019 (COVID-19) pandemic has further provided opportunity to use IT in the new normal post-COVID-19 times. Curriculum placement must be done in alignment with other teaching-learning methods. Training of facilitators, availability of resources, and preplanning help in successful SDL conduct. If implemented appropriately, SDL can be a great method to help students in their postinstitute lives.

Keywords: Competency, curriculum, facilitator, information technology, self-directed learning


How to cite this article:
Badyal DK, Lata H, Sharma M, Jain AJ. Triple Cs of self-directed learning: Concept, conduct, and curriculum placement. CHRISMED J Health Res 2020;7:235-9

How to cite this URL:
Badyal DK, Lata H, Sharma M, Jain AJ. Triple Cs of self-directed learning: Concept, conduct, and curriculum placement. CHRISMED J Health Res [serial online] 2020 [cited 2021 Jun 24];7:235-9. Available from: https://www.cjhr.org/text.asp?2020/7/4/235/311534




  Introduction Top


Various methods and strategies in learning are being implemented in many countries for undergraduate (UG) medical curriculum. Self-directed learning (SDL) is a relevant and recommended method for UG medical education.[1],[2],[3] All of us have imbibed a part of our learning in medical education through SDL. SDL can be used at all levels of learning, i.e., UG, postgraduates, and faculty development. Its most interesting use is at the UG level as it is an apt time to inculcate SDL skills that can continue to develop and help in learning during postgraduation and beyond as a faculty or professional. SDL skills have been reported to later on improve the performance of physicians and patient care.[4] Therefore, the proper understanding of SDL skills can play a major role in improved learning throughout life.

One of the important broader goals of UG medical education curriculum in many countries is to create lifelong learning skills in the students. The Accreditation Council for Graduate Medical Education has included lifelong learning skills as one of the major components in resident teaching. The American Board of Internal Medicine includes lifelong learning skills as one of the requirements for physicians.[1] The new UG curriculum implemented in India from 2019 has also included the goal of making students, lifelong learners. It has been recommended that SDL should be utilized frequently to develop lifelong learning skills in UG students.[5] Therefore, SDL is a goal in many curricula as well as teaching-learning methods.

SDL adds variety to teaching-learning methods and provides an option to curriculum makers to choose this method in alignment with some learning objectives. The conduct of SDL is quite variable at different places.[2],[6],[7] In several instances, it is confused with self-learning or just asking students to read from books but remaining unobserved. Students and teachers have shown apprehension about the freedom in learning in countries where teacher-oriented learning has been there for a long time. The placement in the teaching schedule is also quite variable and often not preplanned.[2],[8] Therefore, more clarity on concept, conduct, and placement in the new curriculum can play a vital role in the acceptability and implementation of SDL. In this review, we look at the concept behind SDL and how it can be conducted and placed in the curriculum.


  Concept Top


Definitions and theories

There have been many quotes as well as definitions for SDL. One of the most widely used definitions was given by Knowles. It states that SDL is ”a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes.”[1] Collins and Hammond (1987) described SDL as ”a process in which learners take the initiative, with the support and collaboration of others.”[9]

Various models have been described to give a perspective to SDL. Some say it is a process where an individual's voluntariness is more important than instructions while others consider it more of a personal perspective where a mature adult takes responsibility of his/her learning. However, some relate it to context-based methods.[10],[11]

Two learning theories are involved in the process of SDL, cognitivism theory and humanism theory. In cognitivism theory, the student uses cognitive tools, such as information processing, perceptions, and memory to facilitate learning. It includes acquiring, storing, and retrieving information. The learner develops skills for effective SDL. The teacher facilitates the learner about ”learn how to learn.” This theory represents internal cognition restructuring due to changes in individual's knowledge. As per humanism theory, learning is more related to one's own growth as a doctor and human being. There is the exploration of one's emotions and changing the identity of one's self. Self-directed learning is one of the most important principles of this theory.[10] Although there are several definitions and interpretations, the essence of SDL remains in its words, i.e., self (learner oriented), directed (facilitated and monitored), and learning (applicable to lifelong learning).

