Principles from Adult Learning Theory, Evidence-Based Teaching

Principles from Adult Learning Theory, Evidence-Based Teaching free pdf ebook was written by Jacqueline Yannacci on December 08, 2006 consist of 33 page(s). The pdf file is provided by ebp.networkofcare.org and available on pdfpedia since April 03, 2012.

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Principles from Adult Learning Theory, Evidence-Based Teaching pdf




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Principles from Adult Learning Theory, Evidence-Based Teaching  - page 1
Principles from Adult Learning Theory, Evidence-Based Teaching, and Visual Marketing: What are the Implications for Toolkit Development? Jacqueline Yannacci, MPP, Kristin Roberts, BBA, and Vijay Ganju, Ph.D. Center for Mental Health Quality and Accountability NRI, Inc. February, 2006 1
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Principles from Adult Learning Theory, Evidence-Based Teaching  - page 2
Principles from Adult Learning Theory, Evidence-Based Teaching, and Visual Marketing: What are the Implications for Toolkit Development? Jacqueline Yannacci, MPP, Kristin Roberts, BBA, and Vijay Ganju, Ph.D. In 2001, SAMHSA and the Robert Wood Johnson Foundation supported the first national evidence-based practice (EBP) demonstration project to develop toolkits for the dissemination of six EBPs for adults with severe mental illness. The purpose of these toolkits was to create comprehensive implementation guides to standardize the practices for widespread uptake that would be consistent and adhere to the fidelity of an evaluated model. This project was part of the movement to bridge the gap between science and service by giving the field the information to adapt their services to what is known to be effective. The target audience was multiple: consumers, families and supports, practitioners, program leaders, and mental health authorities. Each toolkit was initially packaged in a three-ring binder that included: a user’s guide, articles on the specific practice and on implementation of evidence based practices; specific information for the different target populations; a fidelity scale and a guide for its use; a training workbook for practitioners and clinical supervisors; and two training videotapes, one a general introduction to the practice, and the other being a practice demonstration. Through an eight state demonstration program, the toolkits were piloted in the field. One of the negative findings from the pilot was that the toolkits were not optimal learning tools because the content was too academic and the structure and format in which it was presented was burdensome. Implementers stated that reading through such a large manual was time consuming and that it did not provide detailed information specific to their efforts, barriers they faced, or enough tools to assist in implementation. The most popular and widely used part of the toolkit was the video which was not as academic or dense as the manual. (Based on the pilot experience, the format of these materials is being revised.) The pilot also uncovered that the infrastructure needed to support implementation typically did not exist at the state, local or provider level. Administrators and providers could understand the practice itself, but had difficulty setting up the financing, training, management and data 2
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collection systems that support the practice. They also struggled with the fundamental issue of how to change clinician behavior from the usual way of doing business. For development of the second generation of toolkits, a literature review was undertaken to assist in producing an effective learning tool that is appealing to its intended audience was explored. Since the fundamental purpose of the Implementation Resource Kits (IRK) is to develop new knowledge and skills, understanding how adults learn was examined. The IRKs are also being marketed, thus understanding basic marketing principles for maximum appeal and use was also examined. This review is based partially on the provided bibliography (2005) by Mary Ann Meyers, Ph.D. of Westat. This literature review was not meant to be a comprehensive review of adult learning or marketing; many reviews already exist. The purpose of this paper was to cull together these existing reviews to ensure that the IRK development was not inconsistent with theory and empirical findings. The result was the identification of common principles and tested components in these fields that can guide how to frame the focus and content of the toolkit. The common principles presented in the third section of this paper are basic elements of adult learning. These principles are: Audience must be engaged by understanding how learning the new material will be beneficial; Establishing learning objectives first, then outlining content to achieve those learning objectives; Utilizing the limited, but evidence-based, teaching principles to facilitate the learning. The challenge becomes reconciling these principles to create a comprehensive and in-depth IRK with the available resources. Understanding the basic implementation process and core components of implementation may further pinpoint the focus of the IRK. As outlined by Fixsen and colleagues (2005) the transition of an evidence based practice to routine use by a clinician resulting in positive consumer 3