The need

Learners are not preprogrammed for SDL. There are situations where learners need to have a desire to learn and ability to do so without direct supervision. One of that scenarios is the recent pandemic that has paralyzed the entire world. Based on experiential learning, immediate reactions were that people (leaners here) in all countries started using masks, handwashing, and social distancing. Long-term adaptions which were appropriate led to better management of pandemic by people/leaders (learner here) in some countries [Figure 1]. Experiential learning is based on Kolb's learning cycle.[12],[13]{Figure 1}

Various challenges in medical education can be met with the development of SDL skills in students. Some of these challenges are:

  • Vast curriculum taught by a variety of teachinglearning methods
  • Different learning styles and pace of learning of students – SDL allows students to learn at their own pace and with their own learning style
  • Shrinking faculty – SDL enables students to take responsibility of a part of their learning/syllabus
  • Need to constantly update knowledge – as we look at developing students as lifelong learners, SDL is reported to make them ready to update knowledge on their own
  • Difficulty in understanding relevance of the varied subjects and memorization – SDL is known to improve a student's ability to cross-link learning context and improve retention and application of knowledge[4]
  • Addressing adult learners – SDL treats medical students as mature adult learners. This improves their learning[14]
  • Need for the globalization of medical education– global learners are being given similar experiences and opportunities to learn
  • Advent of online learning and virtual universities: pandemic has made us experience online courses; more virtual courses and may be virtual universities too can be a possibility in new normal after pandemic[15]
  • Cost of higher education – E-learning is an excellent example of SDL that is a cost-effective solution to higher education in certain areas of medical education.



  Conduct Top


Several publications are available on the concept and theories related to SDL.[2],[6],[7],[8] However, the design of SDL sessions and their successful implementation is still a challenge. One of the major concerns that plague SDL is that teachers/faculty either start lecturing in SDL session or make students compulsorily sit in a classroom with their books. The finer details of the process are often overlooked. SDL is not the same as asking students to sit down in a room, open books, and read. It is different from self-learning too. Self-regulated learning is very focused approach with specific tasks, while SDL is a general approach for learning.[16] Students also find it challenging and very demanding. As in the number of countries, students are tuned to spoon-feeding in the schools, and hence, it is not easy for them to shift gears for SDL that needs them to manage their overall learning activities and monitor their own performance.[2],[3]

Various preparations are needed before start of SDL sessions. These include:

  • Faculty training, formation of core committee
  • Selection of topics and placement in the curriculum
  • Orientation of students to SDL program
  • Gathering resources necessary for starting SDL program, i.e., venue, timetable adjustments, computers with Wi-Fi connection, computer personnel
  • Formation of online group of the students and faculty
  • Distributing prereading information to the students
  • Actual conduct of SDL session.


Let us discuss few important steps

Selection of topic

Selection of appropriate topic is important to appeal to a student's interest and motivate them to learn by themselves. For example, a person from India might be more interested to learn French; an American baseball player might be more interested to learn about cricket. Choose topics which stimulate thinking of the students. The topic should be doable in the time frame and should not just be a collection of huge data or merely a topic which has minimal information available. Taking into consideration, the above points now review syllabus or competencies in the curriculum to identify which topic is best suited to be learned by SDL. Topic can be in the form of a competency (s) and can be introduced as a case, trigger or just as a topic statement, for example, management of shock, antiplatelet drugs, management of Parkinson's disease, pharmacotherapy of tuberculosis, oral contraceptives, and pharmacovigilance in the subject of pharmacology in the second phase of MBBS curriculum.

Assess readiness to learn

Students who are autonomous, organized, self-disciplined, able to communicate effectively, able to accept constructive feedback and engage in self-evaluation and self-reflection can be considered as ready to learn by SDL. These components are also part of other teaching-learning methods. Studies show that students in Asian countries where traditional teaching has been used for a long time need more support and guidance in the initial years of SDL.[3],[17]

Designing module

This involves finalizing the contents based on the selected topic. Review the information available/resources for the students. Decide on the number of contact sessions and duration of the intervening period. Decide on how many hours are needed for contact sessions.

Actual conduct of the session

A sample SDL session conduct is described in [Figure 2] and can be used in competency-based UG medical curriculum. One topic can have two contact sessions and intersession period/gap interval of 7 days. Each contact session can be of 60 min duration [Figure 2].{Figure 2}

  1. First contact session: it includes instruction to the small group (8–15 students). Students get a piece of information on a relevant topic in the form of a case or a trigger. Students set learning goals and milestones to be achieved and various modes of their achievement. Learners need to take responsibility for their learning; remember that in SDL learner has a very important place.


  2. Every student has to define his/her needs and approach. This can be through various ways of learning such as deep approach, superficial approach, or strategic approach. In SDL, the role of the teacher is as a facilitator. The facilitator helps in refining goals and finding resources and informs the time limits. Teachers need to shift gears from being an information provider to being a facilitator. The facilitator needs to enhance learning in the process of learning and enhance their critical thinking.[13],[18] This continues in the intersession period too, and facilitator in a way bakes the learner to become self-directed learners. This is not so easy, as several times, teachers start a minilecture as they are bubbling with knowledge.

  3. Intersession period: this period extends over days and students find and explore resources, read and approach facilitator as needed. Facilitator's role is to facilitate learning, guide for resources, and make sure to engage them in learning. Students learn to manage their own time as well as resources. Resources, especially, in coronavirus disease 2019 (COVID-19) times can include YouTube videos, surfing the internet using key words, e-journals, and e-books
  4. Second contact session: this session is for 60 min and involves debriefing, and during debriefing, there are many opportunities for learning to be assimilated. Facilitator needs to guide on those learning points keeping in view the learning goals. This session also involves assessment of learning.


Assessment of students in SDL can involve multiple methods, i.e., grading of project work, grading of the case presentation, through questionnaires, self-assessment: online quizzes, tests, games, Objective Structured Clinical Examination, Objective Structured Practical Examination, tutorials, multiple-choice questions, feedback from peers/facilitators/experts, and reflections. Learning management system can be very handy to record these assessments.

Evaluation of SDL is done at the end of all sessions of a topic. This can be done after few topics have been covered under SDL. Evaluation considers the overall SDL program and may involve many methods, i.e., grading done by facilitator, immediate feedback, logbook entries, multisource feedback, portfolios, assessments conducted, number of hits at resources, library visit entries, and reflections. In one's institution, one can decide all time durations as per the curriculum implementation plans.


  Curricular Placement of Self-directed Learning in Curriculum Top


Every curriculum uses various methods to teach students. The use of multiple methods improves learning. Based on syllabus or competencies, decide how many topics are to be covered with SDL in each subject. Each topic will need 2–3 SDL slots in timetable in continuity. This spaced learning to visit the topic after few days is helpful for long-term retention and confers to spiral curriculum.[13] Then, distribute SDL sessions over the entire year for each subject. Make sure that topics are in alignment with other topics being covered by other teaching-learning methods. Avoid crowding together of SDL session in few months only. If students are getting exposed to SDL for the first time, they will need more time for initial SDL sessions. Once they understand the process, then it would be easier for students to go through these sessions.

Make sure of the availability of facilitators for SDL sessions. Spacing SDL sessions can help in that concern. Apart from faculty, postgraduate students can also be facilitators but train them in facilitation skills.

Use of media and current technologies in self-directed learning

Information technology (IT) plays a big role in medical education and is very apt to be used in SDL. This is so true in the COVID-19 era, where all educational courses have shifted to online modes using IT throughout the world. In fact, technology can help a lot in SDL implementation, especially in the monitoring process. The hits by students on particular website can be monitored through institutional servers when students log into institutional library services. Video recording of sessions can be done. Online resources can be provided to students on the institutional learning management system. In case-designing, various online videos, cases, etc., can be used.[19]

Students can share the ideas/projects/research/presentations with peers on Google groups, WhatsApp, Telegram, Signal, etc., where they will get feedback and improve in that field. Online simulations can be used for skills learning.[20] Advanced technologies such as soft boards, scanner highlighter, smartphones, and smartwatches can also be useful. Facilitators can share links to online resources. Online tools can be used for debriefing.

There are several challenges in designing and implementing SDL in an institute. Various studies have reported as motivation to be a leading challenge, as facilitators and students need to invest a lot of time and resources. Keep in mind the workload on students and use SDL as one of the teaching-learning methods.[8],[12],[18],[19],[21] The time investment by facilitators in SDL is not a part of the usual teaching responsibilities of teachers in India. Training of facilitators and availability of resources have to be planned well before sessions. Monitoring the intersession period is a challenge with the existing setup in many institutions in India. Electronic monitoring, use of IT, and access to reliable resources are another challenge. One of the models for SDL describes a three pillars model for SDL that focuses on these areas. The three pillars include skills, motivation, and self-belief, and strengthening these components can take care of some of these challenges.[13]

To conclude, SDL can have a very high impact role in medical education if used appropriately. The concept should be understood entirely to implement it successfully. The training of the facilitators and readiness of students must be ensured before starting SDL sessions. The sessions in an institute can be further improved based on feedback from stakeholders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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