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outcomes is a complex and time and labor intensive process. In its most simplistic, the process requires multiple activities by various actors to set up an infrastructure with trained, skilled staff to implement the practice and embark on quality assurance activities. The stages of implementation are outlined as follows: Exploration and Adoption Program Installation Initial Implementation Full Operation Innovation Sustainability Considering the complex set of activities outlined above, what tools and resources can be produced and distributed to states, providers, consumers, and family members to facilitate the implementation process? Understanding what can be accomplished through a particular medium, establishing practical learning objectives, and following established teaching techniques, is imperative for the effective creation of the next generation of IRKs. This paper is organized to 1) provide a foundation of knowledge from the literature as to historical and current theories defining how adults learn, evidence base for teaching professionals in the health field, and visual marketing techniques; 2) outline a decision making guide using the common themes and principles to define the focus and audience, content, and format for the IRK. I. Adult Learning Theory and Evidence-Based Teaching Models Adult Learning Theory Adult learning theory and evidence-based teaching outline a variety of components demonstrating how adults learn which provides some guidance on how to structure and deliver new information for optimal uptake and mastery. The theories and research reviewed do not point to a specific model or models that are recommended. Many ideas about how learning may take place can be used as a foundation to think through the audience, content, and format of the IRK. Appendix A lists the various psychological and educational models of adult learning with 4
Principles from Adult Learning Theory, Evidence-Based Teaching  - page 5
a description of the model, the associated research and evidence, and key components are highlighted for quick examination. This appendix will be referenced throughout this review. Adult learning theory first focused on distinguishing adult learning from that of children in a formal education system. In the 1970’s, several books were influential in specifying these distinctions for adult learners. Examples include Houle’s The Design of Education (1972), Kidd’s How Adults Learn (1978), and Knowles’ The Adult Learner: A Neglected Species (1973, 1998). Knowles’ work was the most influential because it outlines six principles of adult learning (Table 1). Knowles’ theories focus on the adult learner as one who is independent and has a need to understand how the learning something new will benefit them, how it fits into their existing knowledge, and reinforces their autonomy to learn in a way that works for them. Knowles’ model does not have clear evidence to support it as a whole and is criticized as being more predicative than descriptive. However, as this literature review moves through other theories and models, these basic themes are the basis of models currently under evaluation. 5
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Table 1 Knowles’ Principles of Adult Learning 1. Need to Know – Adults need to know why they should learn something, meaning the reason they need to learn something or how it will benefit them. 2. Self-Concept – adults fight against others imposing their wills on them, but having been conditioned through the national schools system of a dependant learner, they need to be moved into a self-directed learner where they are responsible for their own learning and the direction it takes. 3. Role of Experience – Adult’s experience should be used in their new learning and the technique should include ways to include the adult’s knowledge as a tool that they can draw upon and also provide engagement by acknowledge them for their experiences. 4. Readiness to Learn – Adults seek out learning as a way to better with real life tasks and problems. 5. Orientation to Learning – the new learning should clearly define how the new learning will apply to their life in some fashion. 6. Motivation to Learn – internal motivators are important than the external motivators that adults may receive for more learning. These internal motivators can come in the form of increased job satisfaction, self-esteem, and quality of life. Note: From Fidishun, Dolores (n.d). Andragogy and technology: integrating adult learning theory as we teach with technology [Electronic version]. Retrieved September 16, 2005. http://www.mtsu.edu/~itconf/proceed00/fidishun.htm. Another commonality from many of the early models was learning as an individual task. The early psychological models including behaviorism, cognitivism, cognitive constructivism, and humanistic psychology (Appendix A) determined that learning was an individual process of changing behavioral patterns, or increasing or altering mental models and processes (Tusting, 2003). The definition of behaviorism outlines that learning is a trained response through rewards, while the theories of cognitivism and cognitive constructivism outline a more complex cognitive process where new learning builds on the person’s existing knowledge and that the learner should be allowed to develop their own style and follow their own interests. Humanistic psychology points out that individuals strive to improve themselves and have unlimited potential to do so. Knowles theory as outlined in Table 1 is based on humanistic theory. However, all of the theories addressed still focus on the individual learning process that occurs without consideration of context; learning is seen as being independent of the person’s social setting, 6
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position or culture. The early psychological learning models are based largely on classic psychological models including those by Skinner, Bandura, Piaget, Bruner, and Maslow. The idea that age is a key marker for the difference in learning and that it is solely an individual process are questioned and expanded upon with current theories and models. Hanson, in her book entitled The Search for a Separate Theory of Adult Learning: Does Anybody Really Need Andragogy?, asks if the distinctions of learning are due to age, because little evidence exhibits a clear difference, or it is a difference in individual characteristics, setting and social context. Brookfield reinforces the notion that “learning is a collective process involving cultural formation and reproduction of symbols and meaning perspectives. It should not be understood or researched as if it were disconnected, idiosyncratic and wholly autonomous.” (Brookfield, 1995) This alternative paradigm that houses theories such as developmental theory, activity theory and social constructivism, situated cognition, brain science, and cross-cultural learning are specifically grounded in how the interaction between the learner and their social context work in conjunction to facilitate and reinforce the learning process. Developmental theory places learning as socially and culturally contingent in terms of social roles and positions of the individual. Conducting learning through interaction with others who are at the same level of learning while understanding that mediational and artifacts of learning play an important role is the crux of activity theory and social constructivism. Situated cognition states that those social practices in which the learner is comfortable can be a starting point for education. In the medical field of neuroscience, researchers are now developing theories that suggest the neuron pathways are formed during the individual’s interaction with the outside world. All theories have undergone evaluation, but it is limited and non-conclusive. The brain science research is the most concrete with the hard scientific evidence, yet still in early stages of research. Developmental theories and situated cognition have had the most evaluation and work compared to the others. Research is also being conducted on other models that show how an individual’s behaviors and practices influence the formal learning process (self-directed, informal learning), a non- traditional approach to the classroom (distance learning) and models that focus not on the 7
Principles from Adult Learning Theory, Evidence-Based Teaching  - page 8
transfer of particular knowledge, but teaching adults how to learn in a complex and changing environment (learning how to learn, practical theorizing). Self-directed – Can be an individual characteristic or an instructional method. It is a process of setting educational goals, locating resources, determining methods, and evaluation. The research is limited and considered too narrow and of poor quality. Informal Learning -- Informal learning outside the classroom does occur, which has an impact on learning in the classroom. Several studies document this phenomenon, such as Livingstone’s Canadian telephone survey (Tusting, 2003, 25). Distance Learning – Refers to learning in a setting not based in the classroom or in proximity to the instructor, but over a distance. Educational themes of empowerment, critical reflection, experience and collaboration can inform distance- learning activities. Little research has been done that proves its effectiveness. The more extensive use of the Internet as a medium for distance learning is making this approach more widely available and evaluated. Learning how to Learn – The learner seeks to understand their learning experience, how they learn best, and what they can do to gain control over their learning. The ideal is to be able to learn in a range of situations. The research in this area is limited. Practical Theorizing - Practitioners learn new theories to guide their practice. The new theories are integrated with the practitioners’ current theories, both formal and informal. The practitioner then evaluates their actions through the lens of these theories. Research is limited to one study. The most extensively evaluated model of learning is Problem Based Learning (PBL) ( e.g., Experiential Learning and Critical Reflection are models). The hallmark is that learning is facilitated through experience and hands-on techniques such as simulations and case studies. This model has been used extensively throughout international education practices. Early studies of this approach support its effectiveness over the more traditional didactic models, but Stuart and colleagues (2004) point out that those articles are dated with methodological problems such as non-comparable sample groups, single-group post-test design, and non-objective outcome measures without reliability and validity. Current research, including randomized control trials 8
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and systematic review of studies registered with the Cochrane/Campbell collaborations are underway. Initial findings from these reviews do not show overwhelming evidence regarding the effectiveness of PBL in different contexts with different student groups (Stuart, et al. 2004). In their article, Stuart and colleagues list problem-based learning as a component of evidence-based teaching. With so many theories and models, the question remains: is one superior to the other or which one should be followed? Hanson (1996) proposes that even focusing on one model for a population of diverse learners in different settings who are learning different things may not be the correct focus. The concept that not one model exists for all learners in all situations is aligned with the post modern social theory which states that when creating an explanation that one must take diversity and fragmentation into account. Using a single explanation can be one way to silence and impose power over dissenting voices and is not a representation of truth. There may not be a single model, but one may need to be created that is conducive to the contexts and practices in which the learning takes place. In fact Knowles’ later work refocuses his idea of adult learning as the sole model for every situation. He changed his model and stated that when a learner is completely new to a subject, pedagogy (theory of learning for children) may be the most appropriate model. After which, his adult learning components may be the sustaining model. As Tusting and Barton summarize, “Most of the models of adult learning developed from within adult education move beyond examinations of learning as a decontextualized process to address questions relating to the meanings of, and motivations for, learning in people’s lives. This may be in terms of self-direction, reflection, autonomy, problem-solving or transformation and recalls, from a different perspective, the intrinsically socially-situated nature of learning that emerged from the review of the psychological literature. The key point to take from this is that learning for adults is always related to their real lives, their real problems and their real issues, and that we therefore need to try to understand and make links with these.” (Tusting, 2003, 32). Evidence-Based Teaching (EBT) 9
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The drawback to EBT is the lack of empirical evidence that supports it. As Stuart, et al points out, the lack of research is due to under-funding, education funds targeted at children, lack of interest, and methodological issues (random assignment, control of confounding variables, maintenance of fidelity, generalizability). Some of the theories outlined in Appendix A do have limited supporting evidence. The bottom line is that “adult learning theory and related approaches are well grounded theoretically, their evidence base is limited and they are perhaps best thought of as models or sets of assumptions about learning.” (Stuart et al, 2004) Stuart and colleagues (2004) suggests another approach is to focus on teaching models. They make the point that learning is different from teaching. Teaching must be based on practices empirically tested to change the practice and knowledge of the learner while exhibiting positive outcomes on the person receiving the new service. Their paper outlines broad domains of learning, a teaching-learning process, learning outcomes, and what evidence-based teaching components and models currently exist. Since the goal is for behavioral health practitioners to implement health practices with an evidence-base, they should be taught about these practices in an evidence-based way. The teaching practices with supporting research come from the medical field which are extrapolated to the behavioral health care field due to similarities in the type of dissemination and change in practice sought through the teaching. (Association for Medical Education in Europe initiative cited later in paper) Stuart and colleagues (2004) outline three domains of learning: cognitive, affective, and psychomotor. The traditional focus of learning has been on cognitive (mental capacities and processes), while in the behavioral health field, affective (values and attitudes) may be the most challenging to change. Practitioner beliefs, attitudes and values are strongly ingrained, yet as research shows that attitudes and belief can be a predictor of behavior, the most necessary to affect. Psychomotor (perceptual skills) are also important in developing the clinicians therapeutic skills. Once the type of learning to be achieved is identified, the specific outcomes of the learning must be outlined (Table 3). The teaching-learning model in Table 4 takes the type of learning and the outcomes of each and focuses on how the teaching can facilitate the individual to receive, learn, 10
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